Infectious Disease MRSA and the Role of the Nurse Practitioner

Infectious Disease MRSA

 Methicillin-resistant Staphylococcus aureus (MRSA), is a common bacteria. About 20-40% of people carry it their noses and may carry it on their skin (Aboualizadeh et al., 2017). Studies show that about 33% people carry staph in their nose, usually without any symptoms or illness (Aboualizadeh et al., 2017). People who have MRSA on their skin can contaminate the items that they touch as well as shedding MRSA into the air, which can persist in the environment for prolonged periods of time unless removed through cleaning (Aboualizadeh et al., 2017).

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MRSA commonly colonized in warm, moist parts of the body, such as the axilla, groin, perineum, and nose. People with MRSA infection sometimes think that they have a spider bite. However, unless a spider is actually seen, then likely it is not a spider bite (Nazarko, 2014). Most MRSA skin infections appear as a bump or infected area on the skin that might be red, swollen painful, warm to the touch, full of pus or other drainage, and accompanied by a fever (Nazarko, 2014).

 If left untreated, MRSA infections can become severe and cause sepsis, a life-threatening reaction to severe infection in the body. Other strains of MRSA can produce a toxin that is responsible for toxic shock syndrome and gastro-enteritis if ingested (Nazarko, 2014). MRSA is responsible for approximately one-third of all wound infection in hospitals. MRSA infection increases length of hospital stay, increases treatment costs, and increases risk of death.

Treatments for MRSA is to remove MRSA from the skin and nostrils by using a topical antimicrobial ointment and oral antibiotics (Nazarko, 2014). The antibiotic recommended will depend on the strain and resistance of the MRSA. While undergoing treatment, it is essential that the patient also ensures that the environment is clean to prevent re-colonization and/or re-infecting the area (Nazarko, 2014). Also, many MRSA skin infections may be treated by draining the abscess or boil and may not require antibiotics.

 Prevalence rate of MRSA are based on population and geographical location. One study found a 59% overall prevalence with a range from 15% to 74% of MRSA are presented in the emergency departments in 11 major United States (U.S) cities (U.S. Department of Health & Human Services, 2019). Increases in MRSA infection rates occurs in young adults, children, Native Americans, Alaskan natives, and Pacific Islanders. The highest rates of mortality are black males over the age of 65 years old. According to Centers for Disease Control and Prevention (CDC) an estimates of 19,000 Americans died from invasive MRSA infections in 2005 (U.S. Department of Health & Human Services, 2019). Today, the increased incidence of MRSA has become a national health priority because patients seek healthcare approximately 14 million times a year for suspected MRSA infection (U.S. Department of Health & Human Services, 2019).

Determinants of Health

 MRSA first emerged in pediatric population in the 1990s and the incidence of pediatric ambulatory has nearly tripled (Aboualizadeh et al., 2017). Close contact with people who have been infected with MRSA increases the population risk for MRSA infection. Therefore, implementing personal protective equipment (PPE) is important to prevent the spread of MRSA. Several published reports have documented MRSA outbreaks among military, religious, and sport communities (Robinson, Edgley, & Morrell, 2014).

 Carpeted floors were identified as the surface with the highest incidence of MRSA infection in an athletic facility, and crowding and poor hygiene in community settings contribute to the spread of MRSA infection (Aboualizadeh et al., 2017). Removing carpet floor and applying hard floor will makes it easier to disinfect work environment. Overcrowded environment are more likely to transmit MRSA, it is estimated that 85% occupancy is best, as this allows staff sufficient time and space to ensure the environment is clean and procedures are adhered (Aboualizadeh et al., 2017). MRSA poses a much greater risk in hospitals, where there are large numbers of invasive devices and where operations are being carried out (Aboualizadeh et al., 2017). Furthermore, each time a member of staff attends to a patient, they should wash their hands with liquid soap and water.

Host Factors

 MRSA is a non-spore forming and gram-positive cocci agent that appear as golden tinged clusters when seen under a microscope (Nazarko, 2014). Older people are at greater host of developing MRSA than younger people because they have impaired immune systems. People who are colonized with MRSA are at risk of developing an MRSA infection because the individual has MRSA bacteria on his or her skin (Nazarko, 2014). Hospital treatments, including intravenous infusions, urinary catheterization and surgery, all provide a ‘portal of entry’ and enable bacteria that have been sitting harmlessly on the person’s skin to enter the body and cause a potentially life-threatening infection (Nazarko, 2014).

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 MRSA is rarely spread by airborne transmission. There is little evidence to suggest that nasal carriers of MRSA transmit disease. MRSA is normally spread from patient to patient on the hands of nursing and medical staff. MRSA can remains on the hands from minutes to hours. Overcrowded and understaffed healthcare environments are more likely to lead to infection control breaches and transmission of MRSA (Nazarko, 2014). To break the chain of infection and prevent the spread of MRSA is hand washing.

Role of FNP

 According to American Association of Nurse Practitioner (AANP), the role of the primary care nurse practitioner is to provide healthcare to patients of all ages and walks of life (American Association of Nurse Practitioners (AANP), 2019). Nurse practitioners (NPs) assess patients, order and interpret diagnostic tests, make diagnoses and initiate, and manage treatment plans including prescribing medications (AANP, 2019). NPs role in management of infectious disease is to understand the different stages allows for a better understanding of the approach to the prevention and control of disease (Robinson, Edgley, & Morrell, 2014). NPs use the population-based models as it related to evidence-based practice to focuses on populations as risk, analysis of aggregate data, evaluation of demographic factors, and public health through the use of population health sciences of clinical practice (Robinson et al., 2014). Finally, NPs play an increasingly important role in evaluating the quality and effectiveness of healthcare delivery such as reduce the cost of care and improve the patient’s experience of their healthcare.

References

• Aboualizadeh, E., Bumah, V. V., Masson-Meyers, D. S., Eells, J. T., Hirschmugl, C. J., & Enwemeka, C. S. (2017). Understanding the antimicrobial activity of selected disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). Plos One, 12(10), e0186375. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186375.
• American Association of Nurse Practitioners. (2019). All about nurse practitioners. Retrieved from https://www.aanp.org/about/all-about-nps.
• Nazarko, L. (2014). Methicillin-resistant Staphylococcus aureus (MRSA): A guide to prevention and treatment. British Journal of Healthcare Assistants, 8(8), 377–383. Retrieved from https://www.magonlinelibrary.com/doi/abs/10.12968/bjha.2014.8.8.377.
• Robinson, J., Edgley, A., & Morrell, J. (2014). MRSA care in the community: Why patient education matters. British Journal of Community Nursing, 19(9), 436–441. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25184897.
• U.S. Department of Health & Human Services. (2019). Center of disease control and prevention: Methicillin-resistant Staphylococcus aureus. Retrieved from https://www.cdc.gov/mrsa/community/index.html.