Hand hygiene has been stated as the one main element that can prevent the spread of MRSA (Gould 2002). Washing hands is not kid’s stuff – not in the era of MRSA. Once entrenched MRSA can be extremely difficult to treat. If it gets into the blood stream it can be lethal (Belkum, Verbrugh 2001). Simor and Andrew (2001) also emphasise that hand washing is the most important control practice. It is essential because personal contact is the primary mode of MRSA transmission.
Therefore good hand washing technique is vital to ensure that the decontamination is effective, as no soap will be effective if the technique is poor. Rayner (2003) affirms this by stating that appropriate hand washing effectively removes transient organisms, which prevents MRSA transmission. It is clear that there are many advantages and disadvantages to the process of hand hygiene, and procedures and protocols should be in place to minimise the disadvantages but in practice these are not always implemented or are hindered in some way.
Personal experience has shown that there are barriers to hand hygiene, whilst working on a surgical ward within a general hospital. As this ward was surgical the importance of hand hygiene needed emphasis due to the number of recently operated on patients and also the high prevalence of MRSA that was already on the ward. From the moment of starting it was iterated the importance of ensuring that MRSA did not spread, especially to the patients that had recently had surgery. Although it is hard to follow procedure if the materials are not available to carry it out to the best of the staffs’ ability.
Also it is very easy to forget especially in such a busy ward about hand hygiene but everyone must be vigilant in ensuring that it is not a regular occurrence. Another means of prevention is the use of protective clothing. Gloves and aprons are considered protective equipment according to Pellowe et al (2004). Gloves should be worn for any contact with a wound, sore, invasive site or mucous membrane of a patient. It is also important to wear them when there is a risk of contamination from any bodily fluids. This should be done for any patients, regardless of MRSA status.
Also, aprons should be worn if extensive soiling is likely or if the patient is colonised or infected with MRSA. This preventative measure should be worn to enhance the effect of hand washing and give added protection and should not be used instead of hand washing. Gloves and aprons are for single use only and require careful disposal when the wearer has been in contact with MRSA. Although fomites (bed linens, towels, dishes) and environmental surfaces have not been implicated as vectors in the transmission of MRSA it has been shown that the spread of MRSA can be greatly reduced by overall environmental hygiene.
It is important to ensure all horizontal surfaces are damp dusted to remove any bacteria from infected skin cells falling as dust (O’Connell, Humphreys 2000). A recent study carried out by the Infection Control Nurses Association (INCA 2003) has shown that improving the wards cleanliness can reduce infections. This was because regular cleaning removes the contaminants and prevents the build up of colonising bacteria on the hospital surfaces, thus reducing the risks of cross – infection. Another major control factor in the spread of MRSA is caring for someone in isolation.
The objective of isolation is to minimise the risk of micro – organisms from the affected person being transferred to others (Wilson 1999). The Centre for Disease Control and Prevention (CDC) reaffirm the above objective by recommending that patients who are colonised or infected with MRSA be physically isolated in a single room – separation can minimise close contact, thus eliminating transmission of MRSA between patients, and nurses tend to wash their hand more when caring for patients who are in private rooms because they have to leave one room before going to care for another room.
If more than one person is infected with the same organism, then they can be nursed together in the same ward. This is called “cohorting” and can be a useful approach for managing outbreaks. It can also reduce the feelings of isolation yet promote nursing care. The most important type of isolation required for MRSA is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient.
In addition the patients notes should be clearly labelled “MRSA” so that this type of accommodation is provided if and when they are admitted to hospital in the future. As well as infection control effective communication is essential in the effort to control and contain the spread of MRSA. The key element in communication is education about MRSA: its’ epidemiology, treatment and control measures. Anxiety about MRSA is often based on ignorance about the risks of infection and the precautions to prevent transmission.
Nurses can do a great deal to allay fears by communicating effectively without breaking confidentiality. For example: nurses should provide information leaflets for patients, visitors and staff; provide notices which describe the precautions needed; talk to the patients about how they can help themselves; and ensure all staff understand the actions they need to take. Conclusion In conclusion, the importance of control and prevention in the spread of MRSA cannot be emphasised enough. MRSA clearly warrants the name “super bug” as it has become a major problem in hospitals throughout Ireland.
Due to the overuse of antibiotics over many years this bacteria has evolved to be resistant to Methicillin – which is a benchmark antibiotic (Simor, Andrew 2001). Antibiotics which deal effectively with this bug are now limited. Thus, the government has been trying to tackle the issue through a range of policy initiatives. Hand hygiene is been promoted because it is widely accepted that most cross-infection takes place via the hands, and hand washing is the most effective and cost-effective means of prevention (Pittet et al 2000).
As nurses account for 80 percent of a patient’s contact with a healthcare professional, it is imperative that proper hand washing techniques are carried out. The environment is not thought to play an important role in the transmission of this bacterium. However, objects in the healthcare environment are frequently heavily contaminated and handled by healthcare workers, so this may not be the case, especially when standards of cleaning are not high. Adherence to the isolation protocol dramatically reduces the rate of transmission.
Following hand hygiene and infection control procedures, some of which mentioned in this essay, will reduce the chance of cross-contamination. Also the continued education of both patients and staff in the area of infection control will aid in the effort to stop the spread of this bacteria. References A Strategy for the Control and Antimicrobial Resistance in Ireland (SARI) (2005) The control and prevention of MRSA in hospitals and in the community Health Protective Surveillance Centre: Dublin Belkum, A. V. , Verbrugh, H. 2001) 40 years of MRSA British Medical Journal (International edition) Vol 323 (7314) pp. 644-646 Centre for Disease Control and Prevention (CDC) (2002) Department of Health and Human Services Gould, D. (2000) Hand decontamination Nursing Standard Vol 15 (6) pp. 45-53 Huskins, W. C. , Goldmann, D. A. (2005) Controlling MRSA, aka “super bug” The Lancet Vol 365 (9456) pp. 273-276 Infection Control Nurses Association (2003) Infection control guidance for general practise Bathgate: INCA O’Connell, N. H. , Humphreys, H. 2000) Intensive care unit design and environmental factors in the acquisition of infection Journal of Hospital Infection Vol 45 (4) pp. 255-262 Ott, M. , Shen, J. , Sherwood, S. (2005) Evidence based practise for control of MRSA AORN Journal Vol 81 (2) pp. 361-374 Pellowe, C. , Pratt, R. , Loveday, H. , Harper, P. , Robinson, N. , Jones, S. (2004) The epic project: updating the evidence base for national evidence based guidelines for preventing healthcare associated infections in NHS hospitals in England: a report with recommendations British Journal of Infection Control Vol 15 (6) pp. 0-16 Pittet, D. , Huyonnet, S. , Harbarth, S. , et al (2000) Effectiveness of a hospital – wide programme improve compliance with hand hygiene The Lancet Vol 356 (9238) pp. 1301-1312 Rayner, D. (2003) MRSA: An infection control overview Nursing Standard Vol 17 (1) pp. 47-53 Simor, M. D. , Andrew, E. (2001) Containing Methicillin Resistance Staphylococcus Aureus; Surveillance, control and treatment methods Postgraduate Medicine Vol 110 (4) pp. 43 Wilson, J. (2001) Infection Control in Clinical Practise (2nd ed. ) Edinburgh: Bailliere Tindall