MRSA and the Importance of Hand Washing - Essay Example

Critical Incident on MRSA and the Importance of Hand Washing Introduction: Anti-biotic resistant organisms pose a severe challenge to those in the health care profession in all health care settings This challenge becomes even more with patients that require critical care. Patients in critical care result from a wide range of reasons and include those with setbacks in their health conditions or post operative patients or accident victims. All these patients are already in life threatening situations and any additional threat to their condition needs to be avoided. Anti-biotic resistant organisms pose such a threat. Methicillin-resistant Staphylococcus aureus (MRSA) is one of these anti-biotic resistant organisms and is capable of causing widespread infection and threat to the lives of the patients in critical care. As such the seriousness of the threat of MRSA in critical care needs to be examined as well as the preventive means against the spread of these infections including the relevance of hand washing. The Extent of the Threat of Anti-biotic Resistant Organisms: The extent of this threat can be seen in the estimates from the United States of America as a result of their observations on anti-biotic resistant organisms and their impact in health care settings that were presented during the Global Consensus Conference on infection control problems and the possible solutions. An estimate presented showed that direct cost as a result of infections from antibiotic resistant organisms was not less than $1.3 billion in health care settings across the United States of America. The report of the Center for Disease Control and Prevention (CDC) is even more alarming in that every year antibiotic resistant organisms are responsible for 2,400,000 infections in the United States of America alone and are directly the cause of 30,000 deaths and are the contributory factor in another 70,000 deaths in the United States of America every year. Each incident of an infection due to antibiotic resistant organisms was estimated to cost $2,300 and the total cost of these infections due to antibiotic resistant organisms work out to $4.5 billion annually in the additional care that is required for patients. Methicillin resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococci (VRE) are two of the antibiotic resistant organisms that are the cause of most concern with their potential for widespread infection in healthcare settings and as such pose a severe threat to patients in critical care. Hand washing was found to be an important procedure that could prevent the spread of infection due to antibiotic resistant organisms. (LeTexier, Ruth. Preventing Infection Through Handwashing). Methicillin Resistant Staphylococcus Aureus: The staphylococci bacteria have shown a tremendous capacity for adaptation to counter antibiotics commonly used. The penicillin group of antibiotics provided a wide range of antibiotics to fight infections. Unfortunately they are proving ineffective against several strains of staphylococcus aureus strains as they produce beta-lactamase to nullify the effect of these antibiotics. Methicillin from the penicillin family was introduced in 1960, as it was a form of penicillin that was effective even against the beta-lactamase producing staphylococci aureus strains. However it was not long before staphylococci aureus strains developed resistance to methicillin and its successor flucloxacillin. This development of resistance was not restricted to methicillin and flucloxacillin, but went on soon to render the third generation cephalosporins and the newer penicillin derivatives ineffective. The term methicillin resistant staphylococcus aureus (MRSA) refers to all these resistant strains of staphylococcus aureus. The threat that they pose with their virulence is even more with limited means to control these infections and prevention of infections should be the first line of defence. Virulence of Methicillin Resistant Staphylococcus Aureus: Staphylococcus Aureus can cause a range of infections from mild infections of the skin to severe systemic infections like septicaemia and pneumonia and as such MRSA is capable of the same infections. The striking feature is that staphylococcus aureus is part o the normal skin flora and the normal locations are axillae, groins, perineum and nose. Heavy colonisation is possible in wounds and cannula sites. MRSA is capable of replacing sensitive strains of staphylococcus aureus and remain there without causing infection but are a reservoir in these carriers and can get transmitted to other patients or healthcare staff. MRSA is usually found in hospitals, where antibacterial agents are used extensively and provide an opportunity to these organisms to develop resistance. (Wilson, Jeannie. INFECTION CONTROL IN CLINICAL PRACTICE). Transmission of Methicillin Resistant Staphylococcus Aureus: Not all strains of MRSA get transmitted from person to person. However there are sufficient epidemic strains that spread from person to person and causing infection that is not easy to treat. Though there remains the theoretic possibility of airborne transmission of MRSA, there has been very little evidence to establish this route of transmission. One of the significant routes of transmission is the contaminated uniform of the healthcare staff and the equipment that is found in healthcare settings. These equipments are even more in critical care and therefore pose an even larger threat. Automation has found its way into healthcare settings and these equipments and data entry devices can be a means for the spread of MRSA. This can be seen from a study that was conducted in a hospital in Chicago on the possible spread of MRSA through the keyboards of PCs and computer equipment. They found that touching the keyboard and other computer equipment could be a means of the transfer of MRSA to patients and cleaning of the equipment was not a solution for the prevention of the transfer of MRSA. The only manner in which the spread could be prevented is by proper washing of the hands of the health care staff in these settings. (Computer equipment could help MRSA spread). The most important route of the spread of MRSA is through the hands of the healthcare staff. The hands of healthcare staff can come in contact with contaminated equipment or in the care of their patients some of who may be carriers. This is especially true in the critical care settings, where the patients are not in a position to take care of themselves due to their critical state and require the assistance of the nursing staff. In addition their treatment recommended would require several invasive procedures and monitoring of health parameters adding to the number of physical contacts between the health care staff and the patients. These contacts create the possibility of the spread of MRSA from carriers to the healthcare staff and from them to other critically ill patients. Thus the hands of the healthcare staff provide a means of the spread of MRSA and can reach endemic proportions in the event suitable preventive methods are not used. This gives rise to great concern, as treatment of MRSA is not easy with the organisms showing resistance to many of the available anti-bacterial agents. The only ant-bacterial agent that MRSA shows sensitivity to is vancomycin. Vancomycin however is expensive and has the potential to be toxic to patients in critical care. These problems with MRSA only add to its potential threat in the care of critically ill patients. Preventive Measures Against the Spread of MSRA: The rationale for measures against the spread of MSRA is to prevent patients that have not been affected by MSRA from getting infected with it. One of the methods is to discharge patients with MSRA and send them home as this has dual benefits. In the first place MSRA flourishes in the hospital environment and not in home the environment and thus reduces the impact of MRSA. The second benefit is that patients and healthcare staff are not exposed to the person infected or a carrier of MRSA and thereby reduce the chances of the spread. This measure however has two disadvantages. The first is that it requires proper screening facilities at the hospital. The second is that it cannot be used in the case of the critically ill and it is this segment of the inpatients that need to be protected more against MSRA. (Wilson, Jeannie. INFECTION CONTROL IN CLINICAL PRACTICE). The second possible measure is to isolate the patients with MSRA and reduce cohort care. This measure was believed to be a reasonable way to prevent the spread of MSRA in the healthcare environment. This is not proving to be true as this study in a hospital showed. Jorge Cepeda and his colleagues as a result of the study conducted by them found that there was no real benefit by shifting patients in intensive care detected with MRSA into cohort-isolation care. In other words the isolating of patients in the intensive care detected with MSRA does not provide the expected results in preventing the spread of MSRA. There are several reasons for the moving of patients into cohort-care isolation failing to produce the desired results. The first reason is that proper screening needs to be done at the time of admission into the healthcare setting. Delay in doing this provides time for the MSRA infection to spread from the carrier or infected person into the health care setting. This is especially so when the patient is admitted from another healthcare environment or has been subjected to several hospital procedures, which is quite likely with a critically ill patient. Screening procedure protocols are not necessarily easy and put extra strain on the healthcare staff, especially when the pressure of not having enough nursing staff is already a problem. The next issue is the hygiene of the healthcare setting itself in the use of isolation as a means of preventing the spread of MSRA. There is no point in moving patients in intensive care to cohort-isolation care if the healthcare environment is conducive to the colonisation of MSRA in the hospital environment. The United Kingdom has one of the highest rates for MSRA in Europe and is known as the ‘dirty man of Europe’. These points to the conclusion that hospital environments in the United Kingdom leave a lot to be desired in the maintenance of hygiene. There is no point in shifting patients in intensive care to cohort-isolation when there is the possibility of MRSA being present in the new environment. Hence for isolation techniques to be successful the healthcare setting needs to be properly screened from time to time for MSRA and the necessary steps to prevent the presence of MRSA in the hospital setting and this is easier said than done. Let us assume that the hygiene factors are satisfactory as well as proper screening is done at the time of admission to assist in the success of shifting patients to cohort-isolation care, we still run into the problem that for isolation to be successful the nursing care to patient ratio should be such that there is one nursing attendant for every cohort-isolation care patient in the intensive care unit. In such a case the chances of exposure to MRSA gets reduced and higher the chances of success in using isolation as a measure of prevention of MSRA. The staffing of the intensive care unit as well as the hospitals around the world have been impacted by the shortage of nursing staff on the whole and qualified intensive care nursing care in particular. This means that proper nurse to patient ratio for isolation, as a measure for making the prevention of MSRA successful is not easily achievable. The cost of isolation as a measure for preventing MRSA is high and therefore all the factors necessary for its success is seldom seen and this makes isolation of patients with MSRA as measure for its prevention less successful. (Lessing, M.P.A. and Loveland, R.C. Isolation of patients with MRSA infection). The third measure that is used for the prevention of MSRA in an hospital setting and in particular in the intensive care units is hand washing. This is a simple yet effective means to prevent the spread of MSRA. It may put some pressure on the healthcare staff in performing an extra routine before attending to the care of their patients but provides the least expensive and most effective means of preventing the spread MSRA in a healthcare setting and in particular in the care of intensive care patients. (Wilson, Jeannie. INFECTION CONTROL IN CLINICAL PRACTICE). Hand Washing: Despite all the advances in medical technology hand washing remains the most effective means of preventing the spread of any infection. Hand washing needs to be employed both by the healthcare attendants and also by the patients. It is when hand washing is not employed to the required level that the spread of infection becomes more than a possibility. Studies have shown that hand washing by the healthcare attendants is normally less than claimed by them. Similarly among male patients the tendency to wash hands after using the toilet is on the lower side with nearly sixty percent avoiding it. While it was found that ambulant patients tended to hand wash more than the non-ambulant patients, still only fifty percent of them did wash their hands after going to the toilet. In the case of the non-ambulant patients none of them did so. The study also unfortunately points out to the fact that healthcare attendants did not encourage the use of hand washing techniques among the patients and also among the visitors of the patients. This lack of the proper use of hand washing is one of the reasons for the spread of MSRA among patients in a healthcare environment and poses a severe threat to those patients in the intensive care units. (Ward, Kate. CARE OF THE PERSON WITH AN INFECTION). Proper hand washing involves the systematic rubbing of all parts of the hand and wrist with soap and water. The efficacy of the hand wash depends on the reaching all parts of the hand and wrist during the hand wash procedure, as the anti-septic soap will not be of any use if it does not reach all parts of the hand. The use of hand wash in removing micro-organisms from the hand and thus preventing its spread can be seen from the fact that even a brief ten second hand wash is capable of removing transient micro-organisms effectively. Proper drying with a towel or air hot-air drier assists the removal of micro-organisms from the hand and thus leaving it clean to attend to the care of the patients. A proper hand wash takes approximately a minute and in the care of patients in the intensive care units there are many times that this acts a hindrance and so there is a tendency to neglect this aspect for the prevention of MRSA. In an environment where there is severe pressure on the healthcare attendant on time available for a hand wash an alcohol rub may be used as the alcohol rub takes only fifteen to twenty seconds. (Wilson, Jeannie. INFECTION CONTROL IN CLINICAL PRACTICE). Devices to aid make hand washing easier have been given prominence as can be seen from the award that was given to a student for designing a portable hand washing device as it was believed that the device would help in addressing a severe health problem in MSRA. (Student's solution to kill MRSA wins award). The reason why the hand wash becomes the most significant means to prevent the spread of MSRA in a critical care unit is because the hands of the healthcare staff are very frequently in contact with the critically ill patient in their care and in the various procedures that are required to monitor their state of health or in their treatment procedures. Furthermore it is the single most effective means of preventing the spread of MSRA in the care of patients in the critical care units. The spread of MSRA in a critical care unit can have a devastating effect on the condition of the patients in the critical care unit. This can be seen from the effect it has in a surgical post-operative care unit. Infection due to MRSA in the case of patients who have undergone cardio – vascular surgical procedures has become one of the most important factors leading to morbidity and mortality of these patients. This is not to say that patients in post operative care from other surgical procedures are not at risk of morbidity or mortality from MRSA. They are and it was seen that in post operative care units’ patients that had developed MRSA infections had a mortality rate that is six times higher than patients without MRSA. These figures are significant when studies show that the more than five percent of the patients admitted into hospitals were carriers of MRSA. Given this high rate of the presence of MSRA carriers in the patients admitted into health care environments and critical care units and the threat of morbidity and mortality in case the patients in the critical care units contract MRSA infection the importance of the prevention of the spread of MRSA can be well understood. There is no possibility of sending a critically ill patient back home nor has isolation proved a suitable means to arrest the spread of MRSA and it is only hand washing among the three measures used for preventing the spread of MRSA that has proved effective. The importance of hand washing in the critical care of patient is most evident, as it remains the best and sole means of preventing the spread of life threatening MRSA infections. (Bagger, Peder, Jens. Zindrou, Dlear and Taylor, M. Kenneth. Postoperative infection with methicillin-resistant Staphylococcus aureus and socio-economic background). Conclusion: In the case of MRSA prevention is better than cure and more so as there are limited means available to treat it. Many a time it is the simple means that proves most effective and so it is with MRSA and hand washing. The simple hand washing techniques provide the means to prevent the spread of MRSA. MRSA could be lethal to a patient in the critical care unit with all the life-threatening conditions that the patient faces. This is the reason that hand washing is so important in patients recovering from a critical incident in a critical care unit. Literary Works Bagger, Peder, Jens. Zindrou, Dlear and Taylor, M. Kenneth. (2004) “Postoperative infection with meticillin-resistant Staphylococcus aureus and socio-economic background”. THE LANCET. Vol. 363, Number 9410. Pp 706 – 708. “Computer equipment could help MRSA spread”. Primary care. 2005. E-Health Insider. 4 Dec. 2005. . Lessing, M.P.A. and Loveland, R.C. 2005. “Isolation of patients with MRSA infection”. THE LANCET. Vol. 365, Number 9467, Pp 1303. LeTexier, Ruth. “Preventing Infection Through Handwashing”. INFECTION CONTROL TODAY. 4 Dec. 2005. . “Student's solution to kill MRSA wins award”. 2005. EveningTimes.ONLINE. 4 Dec 2005. . Ward, Kate. 1993. CARE OF THE PERSON WITH AN INFECTION. In NURSING PRACTICE & HEALTH CARE. Ed. Hinchliff, M. Susan, Norman, E. Susan and Schober. E. Jane. Chapter 16. Pp. 419-420. Edward Arnold. Great Britain. Wilson, Jeannie. INFECTION CONTROL IN CLINICAL PRACTICE. London. Baillere Tindall. 1995. Read More