The Implications of MRSA on Wound Healing - Case Study Example

Swarna1 Word count: 1607 P.Swarnalatha ID # 5448 Order # 156444 12th March 2007 The Implications of MRSA on Wound Healing Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most serious health disorders faced by the human beings in the present era. Methicillin-resistant Staphylococcus aureus (MRSA) is a specific strain of the Staphylococcus aureus bacterium that has developed antibiotic resistance to all penicillins, including methicillin (Foster, 1996). The resistant strain, MRSA was first discovered in the United Kingdom in 1961 and is now widespread, particularly in the hospital setting where it is normally termed a superbug. The symptoms can range from skin boils to necrotizing fasciitis which is popularly known as "flesh-eating disease". There have been confirmed reports that patients who are getting admitted to hospitals for the treatment are most affected group due to MRSA infection (Craig Brown, 2006). It was also found that patients who stay for longer period in hospitals are found to be infected with MRSA in higher rate. MRSA also affects the wound healing negatively. Hence the proper nursing treatment techniques and strict maintenance of hygiene is very much needed for effective cure of MRSA. It has been found in the research studies that MRSA worsens the conditions of wound healing and hence draws attention of medical personnel through out the world. The management of this disease has become more crucial especially in a community set up. The role of base level functionaries like nurses is quite phenomenal in successful management of this disease. Scotland also has a remarkable number of patients suffering from MRSA. It has become a frequent cause of nosocomial infection, its increasing prevalence posing serious therapeutic and infection control problems within the hospital environment. Extended hospitalisation and antibiotic therapy have been identified as additional risk factors for MRSA carriage and infection. It is not exaggerating to comment that MRSA is a major challenge to the burn patient, with potential to cause significant morbidity and mortality. Burn patients have been shown to become colonised and infected more readily than other patient groups. Extensive burn injuries are particularly susceptible to infection as a result of the disruption of the normal skin barrier and accompanying depression of immune responses. Microbial surveillance, epidemiological studies and the introduction of strict infection control regimes can definitely reduce the prevalence of MRSA but may be insufficient for eradication or prevention of outbreak situations if not accompanied with community awareness programmes in Scotland. It was found that nearly one fifth of patients who died after surgery in 2005 had developed an infection in hospitals according to a national survey in Scotland. A total of 126 people, 7.6% of those who died after surgery, had MRSA. In 75 of those cases, it was believed to have contributed to the patient's death. The report also revealed that almost half of the patients with MRSA had the infection when they were admitted. This survey was done for a considerably larger ample. There were 301,894 surgical admissions to Scottish hospitals in 2005, with 240,302 patients having an operation. In 17.8% of cases where the patient died after surgery, they had shown a hospital acquired infection (HAI). This can be compared with 23.5% of people who died after surgery in 2004 (MRSA watch, 2006a). These figures, from the Scottish Audit of Surgical Mortality showed an improvement in terms of MRSA management in Scotland in comparison with that of 2004. The implementation of MRSA infection control guidelines by all the nursing staff in Scotland is crucial in reducing the impact of MRSA on wound healing. Reports confirm that NHS Lanarkshire infection control teams have been responding to the problem by working to tackle the issue with a range of initiatives to help combat infection, including specialist infection control teams in each hospital to ensure staff follow infection control guidelines (MRSA Watch, 2006b). Lanarkshire is the first health board in Scotland to provide a nurse consultant for healthcare associated infection (HAI). The health board has active MRSA surveillance programmes in high-risk units to identify and prevent outbreaks and act quickly to stop spread of infection. Nurses must ensure that patients found to carry MRSA are to be treated with antiseptic skin cleansers, nose sprays and ointment which can be successful in removing MRSA from the body. Special district nursing care has to be provided for suspected MRSA patients in isolation has to be implemented in the event of an outbreak. The hospital staff including nurses should be screened in the event of out break. The district nursing staff must be given high level technical and practical training and should be provided with infection Manual for better management of MRSA. Ensure the usage of ultra-violet light for effective hand-washing procedures. Training programmes like Cleanliness Champions programme for frontline district nursing staff may be encouraged to prevent and control healthcare associated infection (HAI). The district nursing staff must be instructed to participate in MRSA infection control nurses' work and they should be allowed to take part in practical germ identification competitions. Infection Control Awareness Week certainly gives them an extra opportunity to display, promote and share information with the public and other healthcare staff. One must not forget the fact that all the groups of people like district nursing staff, patients, visitors and doctors must take utmost care in regulating MRSA at a lower level which will help in better wound healing and faster patient recovery in Scotland. There should be strict legal action on those people who neglect the care of others and become responsible for spread of community acquired MRSA. One must feel happy at seeing the recent judgment punishing a mother with imprisonment for 20 months for neglecting her child care leading to MRSA. Only thorough and strict health monitoring saved the child's life (MRSA watch, 2007a). This may work like eye opener for those people who work closely with patients but with out following optimum level of precautions. There is also a necessity for conducting large scale rapid tests for deadly superbugs that are spreading MRSA in the community. It is observed that the toxin-producing strains, known as PVL, are spread outside of hospitals via skin-to-skin contact and appear as sores which look like insect bites. The irony is that the existing tests take more than two weeks, yet the bug can kill in a day (MRSA Watch, 2007b) which stresses the need for rapid testing in district nursing for effective cure of MRSA. One must not forget the fact that the best way to prevent a community associated MRSA infection is to practice good hygiene at all the levels. District nursing practices should concentrate on following measures in hospitals and public should be made aware to follow the same in their houses. 1. Keep the hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. 2. Keep cuts and scrapes clean and covered with a bandage until healed. 3. Avoid contact with other people's wounds or bandages. 4. Avoid sharing personal items such as towels or razors, and 5.wear gardening gloves when working in the yard. ' '' '' It is heartening to note that the hospitals are recognizing their ill management in proper cure of MRSA and expressing grievance and apology for the same in Scotland. A grieving family have been given an apology by a health board following the death of an elderly relative at Stirling Royal Infirmary recently. The patient was admitted with blood clots who got contracted with MRSA and died of broncho-pneumonia and a blood clot in her lungs. After the sudden death of patient, patient's anguished daughter and sister demanded answers to a string of concerns over the standard of care Mary had received. They have now been sent an apology from NHS Forth Valley (MRSA Watch 2006c). However they should ensure the general public that they take accurate management practices in coordination with national health policy team members so that the people would be infected with MRSA at a lesser rate. Keeping all these points in view, the present study has been planned with the following objectives: 1) To study and analyze the different causes for MRSA and its effect on wound healing process in community setting in Scotland, 2) To evaluate the existing performance of district nursing programmes in managing MRSA and wound healing in Scotland 3) To determine the genuine difficulties faced by the nurses in hospitals while curing MRSA in Scotland, and 4) To prioritize the MRSA infection and wound control measures in district nursing programmes in Scotland. The literature relating to the different causes of MRSA and effective control measures will be reviewed thoroughly in connection with wound healing in community set up in Scotland. The results will be presented in logical sequence answering the above mentioned objectives and will be analyzed critically under "Results" and "Discussion" chapters. References: Craig Brown. 2006. Want to get out of hospital fast' Then don't go in on a Thursday. The Scotsman. Dated 28th December 2006. Foster T (1996). Staphylococcus. In: Barron's Medical Microbiology (Barron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.' MRSA Watch. 2006a. Nearly one in five Scottish surgery death patients had been contaminated in hospital - injurywatch. MRSA in Scottish Hospitals. Dated 4th December 2006. MRSA watch. 2006b. Hands-on approach to infection control will beat killer bugs. . MRSA in Scottish Hospitals. Dated 8th November 2006. MRSA watch. 2006c. HOSPITAL IN MRSA APOLOGY. MRSA in Scottish Hospitals. Dated 15th March 2006. MRSA watch. 2007a. Jail for MRSA child's mother. Community Acquired MRSA. Dated 22nd February. 2007. MRSA watch. 2007b.'Community superbug tests' needed. Community Acquired MRSA. Dated 4th February. 2007. Read More