MRSA - Preventing Methicillin-Resistant Staph Infections in Healthcare and the Community

Methicillin resistant staphylococcus aureus (MRSA) infection – sometimes referred to as a ‘staph infection’, or ‘golden staph’ – is when a strain of S aureus has developed a resistance to certain antibiotics.

Though commonly associated with healthcare acquired infections (HAIs), MRSA is not only confined to hospital and healthcare settings, but can also exist in ‘community-acquired’ forms (CaMRSA).

CaMRSA can lead to:

• Skin infections (e.g. impetigo)
• Abscesses
• Cellulitis
• Blood infections
• Bone infections
• Lung infections
• And more infected sites

The NSW Government (2012) highlight that anyone may acquire, in particular, skin infections, from CaMRSA, but the main people at risk are those with health conditions such as diabetes, low immunity or broken skin.

MRSA Causes

There is a need to promote hygiene to prevent the spread of CaMRSA, as common modes of transmission (NSW Government, 2012) can involve:

• Contact with open wounds
• Poor hand hygiene practices
• Contact with items utilised by the infected person (e.g. bed linen)

Department of Health (n. d.) highlights that intravenous (IV) catheters can also be a portal of entry for bacteria to get into the bloodstream. Nurses and healthcare staff need to pay attention to signs such as:

• ‘high fever, shaking, and low blood pressure’ for blood infection (which can be life-threatening);
  and, ‘redness, swelling, pain, heat, the presence of pus’ for skin infections (Department of Health, n. d.).

Lopez-Alcalde et al (2015) completed a study into MRSA in the hospital setting and similarly found that there was not enough evidence surrounding MRSA transmission in the hospital setting in relation to glove, gown and mask use.

The study did, however, highlight from its background/summary that in hospitals, MRSA is namely spread by health workers (Lopez-Alcalde et al, 2015).

This can occur due to the worker (e.g. their hands, clothing, equipment etc) becoming contaminated by the infected person being cared for, and then the worker coming into contact with other clients and their environments (Lopez-Alcalde et al, 2015).

MRSA Prevention

In the prevention of MRSA, nurses and healthcare professionals have a responsibility to:

• Inform the Department of Health of diagnoses of MRSA, as it is a notifiable disease
• Implement strategies to prevent the spread of disease
• Educate clients and their families about the infection and how to prevent its spread
• Demonstrate correct hand washing techniques
• Liaise with the infection control team/specialist(s) for the facility/organisation
• Refer clients to the doctor for follow up
• Document thoroughly
• Follow MRSA policies and procedures adequately, such as screening, swabbing, assessment, intervention and treatment.

(Department of Health n. d.)

Nurses and other healthcare workers may be able to contribute to the prevention of CaMRSA via the implementation of health education for at-risk clients in particular, but also general community members.

Education could involve prevention strategies such as:

• Teaching the five moments of hand hygiene
• Teaching correct handwashing techniques which lasts for at least 10 to 15 seconds
• Covering wounds appropriately
• Not sharing personal equipment
• Correct coughing techniques
• Encouraging community members of all ages to remain home if unwell, and to seek medical attention if concerns arise
• Encouraging community members to clean surfaces daily with detergent
• Educating clients not to go into pools, spas, saunas etc if they have open wounds or infected skin
• ‘People who have skin infections or open wounds that cannot be kept covered should not participate in contact sports until the wound has healed or drainage can be contained’

(NSW Government, 2012)

Hughes, Tunney and Bradley (2013) highlighted that hospital practices such as isolation can be difficult at times, for example within aged care residential facilities.

Hughes et al. concluded in their systematic review that nursing homes could consider screening clients at risk of MRSA. This could involve swabbing clients that have been transferred from a hospital setting.

The review also raised a practical point that key educators within facilities should be properly trained and educated regarding control and prevention of infections, as well as hand hygiene and thorough cleaning/decontamination processes. It was concluded by Hughes et al (2013) that increased research into MRSA practices in nursing home settings is necessary.

Gurusamy et a.l state in their 2013 study that it is ‘not clear whether antibiotics should be used in MRSA colonised non-surgical wounds’.

Their study aimed to investigate this question, but there were no trials comparing antibiotic use to no antibiotic use for participants with ‘MRSA-colonised non-surgical wounds’ (Gurusamy et al, 2013). This study highlighted another needed area for MRSA research; this being the identification of best practice for non-surgical wounds that have MRSA (Gurusamy et al, 2013).

Further Research

For any healthcare professionals interested in conducting further research into MRSA prevention, Hughes et al. (2013) convey that ‘future studies could also be designed which examine a specific component of infection prevention and control in the nursing home setting, e.g. hand hygiene or isolation procedures versus usual care or a comprehensive infection prevention and control strategy.’

Their study further recommended that any researcher interested in this field look into the original study as well as other high-quality systematic reviews to note exact research needs on MRSA and CaMRSA.

References

• Governmenet if Western Australia n. d., MRSA, Department of Health, WA Gov, viewed 16 February 2018, http://healthywa.wa.gov.au/Articles/J_M/MRSA
• Gurusamy, KS, Koti, R, Toon, CD, Wilson, P & Davidson, BR 2013, ‘Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) in non surgical wounds’, Cochrane Database of Systematic Reviews, no. 11, viewed 16 February 2018, https://www.ncbi.nlm.nih.gov/pubmed/24242704
• Hughes, C, Tunney, M & Bradley, MC 2013, ‘Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people, Cochrane Database of Systematic Reviews, no. 11, viewed 16 February 2018, http://www.cochrane.org/CD006354/WOUNDS_infection-control-strategies-for-preventing-the-spread-of-meticillin-resistant-staphylococcus-aureus-mrsa-in-nursing-homes-for-older-people
• López-Alcalde, J, Mateos-Mazón, M, Guevara M, Conterno, LO, Solà, I, Cabir Nunes, S & Bonfill Cosp, X 2015, ‘Gloves, gowns and masks for reducing the transmission of meticillin-resistant Staphylococcus aureus (MRSA)’, Cochrane Database of Systematic Reviews, no. 7, viewed 16 February 2018, http://www.cochrane.org/CD007087/WOUNDS_use-gloves-gown-or-mask-contact-hospitalised-patients-staphylococcus-aureus-resistant-common
• New South Wales Government 2012, Methicillin resistant Staphylococcus aureus (MRSA) in the community: Information for the public, NSW Health, viewed 16 February 2018, http://www.health.nsw.gov.au/Infectious/factsheets/Pages/methicillin-resistant.aspx