Delivery in day(s): 4
Infection Control Case Study OZ Assignments
Methicillin Resistant Staphylococcus Aureus (MRSA) infections is a microorganisms based infection which is caused by bacteria. According to National Health Care Safety Network (NHSN), Staphylococcus aureus (SAB) is consider to be a ordinary reason for infections like infections caused in surgery and happening of pneumonia in ventilation which is usually treated by having some antibiotics but when this infection starts adjusting to antibiotics and become resistant to some frequently used antibiotics then SAB caused by Methicillin resistance occurred known as MRSA. It was first acknowledged in 1961 and got spread by touching someone having it even by touching some surgical equipment which has bacteria on it. These infections mostly attack people with low immunity and are visiting to hospitals, clinics etc (Rodvold, and McConeghy, 2014).
Now, this case study is about Mr Bowditch who has ulcer in his right lower leg. He got discharged after stitching the wound but later he was readmitted because he was suffering from wound infection and MRSA infection is also recognized by pathology department due to which now he is being treated by medical practitioner. This study will focus lights on causes of having MRSA, risk factors of it, infection control methods, maintaining of hygiene etc.
Mrsa Infection In Australia
As stated by the President of Australian Society for Antimicrobials (ASA), Graeme Nimmo, Australian clinical practise rulebook is needs to be created for treating and controlling of increasing incidence of MRSA in Australia. It is a nationalized distress and all the committee members are required to be informed of it.
Almost in every state and region of Australia maximum scale set is 2 SAB cases (counting MRSA & MSSA) for each 10,000 days of patient’s treatment as data collected from AIHW - Australia Institute of Health and Welfare.
Total numbers of cases being recorded in 2013-2014 were 1621 which is 0.87 cases for each 10,000 days of patient’s treatment which is lower than previous recording of 1.10 cases out of which 76 per cent cases are of MSSA (Methicillin sensitive SAB) but these cases are less than their national criterion. There is a total decrease of 14 per cent in SAB cases from the number of 1876 cases to 1621 cases in 2013-2014. Out of which MRSA cases jump lower to 389 from previous 589 cases as shown in figure below:
As per Australian Hospital Statistical data: SAB in Australia public hospitals in 2013-14
Infections obtained in hospital, other clinical buildings are generally termed as Hospital acquired infections. MRSA can be categorised in two as community wise spreading and hospital, other clinical facilities wise spreading. Mainly it is categorised on the basis of mode of spreading. Patients having CaMRSA infection have less risk factor than person with HaMRSA infection. HaMRSA caused by when person comes in touch with hospital equipments such as surgical objects; gloves etc in fact by touching infected person without maintaining hygiene while CaMRSA occurred by forming of colonies of bacteria i.e. linkage of cloned groups or by colonization. CaMRSA infections cause more severe effects than HaMRSA and this is due to the presence of PVL & PSM toxins (Hsiao, et. al, 2015).
Risk Factors Make Person Susceptible To Mrsa
MRSA infection is a transmittable infection. Risk factors for having this infection are as follows:
1.Come in contact with hospital equipments without washing hand properly.
2.Making skin contact with crowd especially in health care buildings.
3.Highly consumption of antibiotics.
4.Person with Low immunity are more vulnerable to have infection whenever they visit to hospitals, clinics etc
5.By sharing personal items to others increases the chances of getting infection.
6.Be in limited space with crowd can lead to infections because of skin contact with person having MRSA bacteria on their skin.
7.Open wound are more susceptible to have MRSA.
8.Transmitted through hands of doctors, nurses, visitors. When doctor treat patients without sterilizing their hands then infection get transmitted.
Mr Bowditch diagnosed positive with MRSA because of anyone of these risk factors.
In Relation To Mr Bowditch
Strategy for the control of Antimicrobial resistance in Ireland (SARI) has published some guidelines for maintaining hand hygiene because there are many causes responsible for spreading MRSA but transmitting through hand is common. In case of Mr Bowditch it can be transmitted through skin contact therefore hygiene should be maintained properly while performing diagnosis and health hospital environment should be maintained. Doctors, nurses or other health care staff related with treatment of MRSA should wash hand properly with sanitizers, soap etc after every treatment as well as after touching any medical equipment like surgical gloves, tools, towels etc. Apart from maintaining hygiene with hospital equipments hospital rooms should also be properly cleaned. Medicated napkins should be placed near bed of patient so that person treating patient can use it (Azim, et. al, 2016).
Mr Bowditch infection can be controlled by using some of these steps like covering his wounds and keep changing bandage when they get dirty. Preventing infection from spreading is essential to other healthy persons. First important step to control infection is to maintain hand hygiene. It is very important to wash hand before touching patient and washes hand after treating patient or even after touching any object present in patient room, hospital equipments. There is always a risk of cross contamination in hospital therefore Mr Bowditch should be kept in isolated room. Another reason for keeping patient in separate room is to minimize the working pressure on nurses or hospital staff because if patient will be treated with other patient and number of nurses are less as per requirement then this could lead to create more pressure on staff resulting in decrease working efficiency of nurses.
Defensive clothing should be used when treating patient such as gloves should be wore when entering patient room as well as whenever there is a need of touching patient body juice and other infected matter. Not only gloves but face masks, apron, full sleeve gowns for nurses should be wore. Now, according to UK course of action 3.7 metre sq. Area should be confined to each bed associated with MRSA patient with centre distance of 2.7 metre between beds. One of the important methods to control MRSA is to maintain positive pressure outside the room with corridor so as to prevent cross contamination (Banach, et. al, 2015).
Personal Protective Equipment
Self precaution is very important especially in case of transmittable diseases. There are many personal protective types of equipment which are used while treating MRSA patients such as
1.Gloves: It is necessary to wear gloves whenever there is a possibility of contact with patient blood, urine or other infected fluids. Once used gloves should never be kept for reuse purpose even after washing. All the gloves should be one time use gloves and it should be throwing away as soon as after utilization. And wearing and putting off of gloves should be done with proper method.
2.Face mask: To avoid spreading of infection in nose mucous membranes and to protect from infected fluids of patient like blood; pus etc while doing treatment, face mask is used.
3.Goggles: It is used to protect eyes mucous membranes from infected fluids as an infected fluid contains germs which can be transmitted in your body through this mucous membrane. Sometimes face guard can also be used in place of goggles with the help of breathing apparatus attached to it.
4.Hospital nurses Gowns: Nurses treating MRSA patient are more in contact with patient and there is always high risk of contamination of their clothes, body. Always disposable full sleeves gowns should be used.
5.Shoe covers and bonnets: To avoid person revelation with organism carried by the wind and infected environment shoe cover is used while to prevent scalp contamination bonnet is used (Kang, et. al, 2014).
Assistance Required From Multidisciplinary Team
Comunity Registered Nurse
The role of nurse is not ended not even after the discharge of patient from the hospital. Nurse has to play many vital roles such as inspecting and maintaining health conditions of patient, to give guidance, emotional support to patient and his family at the time of need. The assistance provided by community registered nurse to Mr Bowditch will be as follows: to check vitals conditions such as high blood pressure, fever etc. Nurse will also take care of patient’s surgical site whether it is having infection or not, at the regular interval of time as per requirement dressing will be done. All the symptoms of patient will be recorded as well as changing conditions of patient also get recorded whether he is improving or not, patient condition is analysed by diagnosing tests if needed. Then according to patient’s response and present health condition treatment can be modified only after informing to general practitioner. If needed nurse may do safety inspection so that Mr Bowditch will not fall again. Seeing his age some changes may be done on his restroom, washroom or in other area of house for his safety concern and easiness. For rapid healing of wound nurse will instruct patient and his family about health related topics, safety, precautions and medications. Nurse will inform doctor only if there is a case of life threatening otherwise after some discussion with multidisciplinary team nurse will continue the treatment as prescribed.
Doctor will take feedback of Mr Bowditch in regular interval of time from registered nurse allotted to him. Doctor will observe Mr Bowditch physical condition and will carry regular checkups on the basis of his health condition. Intake of medicines can be changed if needed; doctor will check the medical report prepared by nurse on regular basis and as per requirement can do changes according to wound healing condition. General practitioner can vaccinate Mr Bowditch for rapid healing of his wound and to prevent occurrence of any future infections. After certain time of treatment if he finds out that condition of Mr Bowditch is not recovering then he can refer him to any specialised doctor for any further assistance (Michiels, et, al, 2015).
Medicines prescribed by general practitioner to Mr Bowditch will be provided by pharmacist. The role of pharmacist is also essential as he will see the medicines prescribed by doctor is getting used in right way or not means whether there is no misuse of medicines because misuse of medicines can create severe health issues and Mr Bowditch is taking all his medicines according to prescription. Hence, pharmacist should work as per authorized procedure and medicines given by him should be properly labelled and packed. Most of all, there should not be any expiry medicine given. Pharmacist can also suggest general practitioner to write those medicines which are available in his shop so that he can give those medicines to Mr Bowditch without any delay. Other significant responsibility of a pharmacist is that he should exchange a few words with prescribers so as to make clear the names, drug of medicines prescribed by doctor because if there will be any kind of confusion in providing medicines then it can be proved injurious to prescriber.
Hospital acquired infection can be treated by having some antibiotics but it gets difficult to treat when this infection adapt themselves according to antibiotics. As studied in this paper when infection starts adjusting to antibiotics and become resistant to some frequently used antibiotics then SAB caused by Methicillin resistance occurred known as MRSA is occurred. In this case study, Mr Bowditch case is given who has an ulcer in his right leg as well as also suffering from MRSA. Various risk factors associated with this infection is also studied and how important the role hygiene is understood with individual responsibility of registered nurse, doctor and pharmacist.
In this report we come to the conclusion that the rate of deaths happening due to nosocomial infection can be minimized by taking care of cleanliness, sanitation in hospital and in other health care buildings. This will not only reduce the expenditure cost of hospital if any deaths occur but will also reduce the death rate.
1.Collaboratives, E.P., 2012 Methicillin-Resistant Staphylococcus aureus (MRSA) Infections.
2.Staphylococcus aureus bacteraemia in Australian public hospitals 2013-14 [Accessed on 28/03/17] [online available athttp://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129550037]
3.Banach, D.B., Bearman, G.M., Morgan, D.J. and Munoz-Price, L.S., 2015. Infection control precautions for visitors to healthcare facilities.
4.Hsiao, C.H., Ong, S.J., Chuang, C.C., Ma, D.H. and Huang, Y.C., 2015. A comparison of clinical features between community-associated and healthcare-associated methicillin-resistant Staphylococcus aureus keratitis. Journal of ophthalmology, 2015.
5.Kang, J., Weber, D.J., Mark, B.A. and Rutala, W.A., 2014. Survey of North Carolina hospital policies regarding visitor use of personal protective equipment for entering the rooms of patients under isolation precautions. Infection Control & Hospital Epidemiology, 35(03), pp.240-280.
6.Azim, S., Juergens, C., Hines, J. and McLaws, M.L., 2016. Introducing automated hand hygiene surveillance to an Australian hospital: Mirroring the HOW2 Benchmark Study. American journal of infection control, 44(7), pp.772-776.
7.Michiels, B., Appelen, L., Franck, B., den Heijer, C.D., Bartholomeeusen, S. and Coenen, S., 2015. Staphylococcus aureus, including meticillin-resistant Staphylococcus aureus, among general practitioners and their patients: a cross-sectional study. PloS one, 10(10), p.e0140045.
8.Rodvold, K.A. and McConeghy, K.W., 2014. Methicillin-resistant Staphylococcus aureus therapy: past, present, and future. Clinical infectious diseases, 58(suppl 1), pp.S20-S27.