How Nurses Can Reduce MRSA Risk


How Nurses Can Reduce MRSA Risk

Simple hand scrubbing is surprisingly effective

By Christine Contillo, RN, BSN
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Staphylococcus bacteria can be found almost anywhere and is usually harmless. Studies show that 25-30 percent of the population has the pathogen colonized on skin surfaces or within nasal passages without experiencing any problems. Staphylococcus aureus is normally kept in check by a competent immune system, or causes minor infections that can be cleared with the use of antibiotics. Recently, however, some invasive strains of staph have become resistant to frontline antibiotics such as penicillin. These infections are known as MRSA, or methicillin-resistant staphylococcus aureus.

MRSA often begins with a skin or soft tissue infection. Initially these particular strains were associated with the healthcare system (called hospital-acquired or HA-MRSA) and these particular infections were found in surgical wounds, burns, pneumonia or associated with indwelling catheters. The pathogens were easily spread between patients, often by direct or indirect contact with the healthcare staff, and were treated aggressively.

A disturbing recent trend has been the discovery of less common community-acquired MRSA. This is defined as a MRSA infection developing in a patient who has not been hospitalized for at least a year, nor had any medical procedures done in that same time period. Evidence shows that these strains of CA-MRSA may be more virulent and spread more easily. CA-MRSA can be minor, and often begins with what looks like a spider bite or boil/pustule on the skin. Without proper treatment, or with treatment delayed by the use of ineffective oral antibiotic, these “superbug” infections may proceed to necrotizing fasciitis, infection of the heart valves, or to an unstable toxic shock-like condition that may lead to death.

The risk factors for MRSA consist of the five C’s of transmission: crowding, cleanliness, contaminated surfaces, contact and compromised or abraded skin. Thus it is no surprise to learn that cases of CA-MRSA have been found among members of athletic teams, military recruits, prisoners, or among people visiting public gyms or saunas. Residence in long-term care facilities is a risk factor for HA-MRSA and overuse of antibiotics may be involved in both types.

Improving Hygiene

To minimize the spread of MRSA, healthcare workers should focus on improving hygiene among both patients and staff. In October 2002, the CDC developed guidelines for hand hygiene in healthcare settings that emphasizes the use of soap and hot water for scrubbing hands, along with washing for the proper length of time and using disposable paper towels for drying. Healthcare staff, as well as visitors and caretakers dealing with MRSA-infected patients, should wear disposable gowns and gloves that are discarded before leaving the room, followed by proper hand-washing, the step that is so often ignored. Disposable gloves may reduce microorganisms on skin surfaces by 70-80 percent; hand-washing is necessary to finish the job.

Much research has been done on whether alcohol-based rubs are as effective as hand-washing. What is known is that they reduce the number of microorganisms on the skin, take less time to use, may be less harsh on the skin, and therefore may be used more often. It is estimated that during one eight-hour shift an entire hour of an ICU nurse’s time may be saved by using an alcohol rub instead of taking the time to wash hands properly. Because MRSA can survive on sinks, floors, mops and sponges, the rooms utilized by MRSA patients need to be properly disinfected.

Care must be taken when using public facilities to protect yourself from possible MRSA infection. Antiseptic wipes can be carried for those times when soap and water are unavailable. Simply following the standard blood-borne precautions is always good rule of thumb:

  • Keep cuts and scrapes clean and covered.
  • Avoid contact with the wounds of others.
  • Avoid sharing personal items such as towels and razors.
  • Avoid any surface that may have been contaminated by bodily fluids. In addition, place a barrier (clothing or a towel) between your skin and any equipment handled by strangers. Many health clubs now provide sanitizers to clean handles and seats before and after use.
  • Take all doses of an antibiotic ordered for you. Don’t share or use unfinished antibiotics, and if the condition doesn’t improve within a few days, notify your physician.

Nurses responsible for infection control education or hand-washing protocol in their facility may be interested in the Hand Hygiene Resource Center website, which offers a PowerPoint slide show that can be customized to suit your institution. The CDC site also offers slide sets, posters and buttons.

Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.

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