METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)

The nursing assistant (NA) student Kimberly was eager to help in any way she could. This was her third week into her clinical time in the long-term care facility. The NA Kimberly was paired with asked her to help one of the residents to the restroom. Kimberly was more than willing to help the frail elderly man to the restroom. On the outside of the resident’s door was a yellow sign with the drawing of a black hand in the center. Kimberly knew when she saw this sign there was some kind of precaution that needed to be taken when giving care to the residents in the room. She put on a pair of gloves and asked the NA what else she needed to put on to keep the resident and herself safe from cross contamination. The NA proceeded to tell Kimberly gloves was the only thing needed because the resident she would be helping to the restroom was not the one who had contact precautions. It was his roommate that had methicillin resistant staphylococcus aureus (MRSA) in his covered surgical wound and there was no need to worry about spreading the organism anywhere else. Kimberly proceeded to help the elderly resident to the restroom from the window bed to the other side of the room where the resident with MRSA resided. The MRSA positive patient who was on contact precautions used the same restroom as his roommate. Kimberly listened to the NA because she told her she had been an NA for eleven years. I found Kimberly on her uniformed knees on the tile floor in the restroom helping the resident pull up his pants.   

One common yet avoidable infection seen in hospitals and long-term care facilities is MRSA. Staplylococcus aureus is a bacterium that is normally carried on the skin or in the nose of healthy individuals. It is the most common bacteria that causes skin infection in long-term care and acute care medical facilities. Staplylococcus aureus can also cause pneumonia, infection in the bone, and life-threatening blood infections. It is almost always spread by direct physical contact. Contact can also be indirect which involved touching things such as sheets, wound dressings, towels, medical equipment, or clothes, and then subsequently touching another patient without changing gloves or proper hand washing.

Methicillin resistant staphylococcus aureus was once treated with penicillin-related antibiotics. It is now resistant to these antibiotics and stronger antibiotics are needed for treatment. The most common intravenous antibiotic used is vancomycin. They have also found the oral antibiotic rifampin which is used most commonly to treat active tuberculosis is also effective in the treatment of MRSA. Treatment can be difficult and lengthy depending on the health status of the patient. Methicillin resistant staphylococcus aureus infections can be severe and life-threatening.

The first and foremost practice that has to be performed before and after contact with every patient is handwashing. As simple as it may sound, many medical personnel do not wash their hands correctly or as often as they should. Unfortunately it is the patient or resident that suffers because of the lack of good judgment used by medical personnel who do not wash their hands properly or before patient care. There is always time to wash hands or use the gel antiseptics which are commonly found outside patient rooms in many facilities. The excuse of being too busy is unacceptable. Changing gloves is also critical to prevent the spread of infection and should be done after hand washing as well as during and after patient contact.

If you would like to know more about MRSA specifically in long-term care facilities click here. The Center for Disease Control has a lot of information on MRSA and is also a good resource.