Prevention of MRSA Infection

The control and prevention of MRSA may begin with the prevention of
spread, both before and after hospital admission, but it is a complex infectious
disease with numerous variables that risks infection by MRSA in environmental
and virtual setting. The spread of MRSA occurs primarily by contact with living or
non-living reservoirs of MRSA. It is now common knowledge that the best defense
against the spread of MRSA is maintaining a clean environment in the hospital
through good infection control procedures, but it is impossible to completely
sterilize the environment or keep complete sterility there. It is believed that
colonization usually precedes infection, and the infecting organism is usually the
same subtype as the colonizing strain. This offers a chance to prevent MRSA
infection by prophylactic measures. There are several pathways for MRSA
colonization. Appropriate interventions to these pathways can potentially prevent
the transmission and spread of MRSA.

Hand Hygiene
Hand hygiene has long been recognized as an important way of preventing
the spread of infectious agents in healthcare settings. Most studies have reported
poor compliance with hand hygiene between patient contacts and MRSA infection
rates have continued increasing significantly in National Nosocomial Infection
Surveillance hospitals. The article most frequently cited as showing control of
MRSA infections with improved hand hygiene compliance was from a hospital that
had implemented a program for MRSA surveillance cultures and contact
precautions for colonized patients over the same years, making the relative
contribution of the improvement in hand hygiene unsure.

Environmental Disinfection
Environmental contamination is likely the source of some spread since one
study showed that nurses contaminated their gloves 42% of the time touching
only environmental surfaces in the rooms of MRSA patients and another study
documented frequent hand contamination after touching environmental surfaces
in hospital rooms with bare hands. Two recent studies concluded that enhanced
disinfection was an important measure for controlling epidemic MRSA. In one
study the disinfection related to a whole ward and in the other it dealt with
contaminated ultrasonic nebulizers, which had allowed continuous spread despite
screening cultures and isolation of recognized carriers.
Active Screening and Isolation of Source
Isolation of only the patients detected by routine clinical microbiology
cultures has given little advantage because a large number of colonized patients
did not have a positive clinical microbiology culture and most of them turn
positive just before hospital discharge. By contrast screening cultures and contact
precautions have turned well in many studies because this allows timely detection
and prevention of spread from the full reservoir for spread. A structured review of
the methods employed by studies of MRSA control concluded that many of the
studies had limitations in biostatistical methods, epidemiologic design, or both.
However, the authors concluded that sufficient data were available to conclude
that active screening and isolation effectively control MRSA transmission and
infections, thus the methods should be used. Isolation wards or temporary
division within a ward have been used to control MRSA spread. This kind of
approach is usually associated with active screening and isolation but goes one
step further by putting all colonized patients in an area further away from all other
patients, often divided with staff who care only for the isolation patients.

Prudent Use of Antibiotics

Prudent use of antibiotics has been recommended for decades and most
hospitals report that they have programs for limiting too much or inappropriate
use, but MRSA rates have continued rising. It is likely that the volume of
appropriate use of antibiotics would still serve to create a selective advantage for
MRSA in the healthcare setting even if there were no excessive or inappropriate
use. This makes using an evidence-based method for stopping spread a key
measure of successful programs. Methods for preventing infection at each body
site act to decrease MRSA infections as they do infections by other pathogens.
Such methods have probably been applied in most hospitals and MRSA infections
at all body sites have continued to rise. Due to this reason, measures to prevent
spread are important for preventing MRSA infection. The epidemic strain was
completely eradicated from the hospital over the next year and a half and active
surveillance cultures and isolation of colonized patients were implemented.
Antibiotics are currently administrated almost practicallly owing to the lack of fast
and accurate diagnostic tests for point-of-care therapy. This results to an
excessive or inappropriate use of antibiotics. Heavy use of antibiotic could disturb
the indigenous natural anaerobic flora in a human body which leads to overgrowth
with pathogenic and/or resistance bacteria. Sets of evidence have been found to
support dose-effect relationships between MRSA and antimicrobial use and
bleievable biological models to elucidate this relationship. Prior exposure of
antibiotics such as quinolones has been linked to infection with MRSA. Prudent
antibiotic use is thus important in preventing selection and amplification of MRSA.

Education of Staf
As a vital component of MRSA control and prevention programs, it has been
recommended that proper education and training of health-care workers on
infection control and prevention measures must be included. Education is an
important facilitator for other preventative practices. It can raise awareness of
guidelines and enhance compliance and at the same time, reminding staff of the
importance of good hand hygiene techniques and the main causes of cross-
infections. Knowledge of potential risks of the transmission of MRSA to patients
and potential risks of staff colonization or infection acquired from patients may
facilitate contact precautions and active surveillance thus promoting disinfection
process. Education efforts may also help clinicians to connect incorrect use of
antibiotics to the selection and spread of MRSA.

Health Habits in the Community

With increasing numbers of patients being treated at home as outpatients to
reduce medical costs and with CA-MRSA strains being isolated and trending
toward epidemic levels, precautionary measures are getting important in
preventing the transmission of MRSA in the community. Health habits in
community medicine are the vital tools to limit MRSA spread. Just like in the
hospital, hand hygiene is the most important health habit in preventing the
transmission of MRSA in the community from both colonized and infected
populations. Healthy people, colonized or infected patients, and medical staff
should all establish good hand hygiene practices. Disinfection of the environment
around the patients and room separation for outpatients should be observed as
well as in the outpatient or home treatment setting. Education is another tool for
community medicine in preventing the transmission of MRSA. Such education
includes alleviating the understanding of the outpatients about their infections
and how these infections might spread, also helping the community to understand
the importance of hand hygiene.

With the pervasiveness of MRSA and its treatment challenges owing to MDR
(Multi Drug Resistant), the use of various approaches is crucial to the success of
control and prevention of this superbug. Few measures such as practicing good
hand hygiene, taking precautions against personal contact, cleaning the
environment, utilizing active surveillance/screening, ensuring the prudent use of
antibiotics, and educating staff are important in preventing the spread of MRSA.