Methicillin-resistant Staphylococcus aureus - Essay Example

?In the workplace, the chronic illness renal disease patients need to go to the hospital and clinic frequently; therefore, the decontamination of theenvironment to prevent cross transmission is most beneficial. Moreover, nowadays, one of the most difficult to treat is Methicillin- resistant Staphylococcus aureus (MRSA). Decontamination ensures that there are no medical or health implications in the treatment process with regard to renal medicine. This is due to the possibility of infections that could hinder or act as counteractive measures towards the entire of treating renal diseases. Moreover, cleaning and decontamination alleviates all forms of erroneous diagnosis and reinfections with unknown pathogens, as well as conditions that are not part of the patients’ original condition. In addition, decontamination and cleaning keeps the conditions of renal medicine and the facilities hosting it hygienic and clean for the benefit of the staff assigned to work in the facilities. As a result, the conditions of work should be widely favourable and to accommodate the needs of the staff. This is in relation to productivity and lack of infections and unfavourable working conditions for the members of staff. This works through elimination of risk factors that may distract members of staff from the duties and tasks or create an inconducive atmosphere. Health care facilities such as hospitals, nursing homes and outpatient units, play host to a wide variety of microorganisms that prey on patients undergoing treatment. Healthcare-associated infections, also referred to as nosocomial infections, are defined as those that are associated with medical or surgical intervention within the healthcare facility. For an infection to be described as nosocomial, it has to occur following 48 hours of hospitalisation or surgery or 3 days after discharge (Inweregbu, et al 2005, p.1). Such infections are often caused by breaches in control practices and procedures, which have to be met to ensure patient safety. Such breaches include the use of non-sterile environment during medical intervention, resulting in an infection. Healthcare associated infections are caused by a variety of common bacteria, fungi and viruses, which are introduced in a patient during medical intervention in non-sterile conditions (Memarzadeh n.d, p.10). Despite marked medical advances in the recent years, most patients are always at risk of developing nosocomial infections. In industrialised countries, healthcare-associated infections have a significant impact on public health by contributing to an increase in morbidity and mortality. Similarly, as healthcare facilities stretch their budgets to facilitate the extended care to the affected patients. It is estimated that such infections occur in every 1of 10 patients who are admitted to the hospital, which accounts for about 5000 deaths. Consequently, financial repercussions felt are enormous and translate to billions of pounds for the National Health Service. The relatively high prevalence of nosocomial infections has seen patients extend their stay in hospitals; incurring additional costs compared to uninfected patients. A study conducted by the European Prevalence of Infection in Intensive Care indicated that the prevalence rate in ICU has steeply declined from 1.8% in 2006 to 0.1% in 2012 (NHS Choices 2012). Patients under intensive care units are particularly at risk of hospital-acquired infections owing to the invasive procedures accorded to them. Bacteria, viruses, fungi, and parasites are the main causative agents of hospital-acquired infections in most healthcare facilities, where the pathogens may be present in the patient’s body, the environment, contaminated hospital equipment or the medical professionals. The most common types of healthcare-associated infections are urinary tract infections, ventilator-associated pneumonia, and surgical wound infections (Pennsylvania Department of Health n.d, p.1). For instance, following surgery, the patient may develop an infection around the surgical wound and on delayed management; sepsis may occur leading to rapid and progressive multi-organ infection, which results in death. Bacteria are known for their ability to generate mutations against common antibiotics prescribed for normal bouts of infections. For this reason, bacteria within a hospital setting have acquired mutate genes that confer resistance to drugs regarded as the first line of treatment. This is a worrying tread from the microbiologist perspective and a nightmare to most pharmaceutical companies, who have to perform fresh research to develop new drugs. Staphylococcus aureus and Pseudomonas aeroginosa are is considered the most common pathogens responsible for a wide variety of hospital-acquired infections such as urinary tract infections, respiratory pneumonia, wound infections, bacteraemia, and skin infections. Staphylococcus aureus is a gram-positive bacterium that has its habitat on the human skin without causing any infection; however, injuries on the skin eliminate the protective mechanism leading to infection. The bacterium has been cited to cause acute food poising, toxic shock syndrome, cellulitis, scalded skin, and systemic infections such as endocarditis, osteomyelitis, epiglottitis, and sinusitis. The incubation period for a Staphylococcus aureus infection is dependent on the mode of inoculation to the human body. For food borne staphylococcal infections, the incubation period is between 1-6 hours after ingestion; moreover, diagnosis is made by isolating the pathogen in blood through blood cultures or from contaminated food items. Normal Staphylococcus aureus infections can be easily treated by use of antibiotics over a stipulated period. Staphylococcus aureus is susceptible tobeta-lactamase based drugs, which can be administered intramuscularly, intravenously or used as a skin ointment. However, some strain of Staphylococcus aureus such as Methicillin-resistant Staphylococcus aureus (MRSA) are resistant to most antibiotics and in this case, methicillin. Methicillin is a narrow spectrum beta-lactam antibiotic in the class of penicillin that was mainly used in treatment of most bacterial infections caused by staphylococcal bacteria; however, the use of the drug has been discontinued due to the emergence of resistant strains (Rao 2009, p.2). The emergence of methicillin-resistant strains of bacteria has made the drug ineffective for clinical purposes and has researchers on their toes in order to keep up with bacterial mutations. Penicillinase is a bacterial enzyme produced by most strains of Staphylococcus to compromise the structure of some penicillin. This is achieved through hydrolysis of the beta-lactam ring, which is a key component in most penicillin-based drugs. MRSA is considered a pandemic, causing infections that are difficult to treat and result thousands of health complications worldwide. When antibiotics are applied to an environment inhabited by bacteria, most are inactivated while others have to adapt to the new environment through mutations. Antibiotic resistance is a result of the process of natural selection where those who fail to adapt wither as the strong ones adapt. The mutant genes are then transferred to their offspring, which produces a generation that is fully resistant to the drug in question. Studies indicate that the rate at which microorganisms develop resistance is dependent on the patterns of antibiotic use. For instance the extended use of drugs in the class of broad-spectrum antibiotics such as cephalosporins, has contributed enormously to the emergence of methicillin resistance. Incorrect diagnosis has also worsened the situation by facilitating unnecessary prescriptions, which has led to improper use of antibiotics by patients. In addition, patients who participate in self-medication practices increase the risk involved in development of resistance. Similarly, the use of antibiotics as livestock food additives is common among livestock feed companies to promote growth (Thormar n.d). However, such practices regardless of the profits generated, human health is compromised as this provide vital conditions necessary for mutations to occur. As earlier indicated, methicillin-resistant Staphylococcus aureus is a common occurrence in surgical procedures. Among the procedures affected are those that lie within renal clinics, which are charged with the responsibility of specialised treatment for renal conditions and abnormalities. As a result, urinary tract infections are bound to occur following urinary catheterisation and dialysis procedures. Under normal conditions, bacteria may be found in or around the Urethra but not inside the bladder; however, during the placement of a catheter in a patient, the bacteria can enter the bladder causing infection. Prolonged use of antibiotics and immune suppression in patients contribute to increased cases of urinary tract infections. Patients experience pain when passing urine or have blood in their urine in the event of an infection. Localised infections are characterised by swelling, redness, and tenderness around surgical wounds, which may spread to underlying tissues and organs. This results in sepsis and eventually death if appropriate measures to contain the infection are not taken. Diagnosis of most hospital-acquired infections is determined by evaluation of signs and symptoms of infection and, therefore, close monitoring of the patient’s progress is critical, with wounds receiving adequate attention to check for the presence of pus or abscesses. It is also beneficial to perform laboratory test such as complete blood count and urinalysis to check for the presence of elevated white blood cells, which are indicative of an infection. A review of all procedures and protocols performed on a patient is necessary to establish points of infection. For effective treatment of MRSA infections, it critical that the microorganism is isolated by the microbiology department in culture media and sensitivity tests carried out. This is essential in order to determine the most effective drug to be used in treatment of the infection without the risk of recurrence. In most cases, a combination of drugs is prescribed since MRSA is known to have developed resistance to a majority of penicillins and cephalosporins. Effective drug combinations include doxycycline or trimethoprim with either rifampicin or fusidic acid. Linezolid has also shown considerable antimicrobial activity against MRSA, but its application requires monitoring on a weekly basis. Furthermore, the use of linezolid for clinical purposes is not permitted for periods exceeding one month. The responsibility of preventing hospital-acquired infections lies with all individuals in the healthcare industry. All healthcare personnel should work cooperatively in order to reduce the risk involved as well as the rate of infection during clinical practices. To achieve this, it is critical to establish prevention programmes all levels healthcare provision, be it national, regional or at the health facilities. Health authorities should ensure that preventive programmes are developed to support hospitals in their effort to reduce infection rates. The programmes should in line the national goals and objectives that assure quality healthcare is available to all. Such programmes should provide a harmonised set of guidelines for health care surveillance, prevention, and practice, which should be adopted by all medical personnel. Healthcare facilities should be accorded access to materials and products necessary to facilitate effective decontamination procedures. This would encourage healthcare facilities to take initiative and perform internal audits in order to monitor acquired infections (World Health Organisation 2002, p.9). At the healthcare facilities, hospital programmes should promote good health care practices, personnel training and establishment of epidemiological surveillance. The management with healthcare facilities should ensure sufficient availability of resources to support the objectives of preventative programmes. The United Kingdom’s healthcare system established infection control committees in hospitals that oversee the implementation of surveillance and prevention programmes. The committee is composed of specialists in infection control, epidemiology, and infectious diseases. A study by the Efficacy of Nosocomial Infections Control confirmed that a third of these infections could be prevented if only suitable methods are taken (Haley, et al 1985, p.182). Infection control measures include surveillance techniques, prevention strategies as well as treatment programs. Surveillance describes a continuous and systematic process of data collection, analysis and interpretation of information with regard to healthcare, which is critical for implementation, assessment of public health and effective planning (Stoto 2003, p.1). In addition, it is also essential for timely dissemination of information to health facilities as well as the public. Formed in 1996, the Nosocomial Infection National Surveillance Service, under the management of Health Protection Agency, is charged with the task of collecting information to create a nationwide database. By analysing the information collected, policies can be formulated and implemented effectively based on urgency and prevalence. This serves to reduce infection rates and assist the clinical practice. Presently, surveillance protocols in place include the assessment of surgical wound infections and the other on hospital acquired bacteraemia. Other protocols on urinary and lower respiratory tracts surveillance is yet to be formulated and implemented. Studies done by the European Prevalence of infection in Intensive Care indicate several predisposing factors that encourage the development of hospital-acquired infections. The factors a divided broadly into four categories: related to underlying health status, related to acute disease process, related to invasive procedures, and those related to treatment. Factors that illustrate underlying health status include age, malnutrition, alcoholism, smoking and diabetes while acute disease process factors include surgery, trauma and burns. Medical intervention services being offered can also contribute to the development of healthcare-associated infections. For instance, the administration of immunosuppressive treatment, blood transfusion services as well as the length of stay in healthcare facilities can serve to open routes of infection in a patient. Prevention of hospital-acquired infections requires an integrated and a closely monitored programme in order to limit transmission of microorganisms. The established programmes ensure appropriate use of antibiotics, constant surveillance of infections, and identification and control of outbreaks. In addition, it is critical that staff members are trained in current medical procedures and practices that facilitate reduce the risk of infection in patients. The emergence of hospital-associated infections is determined by patient factors such as effectiveness of the immune system, and intervention performed, which act to increase the risk. It is for this reason that risk assessment is essential since the level of patient care differs. Following risk assessment, it is critical to ensure adherence to established guidelines in order to reduce person-to-person transmission, as well as transmission from the environment (Cambridge University Hospitals NHS Foundation Trust 2008, p.19). The importance of hand decontamination cannot be overemphasised as it a key component in the delivery of healthcare services. Compliance must be met with regard hand washing practices depending on the procedure being done. Routine hand washing procedures involve the use non-antiseptic soap or hygienic hand disinfection with an alcoholic solution. In addition to routine hand washing practices, antiseptic hand cleaning is done especially while offering aseptic care to infected patients. During surgical procedures, elaborate hand washing practices are following, which entail the use of antiseptic soap on hand and forearm for a specified period. The above endures that harmful microorganisms are not introduced to the patient during surgical procedures or follow-up care. Working outfits are made of a material that easy to clean and decontaminate and as such, staff members should be encouraged to them during working hours. The clothes can be disinfected or disposed if need be without incurring extra costs. This ensures contamination if any, does not extend beyond the healthcare facility. It also allows faster response and containment of infections before enormous damage occurs. In aseptic areas such as operating rooms, the staff should wear dedicated shoes and caps or hoods. This protects the patients against microorganism inoculation from infected staff members. In line with distinctive clothing, it is necessary to wear gloves when handling patients at all levels of medical intervention practices. Owing to the delicate nature of standard precautions for the prevention and control of infection in a healthcare setting, adequate methods of cleaning, disinfecting and sterilizing must be in place. In healthcare facilities, strict adherence to the infection guidelines plays a crucial in supporting efforts to reduce the prevalence of hospital-associated infections. Such guidelines should be contained an Infection Control Manual, which is accessible to all. Routine cleaning of the facility is necessary to ensure a clean environment, free from dust and soil since most microorganisms find a home in dirt (Damani 2003, p.74). Cleaning of patients' rooms and amenities should be done on a regular basis using detergents accompanied by bleach solutions.The use of super-heated water during decontamination procedures is recommended since most bacteria, and other microorganisms are deactivated by high temperatures. It is also necessary to include appropriate protocols, which indicate when thorough decontamination and sterilization of reused medical devices is to be carried out. As a standard precaution, patients who are determined to be infected with MRSA should be isolated and infection management protocols activated (Weston 2008, p.163). Contact precautions should be implemented with patients being put on antibiotic medications. This plays a critical role in averting outbreaks by containing infections before they spread. Healthcare assistance is always advised to use alcohol based hand-rub swabs after touching a patient if no dirt on hands and in between each patient. This hopes to decrease the cross contamination and subsequent infection. The healthcare workers are taught to be use disposable wiping cloths and designated equipment for the known pathogen decontamination area such as MRSA. Medical equipment also needs to be decontaminated and sterilized before use on another patient. Equipment such as the dialysis machines needs to be sterilized every time before use. Hydrogen peroxide vapour has used successfully to control outbreaks of methicillin-resistant Staphylococcus aureus in surgical wards that previously were MRSA-free. This was facilitated by screening and decolonization of all staff and patient carriers within the health facility. For instance, in 2007, MRSA was identified at the Royal County Hospital in Winchester following a scheduled culture of samples obtained from two patients who had negligible surgical wound infections (Bioquell 2012). The infected patients were admitted in different sections of a ward at the Hospital, and on further testing, MRSA colonization was identified in most patients admitted. Methicillin-resistant Staphylococcus aureus was also detected among healthcare workers, and an environmental screening test demonstrated hefty MRSA contamination in the ward. Hydrogen peroxide vapour was used to decontaminate the area, with overwhelming success in the effort. On subsequent screening, the staff members and patients demonstrated effective decolonisation while all the patients were discharged as MRSA negative. Decontamination procedures effectively averted a MRSA outbreak that could have had negative implications at the healthcare facility as well as among patients. The application of hydrogen peroxide vapour for microbial decontamination was developed in late 1990s, and its use has maintained. Decontamination procedures vary depending area of contamination such as on facility surfaces, the air or within the human body. Hypochlorite solutions can also be used to clean and disinfect areas suspected to be contaminated with microorganisms such as MRSA.In the event on extensive contamination within the healthcare facility; the concentration of the hypochlorite solution can be adjusted to suit the needs of decontamination procedures. Other decontaminating agents include Lysol, pine sol and sporicides, which have been illustrated to be effective against methicillin-resistant Staphylococcus aureus (American Air and water 2007, p.1). Fumigation can be done in infected air spaces while general spraying and wiping work for surfaces. With regard to medical equipment, ethylene oxide is a highly effective gas that kills all microorganisms lodged within the machines. However, there have been concerns relating to patients’ hypersensitivity due to the gas toxicity. Alternative methods that are equally effective include the use of heat sterilization and gamma radiation (Thomas 2008, p.199). Medical waste and other contaminated medical consumables should be clearly labeled and designated for incineration. The high temperatures involved destroys any microorganisms present inactive and the resulting ashes cannot cause any harm. All established policies and protocols in relation to decontamination and sterilization within healthcare facilities require monitoring. Monitoring facilitates evaluation of the effectiveness of the policies and helps in the determination of weak points as well as areas that require improvement. As such, oversight committees can be established to evaluate the performance. In conclusion, hospital-acquired infections have been indicated to prolonged patients’ stay in hospital, which strains the limited resources available to healthcare facilities. The burden incurred is in relation to the additional time spent in hospital and increases, in the medical expenses. These infections are associated with medical procedures conducted during the administration of healthcare services especially during surgical procedures. Staphylococcus aureus has emerged as the most dominant microorganism responsible for most cases of healthcare-associated infections, due to its capacity to inhibit the action of most antibiotics used. Methicillin-resistant Staphylococcus aureus (MRSA) creates a delicate healthcare problem, as medical interventions are narrowed duea decrease in the number of viable drugs. The development of resistance has been attributed to a variety of reasons, among them being the overuse and misuse of broad-spectrum antibiotics. Studies have demonstrated that most of the hospital-acquired infections can be prevented by the implementation of effective measures and protocols, which enhance sterility due medical procedures. There is the need to observe proper hygiene and practice aseptic techniques by health care workers to minimize the risk of post-operation infections. The prevention and control infections should be everyone’s concern in order to accord the patient a safe environment. Adherence to infection control guidelines and principles is critical for effective dispensation of healthcare services to all, which would also serve to reduce infection rates. Through risk assessment and analysis, predisposing factors can be determined, and protocols established with the aim of correcting mistakes before they yield fatal results. This serves to correct the situation through conducting thorough audits and research into areas of patient welfare. In line with this, indicated guidelines on decontamination procedures for both the environment and medical equipment should be followed to the letter. This marks a significant stride towards decreasing MRSA prevalence in the healthcare facilities. Screening of both patients and medical personnel is essential to identify possible threats. It is critical that infected patients are isolated to prevent the spread of MRSA infections. Therefore, for health-related policies to remain effective, constant monitoring and oversight should be provided to deal with challenges emerging from the implementation process. Further research into innovative means of curbing healthcare-associated infections with regard to methicillin-resistant Staphylococcus aureus needs to be done. This would serve to explore the viable solutions to the relatively high prevalence of hospital-acquired infections. It also ensures the provision of quality healthcare services and enhances safety within healthcare facilities. References Memarzadeh, F. (n.d).The Environment of Care and Health Care-Associated Infections: An Engineering Perspective. ASHE Monograph. 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(2012).Hydrogen Peroxide Vapor can control Nosocomial MRSA Outbreak - Clinical Infectious Diseases Article. [Online] Available at: Read More