Running Head: EBP MRSA

Evidence-Based Practice MRSA 2013 Brian Poirier University of South Florida

Running Head: EBP MRSA

Methicillin Resistant Staphylococcus aureus (MRSA) as the term implies, is any number of strains of Staphylococcus aureus; a generally benign species of bacteria typically present on a percentage of the general population, which has become resistant to multiple antibiotics including Methicillin. Over the course of this paper the pathophysiology, clinical relevance including the economic burden and financial cost to society and evidence based prevention of transmission in a hospital setting, will be discussed. Staphylococcus aureus (S.aureus) is a Gram-positive species of bacteria which is a part of the normal flora that is present on, and can colonize, the human integumentary system and respiratory tract (20% of the human population) (Staphylococcus aureus, 2013). S. aureus is a facultative anaerobic organism, which allows the species to thrive in the oxygen rich atmosphere of our skin and exposed surfaces throughout the environment, as well as reproduce in the comparatively low oxygenated environment of human tissue. Colonization of the human skin or respiratory tract is generally benign but as Gordon and Lowy (2008) note Colonization provides a reservoir from which bacteria can be introduced when host defenses are breached, whether by shaving, aspiration, insertion of an indwelling catheter, or surgery. Colonization clearly increases the risk for subsequent infection. Those with S. aureus infections are generally infected with their colonizing strain. (p. S350) Once introduced into tissue S. aureus has an array of leukocyte evasion techniques and enzymes that enable it to penetrate tissue and spread. Its main defense is production of an antiphagocytic microcapsule and the secretion of several enzymes, such as proteases, lipases, and elastases (Gordon and Lowy, p. S351). An infection S. aureus can present a variety of signs

Running Head: EBP MRSA

including abscesses, acne, cellulitis, septicemia, pneumonia or virtually any sign of bacterial infection of the body. Symptoms generally include fever, malaise, edema, pain at the site of infection and other general symptoms of bacterial infection. Infections are generally diagnosed by clinical presentation and culture and sensitivity labs on any discharge or tissue suspect of bacterial infection. MRSA infections, although currently a global crisis, have been increasing in prevalence for decades. Methicillin was first introduced in the late 1950s and reports of infections with strains MRSA were reported within one year. (Gordon and Lowy, 2008). As the number of MRSA infections acquired have increased, so has the financial burden increased on society. In 2005 alone there were over 368,000 confirmed cases of MRSA in the United States (Barnes, p. 8), each case requiring hospital staff time and resources and possibly resulting in lost wages and missed work by extended hospital stays by patients, an estimated loss of $1.4-13.8 billion (Lee et al., 2013). In addition to the tremendous monetary losses, each year over 19,000 patients die from MRSA; more than HIV/AIDS (MRSA Screening Saves Lives, 2013). In the healthcare setting MRSA is spread by direct or indirect contact with infected individuals or discharge from infected abscesses or wounds. Generally hand hygiene has been the preferred evidenced based practice to prevent the spread of any bacterial or viral infections in healthcare settings. Isolation of infected patients and mandatory donning of personal protection equipment (gloves, surgical masks and gowns) by healthcare providers while giving treatment has also been adopted to limit the spread of microorganisms by contact. Additionally a recent study by Kong et al. questioned whether the hierarchal organization (beds in cubicles, cubicles in rooms, rooms in wings, etc.) of hospitals and grouping of infectious patients could increase the transmission of MRSA from infected patients to healthy patients via healthcare providers more

Running Head: EBP MRSA

readily. Kong et al. found that although there is significant between-cubicle variability in risk of MRSA acquisition within the hospital, most of the variability of MRSA acquisition risk was spatially random (p. 8). The study also suggested that the main driver of MRSA transmission between patients in a healthcare setting was the presence of a MRSA positive patient up to two weeks before a subsequent patient was housed in the same room (Kong et al., 2013). This implies that environmental disinfection is as important as isolation and hand hygiene. New research will continue to discover therapeutic practices to benefit healthcare providers and patients in the healthcare setting but contemporary practices such as hand hygiene, aseptic technique and protective equipment will continue to be the driving force behind the reduction of infectious pathogens.

Running Head: EBP MRSA

References Barnes, B.A. (n.d.). Negligence, Medical Malpractice, Vicarious Liability, Or Patient Responsibility: Who Should Pay When A Patient Contracts MRSA From A Healthcare Facility? Retrieved from: http://www.humesmith.com/media/MRSA%20Published%20Law%20Review%20Note.p df Gordon, R. J. and Lowy, F. D. (2008) Pathogenesis of Methicillin-resistant Staphylococcus aureus infection. Clinical Infectious Diseases, 46 (5), p. S350, 351. http://cid.oxfordjournals.org/content/46/Supplement_5/S350.full.pdf+html Kong, F., Paterson, D.L., Whitby, M., Coory, M., Clements, A. A. C. (2013). A hierarchical spatial modelling approach to investigate MRSA transmission in a tertiary hospital. BMC Infectious Diseases, 13 (449). doi:10.1186/1471-2334-13-449. Lee, B.Y., Singh, A., David, M.Z., Bartsch, S.M., Slayton, R.B., Huang, S.S., . . . . . Daum, R.S. (2013). The economic burden of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 19(6), Abstract retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/22712729

Running Head: EBP MRSA

(2013). MRSA Screening Saves - MRSA Epidemic Spreading Globally Lives. Retrieved from: http://ehis.ebscohost.com.ezproxy.lib.usf.edu/eds/detail?sid=602bd394-f199-4fdc-851a5506cd71de4e%40sessionmgr4004&vid=4&hid=116&bdata=JnNpdGU9ZWRzLWxpdm U%3d#db=bwh&AN=201306040831PR.NEWS.USPR.DC25336 (2013). Staphylococcus aureus. Retrieved from: http://en.wikipedia.org/wiki/Staphylococcus_aureus