Preventing and Controlling Methicillin-Resistant Staphylococcus Aureus In Intensive Care Units

Free «Preventing and Controlling Methicillin-Resistant Staphylococcus Aureus In Intensive Care Units» Essay Sample

It is a matter of fact that intensive care units, often shortened to ICUs, are high-risk settings for the transmission of various strains of bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). In comparison to methicillin-sensitive strains of Staphylococcus aureus, MRSA is resistant to the beta-lactams antibiotic group, including methicillin, oxacillin and other penicillin-related antibiotics. Although MRSA is not more virulent than methicillin-sensitive strains of Staphylococcus aureus, resistance to antibiotics makes it a truly formidable pathogen. MRSA can occur in both hospital-associated (HA-MRSA) and community-associated settings (CA-MRSA). Whereas MRSA infections are localised to the skin in the community setting, it is responsible for life-threatening immunocompromised states, bloodstream infections, surgical site operations and other invasive procedures. Usually, inadequate cleaning of shared equipment and dirty hands of healthcare providers are the main reasons behind the spread of MRSA. Basically, to prevent the development and dissemination of MRSA, a “gospel of soap and water” needs to be preached in both hospital and community settings. Current paper reviews, analyses and critiques two primary and three secondary peer-reviewed articles that deal with MRSA prevention and control measures. A common thread from the five articles indicates that compliance with hand hygiene protocols is one the most effective ways to prevent the MRSA spreading.

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The classification of the five articles into two categories herein is solely for the purpose of convenience and shall be disregarded in the interpretation of the results of this review. First, two primary articles will be reviewed, analysed and critiqued. Milstone, Carroll, Ross, Shangraw and Perl’s (2010) article makes a point that the incidence of MRSA among community members has risen recently. More children infected or colonised with CA-MRSA are admitted into hospitals, thereby increasing pressure on hospital’s MRSA control and prevention efforts. Indeed, the authors argue that CA-MRSA strains can lead to outbreaks of hospital-onset infections. As there are still many lacunae in the existing body of knowledge about the effects of MRSA on hospitalised children in paediatric intensive care units (PICUs), the researchers venture to fill them. Milstone et al. (2010) argue that it could assist healthcare professionals in guiding and planning MRSA control and prevention programmes in the future. To answer their research questions, the authors performed a retrospective corporate study of all MRSA-colonised children admitted to the John Hopkins Hospital PICU during the period of time from 1 March 2007 to 31 May 2008. If an MRSA-colonised patient was admitted to the PICU several times during indicated timeframe, the researchers took into account only the first admission. As to the methods used, Milstone et al. (2010) used BBL CHROMagar MRSA plates for the detection of nasal colonisation by MRSA. Colonies of pale purple colour that appeared on the nasal surveillance swab within 24 hours were confirmed as Staphylococcus aureus. After that, BBL CHROMagar MRSA plates were incubated for additional 24 hours to detect latent MRSA strains. The researchers used CHEF-DR III to perform pulsed-field gel electrophoresis (PFGE) on available store isolates and compared the results with all USA PFGE strain types. Isolates were deemed unrelated if their patterns more than 3 band differences, and vice versa. Rigorous research design and thorough laboratory methods allowed the authors to produce interesting results. Overall, they found that the nationwide spread of CA-MRSA strains contributes to the high rates of HA-MRSA. As CA-MRSA becomes more prevalent in hospital settings, the need to control it grows. Though bona fide compliance with strict hand hygiene policy and other standard precautions can decelerate the spread of MRSA, new control measures are necessary.

Thompson’s (2004) article suggests that MRSA poses an array of problems in ICUs associated with the implementation of infection control measures. Yet, the author argues that ICUs must be the major battleground for combating and controlling MRSA, because MRSA infections that originate there often travel to other wards and hospitals. The goals of Thompson’s (2004) study includes determining the prevalence of MRSA among the Medway Maritime Hospital ICU patients, estimating the risks to which MRSA-negative patients are exposed in the ICU and evaluating the effectiveness of control measures employed at the hospital. Even though the study is not groundbreaking in terms of the pursued purposes, it still offers clear insights into the problem of MRSA control and prevention in ICUs. Thompson (2004) audited records of patients admitted to the Medway Maritime Hospital ICU from the 1st of October, 2001 to the 31st of March, 2004. Likewise, the researcher took nasal and groin swabs from all patients admitted to the ICU once a week and incubated them in brain-heart infusion medium for 24 hours. Thompson utilised the VITEK automated identification system and tube coagulase to identify suspicious colonies and test their methicillin resistance. Depending on the results of these tests MRSA-positive patients were treated either with mupirocin preparations or intravenous vancomycin. The researcher made several recommendations to the control-of-infection department on the basis of his findings. Thompson (2004) found that a spell in an ICU is fraught with risks of acquiring MRSA for those patients who did not have prior to hospitalisation. The risk is “1% per day in the first week and 3% per day thereafter” (Thompson, 2004). Contrary to what Milstone et al. (2010) found, Thompson (2004) argues that standard MRSA prevention and control measures have limited success. He further notes that ever more vehement application of the old measures, as well as intravenous vancomycin injections, are not effective too and new ways to treat and control MRSA are necessary.


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