Controlling Transmission of Healthcare Acquired Methicillin-Resistant Staphylococcus Aureus (HA-MRSA) Infections

ENVIRONMENTAL EPIDEMIOLOGY
1. Research (PICO) question

Can transmission of healthcare acquired methicillin-resistant
Staphylococcus aureus (HA-MRSA) be controlled by multiple
interventions?
P (population) - patients and nursing staffs
I (intervention) – Addressing the need to tackle transmission of methicillin-
resistant Staphylococcus aureus (MRSA) in hospital settings and examine the
good practices
C (comparison) – various strategies to minimise the acquisitions of MRSA
O (outcome) – curbing healthcare acquired (HA) complications by MRSA.
2. Background
i. Literature review
The review of several literatures was conducted utilising the search databases
such as CINAHL, PubMed and EBSCOhost, Additionally the search items
include methicillin-resistant Staphylococcus aureus, control of infection by
MRSA and implementation of control measures for patients and nurses. The
literature search consisted of 53 articles out of which 20 were chosen to identify
the problems, notification on hazard, response to dose, exposure assessment and
characterize the risk.
Globally, healthcare acquired infections are one of the major implications of
mortality. Morbidity and excessive financial burden. Staphylococcus aureus is
most potent nosocomial pathogen leading to healthcare acquired complications
such as pneumonia, meningitis and bacteraemia. The administration of
antibiotics and antimicrobial agents has significantly increased in the recent
past; as a result, there has been a drastic reduction in infection and death rates
(Littman and Viens, 2015). As antibiotics have been the major line of treatment
for a long period, few bacteria have developed resistance towards the antibiotics
thereby rendering the treatment ineffective (Lloyd et al., 2005). Currently,
antibiotic resistance has become a problem worldwide and research is being
done to curb antibiotic resistance (Fukunaga et al., 2016). As such, MRSA, a
strain of S. aureus exhibits resistance against methicillin and is a serious
concern to public health owing to its elevated levels in mortality rates among
the antibiotic resistant organisms.

MRSA or Methicillin-resistant Staphylococcus aureus has its effect in precisely
the similar manner as that of Staphylococcus aureus and leads the exact manner
of infections and sufferings (Lee et al., 2018). MRSA is different from the other
is because of its resistance to some antibiotics. There are various antibiotics
which are effective in such infections but it may be a bit risky to use as it might
have chances to cause severe side effects (Turner et al., 2019). Though,
development of the MRSA infection is very not as much common as for normal
people, but it is more frequent for the individuals who obtain Methicillin-
resistant Staphylococcus aureus to be transporters (Harkins et al., 2017). These
people are often called as ‘colonised’ people, which states that the organism
exists without harming the individual, on their skin or in their nasal region or
throat, and are found to be not cause any difficulties related to health. one of the
amendments that has been made by the legal agencies is patient advocacy in
condition of Methicillin-resistant Staphylococcus aureus infection (Galar et al.,
2019). Patient advocacy provides the right to the person take his/her health care
related as well as treatment related decision and if not possible they can hire
their personal advocates.
Patient advocacy and Personal advocacy is permitted to patients admitted to
health care settings which are licensed under the chapter 405. The legal
amendment states that the patient has total right to choose personal advocate
and the advocate must be with the patient in every process of the examination,
treatment and effective result while suffering from infection due to Methicillin-
resistant Staphylococcus aureus (Werner & Shaban, 2018). The patients have
the authority to recruit more than one personal advocate for themselves. The
patient advocates role is to help the patient make effective decisions regarding
the health, treatment and recovery. The healthcare has the right to limit the
advocates presence in areas where it may risk the patient’s health such as sterile
chambers prepared for the patient as Methicillin-resistant Staphylococcus
aureus has the high chance of spreading. In any circumstance, if the patient
advocate is not permitted to stay with the patient, the health care setting is
bound to provide a written application with detailed reason behind not
permitting the advocate (Walrath et al., 2015). The copies should be provided to
the patient as well as the advocate. It is necessary for the patient as well as the
nursing staff to practice protective measures in order to avoid the spread of the
infection (Werner, Zimmerman & Elder, 2016). The nursing staff needs to
follow basic rules such as keeping the patient in a separate chamber that needs
to be sterile enough to avoid the infection to grow or spread. The nurses at the
same point needs to preserve them from getting infected thus they need to use

protections such as gloves, protective aprons, hand hygiene and other cleaning
and disinfecting measures (Garvey et al., 2019).
ii. Rational and significance:
One of the studies revealed that the risk of mortality was twice higher than that
of methicillin-sensitive S. aureus which significantly increases the duration of
stay, utilizing resources of the healthcare facilities, medication and extra nursing
staffs for care thus leading to economic burden for the patient (Kundrapu et al.,
2012). MRSA can survive on hospital surfaces such as catheters, surgical
instruments, hospital floor and furniture and cause outbreaks if left
uncontrolled. Consequently, it is important to understand the disease burden and
the potential factors associated with the spread of infection in order to manage
HA-MRSA (Fox et al., 2015). Furthermore, identifying the risk factors will
ensure formulation of guidelines and recommendations for prevention policies,
in particular, good hand hygiene, adequate care of vascular devices and
cleanliness of the hospital environment (Minhas et al., 2011).
iii. Biological plausibility:
The biological plausibility includes prolonged bacteraemia resulting in severe
complications such as meningitis and septic shock. In addition, these
complications result in prolonged bacteraemia (Green, 2015). In addition,
MRSA based interventions have a significant impact in surgery, for instance
mupirocin administered intranasally has significantly minimised MRSA
associated infections at the site of surgery in orthopaedic and cardiothoracic
surgery, however not effective in general surgery. The causes for such reasons
remain unclear, however a dosage regimen to decolonise MRSA prior to
surgery and development of rapid diagnostic assays can be effective to curb
MRSA transmission. Also, utilisation of two interventions such as hygiene and
antibiotics or placement of patients in isolation rooms or proper screening can
be effective in the prevention and control.