Methicillin-Resistant Staphylococcus Aureus (MRSA)

This essay analyzes MRSA by identifying its risk factors and evaluating its prevalence in Australia. It examines Mrs. Jenkins’ diagnosis and the relationship between her infection and other factors such as hand hygiene, transmitted-based precautions, and standard precautions. Lastly, the paper examines the role of both community registered nurse and occupational therapist in relation to Mrs. Jenkins’ case.

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Methicillin-Resistant Staphylococcus Aureus (MRSA)
Name:
Institution:

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Introduction
Methicillin-Resistant Staphylococcus Aureus (MRSA) is an infection caused by a human
bacterial microorganism called Staphylococcus aureus (S.aureus). According to Bogestam et al
(2018), S.aureus is responsible for various infections in humans such as bullous impetigo,
folliculitis, boils, cellulitis, septic arthritis, osteomyelitis, post-surgical wound infection as well
as intravascular line infections. The author further adds that S.aureus can also lead to deadly
infections such as meningitis, septicemia and endocarditis. The main aim of this essay is to
analyze MRSA by identifying its risk factors and evaluating its prevalence in Australia. With
specific reference to Mrs. Jenkins, a patient admitted with MRSA, the paper will first identify the
incidence and prevalence of MRSA in Australia. Secondly, there will be an examination of Mrs.
Jenkins’ diagnosis and the relationship between her infection and other factors such as hand
hygiene, transmitted-based precautions, and standard precautions. Lastly, the paper will examine
the role of both community registered nurse and occupational therapist in relation to Mrs.
Jenkins’ case.
The Incidence and Prevalence of MRSA Infection in Australia
The identification of incidence and prevalence of MRSA in Australia has largely been the
responsibility of the Australian Group on Antimicrobial Resistance (AGAR), an organization
that has been monitoring the prevalence of MRSA in Australia since 1985 (Wang et al 2018).
According to the author, there exist two main types of MRSA namely the hospital-acquired
MRSA and the community-acquired MRSA. Community-based MRSA (CA-MRSA) are MRSA
infections acquired by individuals who have not had a recent hospital and may not have

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undergone any clinical procedure such as catheter, dialysis or surgery. CA-MRSA is mostly
manifested in the form of boils, pimples and skin infections that may otherwise occur in healthy
individuals (Askura et al 2018). On the other hand, according to Hongo et al (2018), hospital-
acquired MRSA (HA-MRSA) occur among individuals who might have been in the hospital in
the recent past for clinical procedures such as surgery, catheter or dialysis. They mainly occur
where patients undergo invasive medical procedures or where patients have low immune systems
and are mainly transmitted when a physician touches an HA-MRSA carrier and fails to wash
their hands (Heckel et al 2017). Research has it that the hospital-acquired MRSA in Australia
(Aus-2/3) is associated with most MRSA infections and originated from Australia after
becoming established in most Melbourne Teaching hospitals in the 1970’s. According to Kuonza
et al (2017), the first survey done by AGAR in 1985 revealed that Aus-2/3 was responsible for
25% of all S.aureus infection in most big hospitals in Sidney, Canberra, Eastern Seaboard, and
Melbourne. These revelations called for intensive efforts by the Australian Department of Health
to reduce the prevalence and address the possible risk factors.
A recent study by AGRA indicate that the Aus-2/3 may be existing in two types of clones, a
phenomenon suspected to have been the cause of an increase in the prevalence of MRSA in the
period of 2001 and 2005 especially within New South Wales, Queensland, and Victoria (Becker
et al 2018). However, studies by Guimaraes et al (2017) indicate a decline in Aus-2/3 prevalence
in the year 2009 and the decline is estimated to have continued at a rapid rate since then.
Nonetheless, Sorensen et al (2017), Naidu et al (2017) and Herrera et al (2016) acknowledge that
Aus-2/3 has largely contributed to various community-onset infections especially among patients
with a history of admission into facilities characterized by its prevalence.

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As illustrated by Sato et al (2017) in figure1 below, the decline in the prevalence of Aus-2/3 has
largely been attributed to an improvement in infection control within Australian hospitals, an
introduction of The National Hygiene Program in 2008, and the implementation of policies that
demand public reporting of MRSA infection trends in Australia. Sato et al (2017) also note that
the decline in the prevalence of Aus-2/3 has largely been boosted by the implementation of
National Safety and Quality Health Service (NSQHS) Standards which mainly advocates for
preventing and controlling infections associated with healthcare.
Fig.1: Prevalence of HA-MRSA in Australia Since 2001
Source: Sato et al (2017)
Naro et al (2018) believe that CA-MRSA had its first onset in Australia in 1980’s and has since
increased in prevalence to exceed the prevalence of HA-RMSA in Australia. In fact, according to
the author, CA-MRSA is largely believed to have rivaled HA-MRSA as the cause of hospital-

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onset infection in Australia. Part of the reason for their high prevalence is its high resistance to
antibiotics and it is estimated that this resistant is likely to increase over time (Ghaznavi-Rad et
al 2018).
Blanco et al (2017) claim that CA-RMSA was first noted in Australia in 1985 and became more
prevalent in Kimberley region in 1989. By 2004, a number of CA-RMSA clones are believed to
have gained much prevalence in Western Australia. Fast forward to 2014, CA-RMSA is believed
to have accounted for 45% of all hospital-onset infections as compared to HA-MRSA which was
at 48% (Sato et al 2017). The following figure (figure 2) illustrates AGRA’s survey of CA-
MRSA prevalence between 2001 and 2014:
Fig 2: Prevalence of CA-MRSA in Australia Since 2001
Source: Sato et al (2017)

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Risk Factors for RSMA
In the case of Mrs. Jenkins, her MRSA infection could be a HA-MRSA because she has a history
of sustaining an injury and was admitted in the hospital where her wound was dressed and
cleaned before discharge. He has now been readmitted again and the doctor has diagnosed her
with MRSA. According to Carfora et al (2016), HA-MRSA usually occurs on patients who have
recently had a hospital admission and therefore it is highly likely that Mrs. Jenkins’ earlier
admission might have exposed her to HA-MRSA.
Because both HA-MRSA and CA-MRSA occur in different settings, Mrs. Jenkins might have
been exposed to HA-MRSA as a result of three main factors namely:
 Being hospitalized
 Undergoing an invasive medical procedure, and
 Longer residence in the hospital.
Being hospitalized is a great risk factor for HA-MRSA because a hospitalized patient is highly
exposed to carriers of MRSA bacteria (Wang et al 2018). In the case of Jenkins, the physician
might have touched his wound during dressing with gloves which may have earlier been used to
handle a HA-MRSA carrier patient. Likewise, the hospital might not have been at a good
hygienic condition when Jenkins was fist admitted in the hospital. This is because according to
Bogestam et al (2018), MRSA bacteria spread rapidly in hospitals that have poor hygiene
practices. Jenkins could have also been exposed to HA-MRSA as a result of getting into contact

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with invasive medical devices especially if the physician used them during wound dressing.
According to Hongo et al (2018), invasive medical materials such as scissors, catheters, and
surgical knives provide a pathway for HA-MRSA to invade the patient’s body. The hospital
bedding could have also been a risk factor for Jenkins to contact HA-MRSA if at all she lay on
some that were not properly washed or sanitized. According to Heckel et al (2017), HA-MRSA
bacteria tend to reside on unclean or poorly kept hospital linen such as bed sheets or blankets.
Other risk factors for RMSA include keeping wounds uncovered, using other people’s personal
items such as razors, towels, clothing and sheets, keeping unclean hands especially after touching
other people’s personal objects, and lack of protective gadgets such as gloves in hospital settings.
While some of these risk factors may not relate to Jenkins’ case, being aware of them minimizes
the likeliness of getting MRSA (Askura et al 2018).
Hand hygiene and HA-MRSA
Nearly a decade ago, Ignaz Semmelweis discovered a relationship between health workers’ hand
hygiene and infections to patients. Indeed, several years after his death, a slew of evidence
(Kuonza et al 2017; Becker et al 2018; and Bogestam et al 2018) are still emerging to show that
there is an association between healthcare-associated infections and health workers’ hand
hygiene. As a result, scholars have proposed improved hand hygiene as a major prevention
remedy for HA-MRSA. In fact, while there is still no consensus among scholars over the best
control mechanism for HA-MRSA, a majority of them (e.g. Heckel et al 2017, Kuonza et al
2017, Becker et al 2018 and Bogestam et al 2018) agree that keeping hand hygiene is a

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cornerstone remedy. For instance, Pittet et al (2009) launched a quasi-experimental study to
investigate the effects of maintained hand hygiene on the infection rates of HA-MRSA. The
intervention included an increased access to alcohol hand scrubs and visual hand washing
reminders. Feedback from the hospital staff indicated an increase in hand washing compliance by
18% with a reported decrease in HA-MRSA episodes in the hospital by 0.5 incidences per 10000
patient-days. This and other studies (Hongo et al 2018, Heckel et al 2017 and Sorensen et al
2017) reveal that keeping high-level hand hygiene by washing hands with antibiotic soaps after
touching body fluids, secretions, excretions, blood or contaminated items reduce the chances of
Jenkins contracting HA-MRSA. Kuonza et al (2017) also recommend that when hands (with
gloves or not) are visibly soiled with body fluids or blood when handling the same patient,
physicians should wash them with clean water and soap to prevent cross-contamination of the
patients’ different body parts.
Standard Precautions
Apart from hand hygiene, the other standard precaution required to be maintained to prevent
HA-MRSA include gloving, eye, mouth and nose protection, gowning and proper laundry
handling. According to Hongo et al (2018), wearing non-sterile and clean gloves when a
physician is likely to handle blood or other infectious fluids such as non-intact skin (e.g. Jenkins’
wound), mucus, or contaminated intact skin is extremely important. The gloves should also be
carefully removed after handling the patient to prevent hand contamination. While handling
mucous membrane, the physician should wear protective gear such as masks, face shields,
goggles, or a combination of both; on the nose, eyes, mouth, and ears to avoid contact with

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splashed blood or infectious fluids (Wang et al 2018). According to Bogestam et al (2018), it is
also a standard precaution to wear gowns to protect the physician’s skin from contamination and
to ensure that the physician’s clothes are not contaminated by body fluids or secretions. After
dressing Jenkins’ wound, it was necessary to transport or handle his bedding/linen carefully to
avoid contamination of air or the nearby surfaces (Askura et al 2018).
Transmitted-Based Precautions
Transmitted-base precautions for HA-MRSA are categorized into droplet, airborne and contact
precautions. According to Kuonza et al (2017), contact-based precautions are normally meant to
prevent the transmission of HA-MRSA through direct or indirect contact with a carrier and may
include placing patients diagnosed with HA-MRSA in private rooms or together with other
patients with similar diagnosis. It also involves keeping the patients quarantined in their
respective rooms unless they are to be moved for a medical procedure (Wang et al 2018).
According to Hongo et al (2018), other contact-based precautions include wearing gloves before
handling the diagnosed patient and observing all the other standard precautions related to HA-
MRSA.
Droplet precautions are meant to prevent transmission from infectious agents that can drop from
the patient through sneezing or coughing. According to Bogestam et al (2018), they include
keeping the patient in surgical masks when out of the room, keeping them in private rooms
unless they are to be moved for a medical procedure, keeping patient care items such as pressure
cuffs dedicated to the patients only, and teaching the patients to cover their nose when sneezing

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or coughing. Being an old-age patient, these precautions should be implemented with care to
ensure that she does not perceive her isolation as a disregard to her health situation or age
(Sorensen et al 2017). It is also important to explain to Jenkins the importance of each procedure
to gain her best cooperation.
Role of Community Registered Nurse and occupational therapist in Jenkins’ Situation
Hongo et al (2018) write that a community registered nurse’s major role is to attend to patients
receiving health care services outside the hospital setting. In the case of Jenkins, a community
registered nurse would help meet her health needs in respect to her old age situation especially
owing to the fact that she is highly prone to forgetting to take her prescribed medication, and
maintain the required hygiene for the wound to heal faster. Typically, the nurse would be
responsible for cleaning and dress Jenkins’ wound, ensuring Jenkins maintains the oral
medication until the end of the dosage, and maintain Jenkins’ general hygiene to ensure that she
does not infect other people around her with MRSA. On the other hand, an occupational therapist
majorly offers therapy services to patients with chronic musculoskeletal illness. In the case of
Jenkins, an occupational therapist would be responsible for helping improve her performance of
daily activities such as valued daily roles, social interaction and leisure activities (Wang et al
2018). According to Bogestam et al (2018), an occupational therapist would also assist Jenkins to
adapt to life routine disruptions as a result of her wound and maintain her physiological balance
as a result of her health and age condition.

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