MRSA Prevention and Detection

Debby Boyle
Nicole Cory
Linda Hansen
Anne Hendricks
Methicillin- What is MRSA?
Resistant Methicillin-resistant Staphylococcus
aureus ( MRSA) is one of the major
Staphylococcus nosocomial pathogens responsible for
Aureus increased morbidity, mortality, and
prolonged hospitalization (Kucina et al.,
2008). MRSA was first reported in the
United Kingdom in 1961, when it was found
that Staph aureus infections were becoming
resistant to beta-lactum inhibitors such as
methicillin (Romero, Treston, & O’Sullivan,
2006). Staphylococcus aureus bacteremia
(SAB) is a potentially lethal and increasingly
common infection in hospitalized patients
(Lahey, Shah, Gittzus, Schwartzman &
Kirkland, 2009).
MRSA in the Healthcare Setting
• MRSA ranks “among the most prevalent pathogens in hospitals worldwide” (Diekema & Climo
2008, p.1192).
• Infections caused by multidrug-resistant gram-positive bacteria represent a major public health
burden in terms of morbidity and mortality, increased expense in patient management, and
implementation of infection control measures (Woodford & Livermore, 2009).
• The "superbug", MRSA, regularly attracts media interest and there is political pressure to reduce
MRSA infection rates (Woodford & Livermore, 2009).
• Each year126,000 patients hospitalized develop MRSA and 5,000 of
those patients die (Klevins et al., 2007).
• Today’s numbers state that 46 out of 1,000 patients have MRSA
(Klevins et al, 2007).
• Healthcare Acquired-MRSA patients have an increased
length of stay up to nine and one-tenth days and incur
costs of roughly $30,000 per episode (Richmond et al, 2007).
Several factors are listed as contributory to the increased and
persistent nature of MRSA in the healthcare setting (Barnes
& Jinks, 2008).
• Inappropriate prescribing practice (compounded by the
use of antimicrobial agents in veterinary and agricultural
practices)
• Poor and inconsistent infection control measures such as
hand washing
• Lack of adequate surveillance together with inadequate
isolation resources for colonized or infected individuals
• Nurses’ lack of knowledge and understanding of
epidemiology, microbiology, pharmacology and infection
control have also been singled out
Some patients are at higher risk for contracting
MRSA including:

• Patients with known previous MRSA infection

• Patients who have been hospitalized three or more times
in one year
• Residents of long-term care facilities
• Patients with chronic wounds (Kucina et al., 2008).
Hand-Washing •In two different studies, hand washing was shown
to be a key factor in reducing the spread of
microorganisms (Laustsen et al., 2009; Thomas et
al., 2005).
•According to the CDC, “The main mode of
transmission (of MRSA) to other patients is
through human hands, especially healthcare
workers' hands” (Siegel et al, 2007).
•In one study hand-hygiene compliance was
deemed to be 20%, after interventions such as
posting posters, it was increased to 37% (McKinley
et al., 2005).
• Hand hygiene is shown to be the single most
effective way to prevent the spread of healthcare
related infections (Yammamoto et al.,2007).
Environmental Services
• MRSA can live on surfaces for long periods of time
(Hardy et al., 2006).

• In one study, “Environmental strains were more

often identical to those colonizing another patient
elsewhere in the ward, possibly indicating the
spread of bacteria” (Hardy et al., 2006, p. 130).

• One study showed that the highest area (81 of 216

sites) of MRSA contamination was obtained in the
samples from under the beds which led researchers
to speculate as to possible reasons for this finding
(Hardy et al., 2006).

• Even if the bed space was not occupied with a

patient colonized with MRSA, the space still tested
positive for MRSA 20.2% of the time (Hardy et al.,
2006).
Early Detection
• Unrecognized carriers render infection control programs futile, therefore
evaluation of the benefit of screening both the nares and throat was
examined in four study populations (Mertz et al., 2007).
• Clinical trials were 100% correct in identifying MRSA and
98% positive of identifying the less dangerous strain.
• This rapid screening test requires a maximum of three hours
and forty minutes to complete (Kucina et al, 2008).
• Combining swabs of the throat, skin, and nares is important s and throat
was examined (Mertz et al., 2007).
• A because selective colonization of the throat may be more common than
presently acknowledged (Mertz et al., 2007).
Integration of the Evidence
• Most healthcare workers have encountered more than one
undiagnosed MRSA infection in their practice. A rapid test
with results obtained in a 3 to 4 hour period could prevent
this unseemly event.
• The rapid testing is performed utilizing swabs, which is a fairly non-invasive and
inexpensive procedure (Kucina et al., 2008). Patients may prefer to have this
testing done to avoid being placed in tentative isolation, or to avoid potentially
exposing other patients.
• Patients have expressed anger and resentment at contracting the infections and
express dismay at missing work, costs of travel and time/duration of the
treatment. Patients are now understandably fearful of the possible
consequences of healthcare interventions or a stay in the hospital (Barnes &
Jinks, 2008).
Recommendations to Utilize the Evidence
Recommendations include a
plan to implement the rapid
MRSA assay as a screening
tool in order to recognize
patients who have been
colonized with MRSA before
they are transferred to another
nursing unit.

Hand washing is essential in

the prevention of the
transmission of MRSA between
patients and healthcare
personnel.
Utilization of the Evidence

Assess for risk

Maintain isolation
factors: presence of a If positive for MRSA
If found to be at high until culture results
chronic wound, has the patient will
risk, the swabs are obtained. As
been hospitalized require a private
should be obtained always, with every
three or more times room. Contact
and sent for analysis patient, standard
in the last year, or is isolation precautions
to the lab. precautions should
a resident of a long- should be utilized
be maintained .
term care facility.
 • Wash hands after contact with patient s, bodily fluids, and
contaminated items, and after gloves are removed between
patient contact
Hand Hygiene • Use gloves (clean, non-sterile are adequate) when contacting
patient or patient items.
• Use clean gloves when touching mucous membranes and non-
intact skin.

• Always wear gloves; wear masks and eye protection during

procedures that are likely to generate splashes
• Ensure that reusable equipment is not used in the care of
another patient until it has been appropriately
Isolation Precautions decontaminated.
• Isolate patient in a private room or in room with other
patients on MRSA precautions.
• If possible, divide patient assignments so that health care
personnel are not required to care for both (Capriotti, 2003).

• Assure that patient environment is cleaned daily with antiseptic

solution.
• Use single-use disposable equipment; discard in biohazard
Surfaces waste container.
• Ensure that reusable equipment is not used in the care of
another patient until it has been appropriately decontaminated.
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