MRSA In Hospitals And Long Term Care Facilities by Lisa Winterstien     MRSA is a serious bacterial infection that many medical personnel may be unaware of. It has been a long-standing problem for medical facilities and the patient's within. The bacterium is extremely easy to spread among patients and caregivers if proper aseptic technique is not performed. The infection itself is very difficult to eradicate due to its ability to constantly form resistances to new antibiotics. Bringing attention to MRSA and increasing awareness of this bacterial threat will encourage medical professionals to seek further education and put concrete knowledge to practical application. Identification of Threat     Methicillin-Resistant Staphylococcus Aureus (MRSA) is a bacterial infection that resists most usual antibiotics such as nafcillin, oxacillin, imipenem and cephalosporins, but most notably methicillin. It is also becoming an important cause of nosocomial infection in hospitals and long-term care facilities (McNeil, Mody, and Bradley, 2002). As of recently Vancomycin has been used to eradicate MRSA, but there have been findings of Vancomycin-Resistant Staphylococcus Aureus (VRSA) infections that are also becoming treatment challenges (Akron General Medical Center, 2003). The battle to eradicate MRSA is always ongoing because of its ability to produce resistances to antibiotics that have been implemented for treatment.     MRSA infection is generally acquired through caregiver contact with the patient and lack of proper hand washing afterwards. The most common sites for MRSA to colonize have been isolated to urinary catheters, gastrostomy tubes and nasal passages (Capriotti, 2003). These are all areas that are open to infection in any healthcare setting. Persons most susceptible to this bacterium are the elderly or persons that have endured a prolonged hospital stay. The elderly often suffer from MRSA due to the deterioration of their immunity function and/or long-term antibiotic administration (Tada, Watanabe, Yokoe, Hanada, and Tanzawa, 2002). According to an article in Geriatrics (2002), residents of long term care facilities who are colonized with MRSA often carry the same strain of MRSA from three months up to three years. Although difficult to treat, it is easy to prevent the spread of infection just by caregivers simply washing their hands thoroughly. Significance of MRSA to Nursing Education     Nursing assistants may not be well educated on the various bacteria that they are exposed to in a medical setting. The potential lack of knowledge poses a risk to the patient they care for as well as people that they come in contact with. Education on various bacterial infections should be required for all medical professionals and nursing assistants in order to be employed in a nursing facility. Staff could be in contact with the dangerous bacteria and not even know what risks they are posing to the residents that reside in the facility.     There are some simple avenues to facilitate education in the medical profession. When a facility conducts in-services for their medical professionals, the supervisor should take that time to either educate the employees on existing bacteria and/or the latest bacteria that pose a threat to their patients and themselves. Use of signs in bathrooms reminding employees of proper hand washing are already being implemented, however, the results have been less than acceptable.     Infection control teams have been implemented in facilities with MRSA concerns. These teams are there to have a visible presence on wards and be available if staff should need information in regards to patient care (Myatt et al., 2003). The major importance of infection control units is the availability offered to patients or staff members in understanding infection control, what MRSA is, and associated health risks. Significance of MRSA in Nursing Practice     It has been identified that the major cause of MRSA transmission is through patient-to-patient contact by caregivers without proper hand washing. Studies show that hand washing performed by medical professionals is tends to be inadequate for aseptic technique. Multiple reasons for improper hand washing include the lack of facilities and time (Capriotti, 2003). Medical facilities should supply alcohol-based hand rubs for the nurses to use between patients to ensure that asepsis is achieved. A handful size of the alcohol foam rubbed on caregiver's hands for thirty seconds is accepted as good asepsis. Hand rubs are often just as good as hand washing as long as the hands are not visibly soiled. Compliance with this method of asepsis is perhaps tolerated because it is convenient to use while traveling from patient to patient.     Long-term care facilities have implemented policies that prohibit admission of patient's known to be colonized with MRSA (McNeil et al., 2002). Such policies are not recommended as they impose hardships on both staff and residents. However, it has been found that other methods such as isolating the resident under strict contact isolation precautions seem to facilitate both the needs of the staff and the resident. Studies have shown that most MRSA infections occur more than 72 hours following admission (Myatt and Langley, 2003). With this in mind, nurses could screen potential residents for MRSA and place them in isolation rooms promptly to reduce the risk of infecting others. Surveillance should also be included as a measure for nurses to implement maintenance of those known to be colonized with MRSA. A list of residents who are colonized or infected with the bacterium could assist the nurses in keeping track of the spread of infection.     Furthermore, a patient that is infected with MRSA requires a higher intensity of care than usual thus creating higher demands for nursing staff. In a study that measured the cost effect of managing MRSA in long term care facilities; it was found that the cost associated with MRSA in the United States has been estimated to be from $100 million to $30 billion (Capitano, Lesham, Nightingale and Nicolau, 2003). The cost is generally from consumption of resources required to treat the patient, but it also costs more to pay for help from the nursing personnel. The infection itself creates a higher demand for nurses to treat the patient with closer attention, and increases jobs for professionals and assistants alike.     Unfortunately, with the higher demand for nursing assistance, the infection of healthcare providers pose a threat to their job. In some cases, some healthcare providers that have been implicated in the transmission of MRSA to infected residents are removed from duty until cleared of the infection (McNeil et al., 2002). Significance of MRSA to Nursing Research     MRSA has spawned a number of research studies ranging from the cost of treatment to the numerous infection control measures neglected by professionals that could have prevented the infection. Continued research is necessary to find a permanent antibiotic that neither the bacteria can form a resistance to, nor for the antibiotic to develop resistances to other bacteria. MRSA has been an ongoing study because of its amazing ability to form new resistances to antibiotics. Nurses need the available research to assist in proper care of infected individuals. The bacterium will continue to be an enigmatic infection that will challenge nursing research for years to come. Personal Views     As a medical professional, I have been in contact with elderly clients infected with MRSA. I found that my own knowledge on MRSA and other types of staphylococcal infection was limited. When researching this topic, I have become increasingly aware of MRSA and how to prevent the spread of infection.     Proper asepsis is a subject that I wish to discuss with the administration where I work. It would please me to see that my co-workers are adequately educated on this bacterium because of its existence in our facility. I have not come across a nursing assistant yet that is familiar with what MRSA is and its potential health risks. I will take it upon myself to push for education on MRSA within the medical precinct and those within the community because there is not one person that is incapable of being infected with this dreadful bacterium. Conclusion     MRSA is a devastating bacterium that is significant to nursing education, practice and research. It is important to educate the community, your peers, and other medical professionals of the threats MRSA poses on the health of hospital patients, the elderly, and caregivers who assist clients with daily activities. Medical facilities should also consider the use of anti-microbial hand gels to assist in proper asepsis. Encouraging participation in the treatment and research of MRSA is a goal that each person should strive to achieve. References Akron General Medical Center. (2003). MRSA Fact Sheet: Health Tips From Akron General's Patient Education Department. Retrieved Sept 9, 2003 from the World Wide Web: http://www.agmc.org/patiented/pt-mrsa.asp Capitano, B., Lesham, OA., Nightingale, CH., Nicolau, DP. (2003). Cost Effect of Managing Methicillin-Resistant Staphylococcus Aureus in a Long-Term Care Facility (Vol. 51 pp. 10-16). Hartford, CT: Department of Pharmacy Research. Capriotti, T. (2003). Preventing Nosocomial Spread of MRSA is in Your Hands. In MEDSBURG Nursing, 12, 193-196. McNeil, SA., Mody, L., Bradley, SF. (2002). Management of asymptomatic colonization and outbreaks of infection in long-term care. Geriatrics, 57, 16-27. Tada, A., Watanabe, T., Yokoe, H., Hanada, N., Tanzawa, H. Oral bacteria influenced by the functional status of the elderly people and the type and quality of facilities for the bedridden. Journal of Applied Microbiology, 93, 487-491.