Kim Reisma's Policy Paper

Policy on Preventing Methicillin-resistant Staphylococcus Aureus in Healthcare Facilities
When some children were asked what one of their biggest concerns or fears were before being admitted to a hospital a popular response was the fear of contracting a healthcare-associated infection like Methicillin-resistant Staphylococcus aureus(2). Methicillin-resistant Staphylococcus aureus (MRSA) has become a growing problem in hospitals and healthcare facilities. In 2005, there were 94,360 cases of MRSA; 18,650 of them were fatal (1). Since the bacteria are resistant against the usual antibiotics, it can be very difficult to treat a patient once they are infected so the best thing that healthcare workers can do is prevent the invasion.
Carriers, people have the infection but do not have any signs or symptoms, spread the infection to people that have an open wound or sore and do not even know it. This is why it is hard to detect if a patient has MRSA without a screening since many people do not know they are carrying and infectious disease around on them. Healthcare workers are in constant contact with individuals, and can very likely transport the MRSA from a carrier to a person with an open wound and may never know it. Healthcare workers themselves are at potential risk of being a carrier (4). One way to prevent the transmission of MRSA from healthcare worker to patient is not only washing hands, but also screening healthcare workers annually (5).
Northern European countries are taking extreme precautions to keep their numbers of hospital infections low. One of their steps to prevent infections is the use of surveillance cultures to detect if a patient is a carrier. The patients are kept in isolation units until the facilities have received a negative culture back from the laboratory (6).

I. Policy
1. Doctors at Mercy Medical Center in Sioux City, Iowa must collect a specimen from patients’ nose during a pre-surgery visit or 48-hours prior to the scheduled surgery. This will give the laboratory enough time to grow the Staphylococcus aureus to determine if the patient is a carrier of MRSA bacteria. The knowledge of knowing who is a carrier will help healthcare workers by isolating the patients who are carriers to prevent the spread to other patients. It also will allow healthcare workers to take special precautions when dealing with the patient.

2. Hospitals must use prophylaxis on patients who are having emergency surgery. This will help to reduce the chances of the patient acquiring a staphylococcus aureus infection.

3. Annual screenings should be done on all employees in contact with the patients, doctors and nurses. This would include secretaries, janitors, and anyone else who may be in contact with nurses, doctors, or patients who could potentially spread the infection.
Screening each surgical patient does come with a cost; however, the cost of an MRSA kit is exceedingly lower than the cost of a night in hospital bed. The MRSA kits costs approximately $10 (7) whereas the average cost for a night in the hospital costs $420 (8). Patients who have the Staphylococcus aureus infection must stay in the hospital longer and must be put on special medications to try to kill the infection. Therefore, patients will be more likely to pay the $10 to figure out if they, or other patients are carrying MRSA than to pay for extra days to stay in a hospital.
A single measure cannot get rid of the infections, but if healthcare workers continue to wash hands between patients and procedures, practice infection control, get up-to-date education, and take preventive steps MRSA infections will decrease (3).

1. “Fact Sheet: Invasive MRSA.”Journal of American Medical Association 2007: 298(15):1763-1711.< http://www.cdc.gov/ncidod/dhqp/ar_mrsa_Invasive_FS.html> . 22 September 2008.
2. Glasper, A. “Tackling Infection: optimizing the hygiene environment.” British Journal of Nursing.< http://web.ebscohost.com/ehost/pdf?vid=12&hid=7&sid=2eb6fd98-544e-45ff-9475-231f81662b9f%40sessionmgr9> 22 September 2008.
3. Kohlway, E. “Progress made against MRSA but more measures needed.” Nation’s Health.< http://web.ebscohost.com/ehost/pdf?vid=5&hid=8&sid=e470d74d-b877-4624-bb3f-5f37e640e312%40sessionmgr9>22 September 2008.
4. Mullinga, M., Murray-Leisure, K., Ribner, B., et al. “Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management.” American Journal of Medicine.
5. Voss, A., “Preventing the spread of MRSA” <http://www.bmj.com/cgi/content/full/329/7465/521> 23 September 2008.
6. Muto, A., Jernigan, J., et al. “SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus.” Chicago Journals.< http://www.journals.uchicago.edu/doi/abs/10.1086/502213>. 27 September 2008.
7. Fisher Health Care <http://www.fishersci.com/wps/portal/PRODUCTDETAIL?LBCID=94648567&href=&aid=112906> 2 October 2008
8. National Center for Policy Analysis <http://www.ncpa.org/sub/dpd/?Article_ID=9413&page=article> 2 October 2008

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License