The Problem
Many patients check into hospitals and become colonized by methicillin-resistant staphylococcus aureus (MRSA), which is considered the most toxic of all micro pathogens that are resistant to antibiotics, such as penicillin and methicillin. MRSA colonization is now a critical risk factor for later MRSA infection in the hospital. It was established that a significant percentage (between 8.5% and 15%) of all MRSA-colonized patients would have infections in the following years (Chipolombwe, Török, Mbelle, & Nyasulu, 2016). It is further noted that a stronger presence of MRSA in several sites across the hospital is a clear indicator of MRSA infection. Given the growing concern of MRSA as an important cause of hospital-acquired infections (HAIs), studies have focused on the identification of contact routes for transmission, such as MRSA-colonized or contaminated equipment, environmental surfaces, and healthcare workers’ hands (Lei, Jones, & Li, 2017).
MRSA colonized patients and other contact routes remain a vital reservoir of MRSA in the hospital and, thus, effective interventions are necessary to control MRSA infections (Chipolombwe et al., 2016). Lei et al. (2017) considered cleaning and disinfection as clear interventions to contain MRSA in hospitals, but no known optimal cleaning strategies are currently present.
Methodologies for Searching the Evidence
Information for this review was searched from multiple research-based databases, such as PubMed, CINAHL, OMICS International, and BioMed Central. The keywords used for the search included methicillin-resistant Staphylococcus aureus (MRSA) infections, patient colonization, and interventions. All abstracts of the identified relevant journal articles were read to determine their suitability, and only recent (not more than five years) peer-reviewed journal articles were considered for the literature review.
Existing Relevant Knowledge, Analysis and Synthesis of the Evidence
Healthcare-associated infections (HAIs) are critical patient safety concerns. In the US, it is approximated that about 90,000 patients who acquire these infections die every year. Thus, such infections are among the major causes of sickness and death in intensive care facilities (Chipolombwe et al., 2016). The increase in cases of MRSA infection has negatively affected “facility costs, resulted in longer periods of hospital stays, morbidity, and mortality” (Chipolombwe et al., 2016, p. 35). Consequently, in the last decade, there has been much enthusiasm to comprehend the relationship between HAIs and potential contact routes and patient safety outcomes with the end goal of reducing infections and other adverse outcomes.
Cleaning and sterilization of environmental surfaces are undeniable control measures that have been observed to be vital for the control of MRSA in hospitals. Nevertheless, Lei et al. (2017) observed that ideal cleaning procedures, in any case, remain unclear.
Further, evidence suggests that no common consensus exists on the most appropriate control measures and the ideal anatomical swabbing areas, which are less costly for use as a contamination management measure for MRSA (Chipolombwe et al., 2016). Various studies have focused on finding the ideal site or a combination of locations for the identification of MRSA colonization. Factors related to identification strategy, cost, effectiveness, exactness, and study design have been evaluated in different studies. Various nations have diverse strategies on the number of sites for the screening of MRSA colonization for improved outcomes. The US recommends one site for nasal swabbing as opposed to the UK that requires a minimum of two sites (Chipolombwe et al., 2016). Bacteremia surveillance is widely utilized as a passive strategy for evaluating the efficacy of MRSA control approaches. However, it faces the drawback of constant long follow-ups to figure out if contamination control interventions have had an impact on healthcare facilities. There is a need to assess other surveillance strategies to attain the best control measures of MRSA. An integrated measure of three swabs from various body sites brought about the most noteworthy detection rate for MRSA colonization (Chipolombwe et al., 2016). As such, Chipolombwe et al. (2016) concluded that the utilization of three swab sites would likely enhance the acknowledgment and treatment of MRSA colonization, which may thus lessen the contamination and transmission of MRSA to different patients.
Cleaning approaches and procedures must consider “how to clean, where to clean, and when to clean” (Lei et al., 2017). Cleaning may include the entire room, or it may focus on particular areas. The Health Care Infection Control Practices Advisory Committee (HICPAC) recommends the two cleaning methods, but it does not offer any solutions on cleaning frequency (Lei et al., 2017). Further cleaning, when done as such to counteract cross-contamination, will dependably eliminate more MRSA and different pathogens from environmental surfaces. However, it is imperative to recognize that more cleaning is associated with extra costs, including staff time, utilization of cleaning items, and interruption of patients. Furthermore, various environmental surfaces assume diverse roles in MRSA transmission in clinics. Constant cleaning of surfaces with successive hand contact (high-touch surfaces) could have a more remarkable outcome than incessant cleaning of an entire room, and cleaning high-touch surfaces reduces cases of hand contamination and subsequent transmission (Lei et al., 2017).
According to Green et al. (2012), manual professionals, such as physical and occupational therapists, can assume a critical role in identifying MRSA infections and mitigating its transmission in care facilities and communities. Fundamental strategies for protecting patients and medicinal services specialists account for understanding presenting signs, patient education, and following suitable hand and facility cleanliness procedures (Green et al., 2012).
Physicians often face a greater challenge in handling post-surgical lesions and the choice of suitable antibiotics as the extent of multidrug resistance is portrayed as high in several latest findings (Tariq et al., 2017). Hence, physicians must gain vital information concerning the prevalent pathogens in various surgical units and related vulnerability and resistance characteristics to treatment agents for the suitable initiation of treatment on an evidence-based basis. Tariq et al. (2017) concluded that wrong choices of antibiotics, extended periods of prophylaxis antibiotic, wrong timing of antibiotic administration could result in complications, lead to high costs of treatment, and produce more resistant MRSA.
While some studies have reported increasing cases MRSA, others have noted declines after effective interventions (Evans, Kralovic, Simbartl, Jain, & Roselle, 2017). According to Evans et al. (2017) the decline in MRSA HAIs was realized following integrated interventions, including general sustained surveillance upon admission, transfer across units, and discharge; contact measures for colonized or infected patients; enhanced focus on hand hygiene; and hospital culture change where everyone participated in the intervention. Evans et al. (2017) claimed that they could not specifically point out a single intervention that was most effective in reducing HAIs and MRSA transmissions because the project was designed as a quality improvement initiative rather a randomized controlled trial. It was assumed that enhanced attention on MRSA infections could have motivated healthcare professionals and workers to improve practices and procedures for MRSA control.
Nevertheless, it was conjectured that active surveillance was the main factor that led to the decline in MRSA trends observed because no changes were observed following the full implementation of other control measures, including hand hygiene and management of infections from devices. Previous studies have also noted a relationship between active surveillance and reduced cases of MRSA infections (Evans et al., 2017). Practices, such as nasal surveillance on all patients at admission, unit transfers, and discharge, a focus on MRSA and staff engagement, and control of MRSA infections using better procedures for hand hygiene and contact measures could have been responsible for the effectiveness of universal screening (Evans et al., 2017). Healthcare workers also took an active role in the control initiatives in healthcare facilities, which was a factor for reinforcing culture change in hospitals. Moreover, hospitals were also most likely to realize increased compliance to control infection based on standard procedures, such as hand hygiene. Such practices could have also contributed to the decline of other pathogens and infections, including Clostridium difficile infections.
Conclusion
This essay shows that MRSA is a major issue in hospitals because of cases of antibiotic resistance. Many patients are colonized and infected with MRSA. It is associated with morbidity, mortality, extended length of stays, and high costs of care. Studies have demonstrated that MRSA control measures are numerous, but they yield different outcomes. Practices and procedures, such as hand hygiene compliance, staff engagement, active surveillance, and contact measures, were significantly relevant for controlling MRSA and related infections. Further, effective selection and use of antibiotics, the role of therapists, and appropriate cleaning procedures have reduced MRSA in hospitals. Nevertheless, it is imperative to recognize that no consensus exists on the most appropriate MRSA control measures. Thus, hospitals must evaluate several control measures based on effectiveness and costs.
References
Chipolombwe, J., Török, M. E., Mbelle, N., & Nyasulu, P. (2016). Methicillin-resistant Staphylococcus aureus multiple sites surveillance: A systemic review of the literature. Infection and Drug Resistance, 9, 35—42. Web.
Evans, M. E., Kralovic, S. M., Simbartl, L. A., Jain, R., & Roselle, G. A. (2017). Eight years of decreased methicillin-resistant Staphylococcus aureus health care-associated infections associated with a Veterans Affairs prevention initiative. American Journal of Infection Control, 45(1), 13–16. Web.
Green, B. N., Johnson, C. D., Egan, J. T., Rosenthal, M., Griffith, E. A., & Evans, M. W. (2012). Methicillin-resistant Staphylococcus aureus: An overview for manual therapists. Journal of Chiropractic Medicine, 11(1), 64–76. Web.
Lei, H., Jones, R. M., & Li, Y. (2017). Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcus aureus. BMC Infectious Diseases, 17, 85. Web.
Tariq, A., Ali, H., Zafar, F., Sial, A. A., Hameed, K., Naveed, S.,… Hasnain, H. (2017). A systemic review on surgical site infections: Classification, risk factors, treatment complexities, economical and clinical scenarios. Journal of Bioequivalence & Bioavailability, 9(1), 336-340. Web.