Isolation for Prevention of Nosocomial Transmission of MRSA Articles - Article Example

? Article Critique Article Critique Isolation for prevention of Nosocomial transmission of MRSA articles a. Research problem The problem in the four studies is whether the implementation of modified isolation precautions would decrease the rate of acquisition of methicillin-resistant Staphylococcus aureus (MRSA). The research problem in each study is quite significant as it helps in preventing the infection of strains of Staphylococcus aureus in hospitals which is quite resistant to methicillin. The research problem also helps to enhance infection control to prevent the transmission of nosocomial organism given that there are limited numbers of antimicrobials. These articles have provided sufficient background information for the study. Key words are necessary in every research and should be stated in the research paper. Wilson et.al (2005) addressed the use cohorts or isolation to prevent or reduce the spread of MRSA in ICU’s. Willey et.al (2008) discusses the risk factors for MRSA in roommates who are infected with MRSA in acute-care hospitals. Fernandez et.al (2002), is focused on the role of patient isolation is the control of the spread of MRSA in acute care. Gholson, Landry and Ribner (1986) talks of modified versus strict isolation in prevention of MRSA spread. b. Research objectives Gholson, Landry and Ribner (1986) examine the various infection control methods to prevent the spread of MRSA. Wilson et.al (2005) and Fernandez et.al (2002) aims at determining whether patient, staff or visitor compliance with the isolation practices have effects on the nosocomial transmission of MRSA. Willey et.al (2008) investigates the different risk factors for MRSA acquisition in those patients who are exposed to MRSA colonized roommate. Fernandez et.al (2002) evaluates the efficiency of the isolation practices towards the minimization of the spread of MRSA. The research objectives are quite clear and are clearly discussed on the context of the studies. Reading through each of the four studies, it is evident that clarity and link between the research objectives and the study context has been achieved. The study context elaborates the study objectives which bring about the clarity of the research. From the four studies, it is quite clear that the research objectives act as a guide in the context of the studies. This means that the research aimed at achieving all the set objectives. c. Planned behavior theory The four articles used the planned behavior theory in underpinning the study to determine the characteristics and behaviors of the patients before and after the study. The framework chosen is quite clear and well stated and fit well with the research objectives and problem. The theoretical framework for the study is well explained and referenced. For example, the author on the article about “Strict vs. modified isolation of prevention of transmission of MRSA” has used Infect Control 1986; 7(6):317-320 to reference the foundation of the study where all hospitalized patients suffering from MRSA were put in modified isolation precautions. The theoretical frameworks for the other studies apart from the study on “Isolation of patients in single rooms in order to reduce MRSA spread in ICUs” have been well referenced. d. Methods Independent and dependent variables The variables chosen in each study are highly linked to the research objectives as they were adopted to help the researchers in achieving the stated research objectives. All the four studies have chosen different study institutions for a given study period of 4- 12 months. Wilson et.al (2005) undertook a one year study in ICU’s and the variables were MRSA colonization as the independent variable and weekly screen as the dependent variable. Willey et.al (2008) used MRSA infection and infection control logs as the study variables. Gholson, Landry and Ribner (1986) used daily reviews of all organism and infection control program as it variables while Wilson et.al (2005) used infection control program and various isolation practices as the variables of the study. The main concept in the four studies is how to curb the spread or transmission of MRSA in the hospitals. In each of the studies, the measures taken by the researchers positively fit into the research concept. For example, the research based on the spread of MRSA from a single room has made use of MRSA patients were not kept in the same room in order to reduce the spread of MRSA in intensive care units. None of the measures has been used in assessing any complex phenomenon. The measures, techniques and instruments used in all the articles have been well tested and referenced accordingly. The four researches used survey observation tool to determine the spread of MRSA. The reliability of the research is indicated by the fact that it deals one on one with the affected patients and hence likely to be highly dependable. High reliability of the research is indicated by its applicability in all hospitals. e. Study design: Retrospective Cohort Study The study design used in all the four studies is the use of different units of hospital intensive care units for patients infected with MRSA. Patients who are infected or colonized by MRSA are usually put under both the surgical intensive and the surgical inter-mediate care units for observations and to prevent further spread of the pathogen. The study design used in MRSA study depended on whether a patient is considered infected or colonized with MRSA. The study design used therefore does not provide any key threats to the research validity. No significant bias in study methods is evident in the four research articles. The research does not also provide any threat to the study methods. Lack of biasness in the researches indicates a high level of reliability and validity. f. Sampling/data collection: Teaching hospitals Wilson et.al (2005) used data from ICU’s from two teaching hospitals. Willey et.al (2008) relied on the data obtained from a teaching hospital in Toronto with a 472 bed capacity. Willey et.al (2008) made use electronic databases while Gholson, Landry and Ribner (1986) relied on data from Hermann Hospital which has a 720 bed capacity. Wilson et.al (2005) used data from two hospitals where a sample of 18 bed unit consisting of four single rooms was chosen and in hospital B with a 10 bed capacity consisting of four single rooms. Willey et.al (2008) used a sample size of 326 roommates from the selected hospital. No sample size is given in the study by Willey et.al (2008). In the study by Gholson, Landry and Ribner (1986), 12 beds in SICU units with a total of eight single rooms were used and 20 single rooms in SIMU units were used. Data collection carried out from the sampled hospitals using direct observation as the data collection tool. The subjects were selected depending on the research objective of each study with some subjects selected from different units like exposed roommates and single rooms or cohorts. The sampling approach provides unbiased samples for answering the research questions in order to achieve the research objectives. Different sample sizes were used for each research depending on the bed capacity of the chosen hospital. However, the sample size will depend on the number of patients in the intensive care units, bed capacity of the hospital and the hospitals chosen. Any chosen sample depending on these factors will be generalized to the identified target population. That is, the sample size will be generalized for the type of hospitals chosen and the entire MRSA patients in the chosen hospitals. g. Results: Gholson, Landry and Ribner (1986), shows a total of 41 hospitalized patients having acquired MRSA. The study by Willey et.al (2008) shows that 12.6% of the sampled population had acquired MRSA while the study by Wilson et.al (2005) shows that there were no changes in MRSA transmission in nay particular strain of MRSA. The study design used was quite successful and this is because it is evident that MRSA infection and spread was quite minimal in those hospitals where isolation methods and infection control methods were high exercised. Some of the patients who were put in the same room acquired the same strain as their roommates as this was the same with the colonized patients. The conclusion from the four articles is that the infection and colonization of MRSA is high whenever there are no isolation measures taken in the intensive care units (Cooper, Stone &Kibbler, 2004). The p-value for the research is 0.08 which indicates that modified isolation precautions can prevent the transmission of MRSA. Odd risk ratio for the four articles range between 0.6 to 20, confidence levels between 0.4 to 2.5, and the standard error is 0.06. h. Ethical aspects Unlike any other research, the research in the studies does not have human subject issues, and this is because the research was carried out by qualified registered nurses (RN) and hence no intrusion of the patient's privacy concerning their infections. The research was also approved with the researchers had IRB approval from the relevant authorities. The research does not indicate whether the patients were made aware for the reasons well known to the researchers. No human subject issue arose from the research as the names of the patients were not stated in the research hence (confidentiality was highly exercised) protecting them from psychological harm. The patients were also protected from any form of physical harm as none was removed from the intensive care units where they were monitored accordingly. No due influence in coercion to participate as the study was approved by the relevant authorities. i. Discussion/comments: The four studies are quite valid and reliable as they are generalizable to similar hospitals. The research is generalizable to similar hospitals as it gives them insights on the level of transmission of MRSA when patients are isolated. In all the studies, the conclusion by the authors is purely based on the data collected. The conclusion by the authors only emphasizes on information from the sampled data and this makes the authors put across a strong support on the data obtained in the study. All the findings from the collected data have been put across by the authors in connection to the study questions and conclusions done based on the same. It is therefore prudent for one to conclude that all study objectives have been met. References Wilson A.P, (2005). Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. TWhitehouse FRCA Gholson, Landry and Ribner, (1986). Strict versus Modified isolation for prevention of nosocomial transmission of methicillin-resistant staphylococcus aureus. Charles B. Slack, Thorofare NJ Fernandez et.al, (2002). The role of patient isolation and compliance with isolation practices in the control of nosocomial MRSA in acute care. Evid Based Helathc Willey et.al, (2008). Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in roommate contacts of patients colonized or infected with MRSA in an acute care hospital. 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