The Spread of Methicillin-Resistant Staphylococcus Aureus - Research Proposal Example

Does infection control measure prevent the spread of Methicillin Resistant staphylococcus Aureus in hospital patients Introduction The limitationof diseases in a hospital environment is a challenging task. The conditions of the specific environment are such that the risk for possible diseases could be reduced only if applying appropriately customized measures and techniques. Of course, before implementing specific strategies towards the limitation of the risks for diseases in hospitals it would be necessary for the whole policy regarding the hospitalization of patients to be re-structured in order to minimize the risk for patients – especially those who are heavily ill and are likely to stay in hospital for quite a long – for a potential infection within the hospital. In most hospitals worldwide specific rules have been implemented regarding the various phases of the hospitalization of patients – also regarding their treatment; these rules could be regarded as prevention measures – at least up to a level against the spread of infections in hospitals. However, because the specific issue is of significant importance, a series of relevant tests has been made in order to ensure the effectiveness of measures already established worldwide for the protection from infections developed in hospitals; additional control measures have been also proposed taking into account the characteristics of each one infection but also the funds available for the realization of relevant projects. Current paper focuses on the identification and the proposal of the most effective measures towards the limitation of the risk of infection by Methicillin Resistant staphylococcus Aureus in hospital patients. It should be also noticed that in literature and the empirical research, the need for appropriate measures regarding the limitation of infections in hospitals is highlighted; however, the proposals made could be characterized as offering rather partial resolution to the particular problem. For this reason the critical analysis of the findings of these studies has been considered to be helpful for the identification of the most appropriate measures for the limitation of the specific disease in hospital patients. 2. Research Problem The limitation of the development of Methicillin Resistant staphylococcus in hospitals has been an issue extensively examined by the medical researchers internationally. A series of infection control measures have been proposed against the spread of this disease; the effectiveness of these measures has been doubted taking into account the findings of relevant clinical studies. 3. Significance of the Study As noticed above Methicillin Resistant staphylococcus Aureus is a disease quite common in hospital environment. On the other hand, its effects although of rather minor importance for healthy people, they can be quite dangerous for people that are hospitalized – and who already suffer from another disease – or they have suffered a severe trauma from an accident – referring to the most common aspects of the health conditions of people that are hospitalized. On the other hand, even if many studies have been made on the potential prevention measures against this disease no complete study seems to exist regarding the overall limitation of the above disease – i.e. a plan that will offer effective protection from the disease within a limited number/ amount of resources required (i.e. nurses participating in the plan, funds and technology required and so on). In this context, current study is considered to be of significant importance at the level that all aspects of the specific disease will be carefully examined – as possible – while its progress will be also studied in order for appropriate measures to be proposed towards its limitation in hospitals. 4. Background/ Justification Infection in hospitals is a common phenomenon quite expanded in both developed and developing countries worldwide. On the other hand, despite the fact that a series of measures has been taken for the limitation of this phenomenon all these measures have been proved gradually to offer only partial solution to the problem. The fact that the relevant guidelines are not fully followed by medical practitioners could be a reason for this outcome. In accordance with Mascie et al. 2004, 18) ‘the role of humans in the development of antibiotic resistance by medical and agricultural practices is well established’. In other words, if the guidelines given to people working in the healthcare sector are not followed strictly – referring to the suggestions regarding the hygiene applied on all phases of hospitalization or even examination of the patient – then infections are not likely to be avoided with extremely – even fatal – consequences for patients. Many efforts have been made in order to identify the causes of infections in hospitals; regarding this issue it is noticed by Wilson (2001, 44) that ‘the immediate sources of microbes that cause disease in humans are typically another human, an animal or insect vector, soil, or water’. On the other hand, Chicami et al. (1998, 12) supported that ‘infections caused by resistant organisms are associated with increased illness and death while resistant organisms contribute to prolonged hospital stays and increased medical costs; indeed, costs of additional lab tests, therapies, consultations, and time lost from work could add $100 million to $30 billion annually to health-care costs in the United States alone’. In other words, the causes of infections are not easily to be controlled – at least all of them. On the other hand, it could be supported that because significant efforts are made in order for all places in hospitals to be clean the risk of infection is minimized; however, this is not the case. However, in most cases it is proved that the application of simple measures, like handwashing, could prevent the spread of diseases in hospitals. Regarding this issue, it is noticed that ‘handwashing with commercially available products marketed for the public may not have a noticeable effect on natural flora, but may be important in protecting against contaminating organisms picked up in person-to-person or environmental contacts’ (Aiello et al., 2003, 139). The above views are in accordance with those of Akyol et al. (2006, 395) who noticed that ‘as most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered to be the single most important intervention to prevent nosocomial infections’. The use of handwashing as a prevention measure in hospitals around the world should be criticized though especially regarding its effectiveness. All clinical studies conducted up to now – as the ones presented above – prove that handwashing is an important measure for the limitation of infection in hospitals. Moreover, it has been proved that the effectiveness of this measure can be increased if specific terms and conditions are applied. More specifically, the study of Kampf et al. (2004, 864) showed that ‘the best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%); the activity is broad and immediate; Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora; the combination of alcohols may have a synergistic effect’. Other material used in handwashing could be also proved effective- however it should be primarily tested as of its effectiveness on the limitation/ prevention of the specific disease (Methicillin Resistant staphylococcus Aureus). In any case the hygiene rules applied on every hospital should be followed strictly by all medical practitioners as well as by the supportive staff. The specific issue was examined by Breen et al. (1997, 195) who noticed that ‘medical students in their clinical placements must be instructed in appropriate infection control measures, for their own protection and for the protection of patients because the latter may be put at risk by medical students by the transfer of infection (usually bacterial) from patient to patient’. In other words, the potential sources of infection in hospitals can be many; for this reason all people involved in the provision of services in hospitals internationally should follow strictly all the hygiene rules applied on each specific healthcare institute. Various clinical studies have been made in order to prove the potential effectiveness of hygiene measures in hospitals – the potential prevention of the specific disease is also examined in practice. We could indicatively refer to the following ones: a) The study of Holt et al. (2004, 256) in which ‘a series of 33 day-care centres in towns along the west coast of Greenland were investigated in the period 2000-2002 using a questionnaire; the day-care centres in general did not follow hygienic recommendations sufficiently, and the hygienic behaviours resembled more those of home; for public institutions this is not sufficient to prevent cross-contamination, as the risk of spread of microorganisms is high in institutions with many contacts’. The above study refer to public institutions, however its findings could be also used for privately owned ones. b) The study of Kac et al. (2005, 32) who examined ‘the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice’ and found that ‘after hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing; hand rubbing is more efficacious than handwashing for the decontamination of healthcare’workers hands following contact with patients and patients environments while gloving may reduce microbiological hand contamination by transient pathogens’ (Kac et al., 2005, 32). Handwashing as already explained above is a quite common method for the prevention of infection in hospitals; other measures like cleaning the surfaces with specific liquid have been also applied on medical centres and hospitals internationally. c) Referring to specific methods of handwashing Furukawa et al. (2005, 149) tried to identify ‘whether sterile water and brushes are necessary for hand washing before surgery and for this reason twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method; all the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing; tap water was used to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes’. It is clear that a series of measures could be available – additional to handwashing in order to improve the effectiveness of the specific method as a tool of prevention of infection in hospitals. Towards this direction, it has been proposed that washing the whole body could be proved to be even more effective method of prevention against the specific disease (see Wendt et al., 2007); however due to the practical difficulties related with the application of this measure, it is clear that no significant assistance could be expected from the specific measure – only partially where it is possible to be applied. Various other studies, like those of Jevaratnam et al., 2008 and Wilson et al., 2007 refer to the reasons for the development of the specific disease in hospitals leading to significant assumptions for its limitation. 5. Research Questions In accordance with the issues developed above, the research questions that will be mainly developed through this study will be the following ones: a) Which are the most common risks for patients in hospitals internationally? b) Are infections in hospitals treatable? In other words, if the measures taken for the limitation of infections in hospital patients are not proved effective, are there any additional solutions available for the elimination of the infection at another level (i.e. after having being developed)? c) Which are the most common prevention measures used in hospital worldwide for the protection from infections in hospitals? d) Which are the main characteristics of Methicillin Resistant staphylococcus Aureus (main aspects, symptoms and potential methods of treatment) e) Are there any measures that have been proved particularly effective for the specific disease? f) Which is the role of the state to the limitation of diseases in hospitals – are there any measures taken by state for the limitation of the specific disease in hospitals and which are the resources available for the realization of the relevant plans? 6. Research Method The research method used for the examination of the potential limitation of the spread of Methicillin Resistant staphylococcus Aureus in hospital patients is mainly the qualitative research, focusing on the examination of relevant studies, i.e. clinical tests developed in similar environment (hospitals) both in USA and internationally. The findings of these studies will be analytically examined and explained taking into account the conditions of each one of them as well as the resources available for their completion. The specific research method – as described above – is considered to be the most appropriate for the particular study taking into consideration the fact that infection in hospital environment is a quite common phenomenon and for this reason all its aspects have been examined in the literature and especially the clinical research. For this reason, the critical analysis of these studies is considered to be an effective method for the identification of a series of valuable information related with the issue under examination. The material required for the development of current study will be acquired by the University Library as well as by appropriate online Databases (such as PubMed). Because the research focuses on the examination of relevant studies, the particular method was considered to be the most appropriate for the identification of the necessary material. 7. Results and Discussion The results retrieved through the critical examination of the studies described above will be compared as of their relevance and will be critically discussed. Potential graphs will be designed (as possible) in order to represent the various aspects of the spread of the particular disease and its prevention especially in hospitals. It was noticed above that the studies employed in this paper will be in accordance with the main research problem – however, they could also be relevant with the research questions presented above offering explanation to one of the issues developed previously. A Gantt chart is also likely to be used in the paper in order to present more clearly the general aspects of the research problem and identify the areas that would possibly need particular reference. Other potential graphical representations would be also employed at the level that they were proved as necessary in order to present an integrate aspect of the issue under examination. References Aiello, A., Latta, P., Gomez-Duarte, C. Larson, E., Lee, L., Lin, S. (2003) Short- and Long-Term Effects of Handwashing with Antimicrobial or Plain Soap in the Community. Journal of Community Health, 28(2): 139-148 Akyol, A., Ulusoy, H., Ozen, I. (2006). Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units. The Journal of Hospital Infection, 62(4): 395-405 Breen, K., Cordner, S., Plueckhahn, V. (1997). Ethics, Law and Medical Practice. St. Leonards: Allen & Unwin Holt, J., Skifte, T., Koch, A. (2004) Infection control in day-care centres in Greenland. International journal of circumpolar health, 63(2): 256-260 Jevaratnam, D., Whitty, C., Phillips, K., Liu, D., Orezzi, C., Ajoku, U. (2008) Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ, 26(336): 927-930 Kac, G., Podglajen, I., Gueneret, M., Vaupre, S., Bissery, A., Meyer, G. (2005). Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study. Journal of Hospital Infection, 60(1): 32-39 Kampf, G., Kramer, A. (2004) Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clinical Microbiology Reviews, 17(4): 863-893 Kampf, G., Wigger, W., Wilhelm, K. (2006). Do atopics tolerate alcohol-based hand rubs? A prospective, controlled, randomized double-blind clinical trial. Acta Dermato Venereologica, 86(2): 140-143 Mascie, N., Mcgarvey, S., Peters, J. (2004). The Changing Face of Disease: Implications for Society. Boca Raton: Routledge Wendt, C., Schinke, S., Wurttemberger, M., Oberdorfer, K. (2007) Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infection Control and Hospital Epidemiology, 28(9): 1036-1043 Wilson, A., Hayman, S., Whitehouse, T., Cepeda, J., Kibbler, C. (2007) Importance of the environment for patient acquisition of methicillin-resistant Staphylococcus aureus in the intensive care unit: a baseline study. Critical Care Medicine, 35(10): 2275-2279 Read More