Evidenced-based practice for control of methicillin-resistant Staphylococcus aureus

AORN Journal,  Feb, 2005  

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The article "Evidenced-based practice for control of methicillin-resistant Staphylococcus aureus" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is February 29, 2008.

Complete the examination answer sheet and learner evaluation found on pages 377-378 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on methicillin-resistant Staphylococcus aureus, nurses will be able to

1. describe the manifestations of a Staphylococcus aureus infection;

2. explain how antibiotics are misused, resulting in an increase in antibiotic resistance; and

3. identify methods to manage personnel who are carriers of methicillin-resistant Staphylococcus aureus.

The incidence of antibiotic-resistant infective agents is increasing among health care providers and patients in acute care facilities. (1,2) One strain of Staphylococcus aureus, (ie, methicillin-resistant Staphylococcus aureus [MRSA]), is resistant to methicillin, oxacillin, nafcillin, cephalosporin, and other beta-lactam antibiotics. (3) Outbreaks of MRSA are occurring worldwide. (4) In the United States and Europe, the prevalence of MRSA was less than 3% in the early 1980s but rose as high as 40% in the 1990s. (5) In Canada, the first case of MRSA was reported in Ontario in 1981, and since then, outbreaks have been reported throughout Canada. (5) Although the overall rates of MRSA are lower in Canada than those reported in the United States, its prevalence is increasing substantially. (1)

Many outbreaks of infection in hospitals have been caused by MRSA, so MRSA infections have become a primary concern for many health care institutions. (5) The clinical manifestations of a Staphylococcus aureus infection include, but are not limited to,

* abscesses,

* endocarditis,

* osteomyelitis,

* postoperative pneumonia, and

* skin and surgical wound infections. (6,7)

Infections caused by MRSA can cause severe morbidity and mortality (8) and have become a significant global health issue with serious consequences for all areas of hospitals, especially the OR, postanesthesia care unit (PACU), and medical-surgical floors. (4) The consequences to patients are pain, discomfort, distress, and risk of death. Prolonged hospital stays may lead to loss of income, recovery delays, isolation, and increased medication costs. The consequences to health care facilities are additional costs associated with

* increased medication costs,

* increased staffing,

* more frequently used laboratory services,

* need for special isolation procedures, and

* prolonged hospital stays. (3,5)

SIGNIFICANCE TO NURSING PRACTICE

The chief reservoirs of MRSA are infected or colonized patients; (9) however, health care providers also can act as reservoirs for MRSA and can harbor the microorganisms for many months. (9) Transmission of MRSA occurs primarily via the contaminated hands of health care workers who do not follow appropriate infection control measures. (10) Nurses' hands frequently become colonized with MRSA from

* patients who are colonized or infected;

* their own colonized or infected body sites; or

* equipment, patient care items, or environmental surfaces contaminated with body fluids that contain MRSA. (3,8,99)

The College of Nurses of Ontario (CNO) provides specific guidelines for general infection control practices, which include hand washing, use of protective barriers, care of equipment, and health practices of nurses. (11) The CNO states,

   Infection control is integral to safe
   nursing practice. Nurses should be
   aware of the potential for transmission
   of infection in their practice setting
   and take all measures necessary
   to practice." (11) (p3)

The Centers for Disease Control and Prevention (CDC) has established standard and contact precautions that clearly define methods to help control the spread of MRSA (Table 1). (9)

RATIONALE AND EVIDENCE

The CNO emphasizes that "hand washing is the single most important infection control practice." (11) (p10) Hand washing is essential because personal contact is the primary mode of MRSA transmission. (6) Appropriate hand washing effectively removes transient organisms, which prevents MRSA transmission. (6,12) Several research studies have found that hand hygiene is an effective method of controlling MRSA infection.