What’s The Problem with MRSA?
MRSA is commonly known to affect hospital patients. This does not only cause issues, but it causes deaths. For, the main question for many sufferers of MRSA is of course how they contracted it. Many blame the hospitals, for after all 20-30% of people, carry it out there skin without knowing, but this coupled with poor standards of hygiene in most of Britain’s NHS hospitals, which are the perfect breeding ground, is the cause of the spread of the MRSA super bug? Surprised that baby you could be carrying the deadly MRSA, there is nothing to be worried about, unless you admitted to hospital that is, well this is how many sources see the situation. The bacteria can be present on the body but it doesn’t have to cause any harm. Doctors also call this being ‘colonized’ with MRSA. Most people who carry MRSA in this way don’t go on to develop an infection. You get an MRSA infection when the MRSA bacteria get into your body tissues or bloodstream and multiply. They can get in through a break in the skin, such as a wound or drip site, or by travelling up a tube into the bladder (a catheter). This is what makes hospitals so to blame, as you do not sit at home with a catheter do you? The most common ways, (stated above) to contract the illness are only common place in hospitals, where of course there a large number of people; perhaps a selection of the 20-30% that are ‘carries’ are also involved; in cramped conditions, eating, as we all know, less than nourishing meals.
Background:
What Is MRSA?
FROM ARTICLE TWO:
The extract above, states what MRSA is. I think this a correct account of the infection, as it was obtained for a reliable course, listed and assessed in the bibliography .It also explains some symptoms read on to discover how it can affect people in depth.
How Can It Affect People?
MRSA has been featured in the news and on television programs a great deal recently. This particular type of bacteria causes “staph” infections that are resistant to treatment with usual antibiotics. The extract from article six, displays some affects of MRSA, upon people who have contracted the disease, and who it is most likely to affect. The extract also explains how MRSA is linked to hospitals as it is more likely due to the environment to be present there. It also weakens the immune system greatly leading to other bacterial infections which could then lead to fatalities, amputations or other seriously health affecting conditions. Which is why some people argue that it is not safe to go into a hospital, or hospital type environment for there is a decidedly increased risk of contracting MRSA.
FROM ARTICLE SIX:
MRSA Infections in hospitals
As we have already established there is a correlation between hospitals and MRSA, but why is this? There must be a simple explanation for this, other than it is just because hospitals contain sick people? Then why doesn’t every person who goes into a hospital return with a hundred diseases/infections? What’s the reason that makes MRSA so potent, other than antibiotic resistance? Because MRSA lives on the skin and in nose, usually without harm, many patients when going to hospital do not know that they are colonized with MRSA. This means that it is the potential ability for the infection to the spread to colonized patients wounds if they undergo a surgical procedure; or if someone close to them in the hospital has an open wound;, or consequently a member of staff who is not following the hand washing schemes passes it to another patient. Colonized patients often have a ‘reservoir’ of MRSA that could fuel this spread as the MRSA infection survives in clusters of the bacteria that can and will split up to achieve better habitats. This means that in most cases the affected patient(s) believe that they have contracted the infection from hospital, and therefore blame the staff facilities and when they in fact have brought it them with themselves into the hospital in the first place. This is why not many people contract many infections in hospitals, as MRSA colonized patients, this behaviour is not available to most other infections, so you either have it or don’t; and if you do the hospital will know and subsequently treat you in isolation or with great care, hopefully. When a person contracts MRSA, this is called ‘endogenous’; there are some risks that encourage MRSA that do not affect other infections, this is why it is so strong. These include breaks to the skin, indwelling catheters, deficiency in immune systems i.e. low white blood cells. If you have contracted the infection from a hospital or another patient, this is called cross-infection. In addition, MRSA may be spread via contaminated equipment or through the environment, and this is a large problem in hospitals as for many patients they are situated in the same ward/environment throughout their treatment, using and sharing the same equipment such as toilets, TV’s and telephones. The extract from the article shown below tells me that the infection has again evolved to suit hospital environments. This sudden evolution yet again adds fuel to the infection rates. But what else is to blame? And why can’t it be treated with a high success rate, this is due to antibiotic resistance read on to find out more.
FROM ARTICLE THREE:
MRSA Infections in the Community
FROM ARTICLE FOUR:
Patients may be colonised with MRSA when they leave hospital, and there has long been concern that MRSA might spread from hospitals into the community. The article above supports my theory that sometimes it is safer to be inside a hospital, for it displays that you are at the same risk of contracting MRSA in the community as you are in Hospital, but in hospital at least then can offer you treatment. However, is also highlights how there are different strains of MRSA, so which is more serious, and which strain, hospital, or community MRSA, arrived first and why? MRSA originates from colonisation of course, and the following paragraph explains how you being diagnosed as being ‘colonised’ with the infection.
How is colonisation with MRSA diagnosed?
Surely it would be easiest to ‘swab’ or test each new patient for MRSA; so how do you detect MRSA on a person if they’re not infected. To diagnose MRSA infection, swabs of inside the nose and a small scraping of the skin are sent to test for clusters of the bacteria. Could this be a simple life saving test? Maybe this should be considered? When documenting colonisation or infection, it is important to establish how the infected person became so. The main healthcare risk points are as follows:
Contact with patients who have compromised health and require intense care, often including the insertion of devices to provide essential treatment; Those staff providing such care will also be at risk, of picking up, in particular, bacteria, which may never affect them as healthy individuals, but may be a factor in cross infection to vulnerable patients. Other staff and visitors may be at risk also.
How Has Antibiotic Resistance Helped The Spread of MRSA In Hospitals?
As many articles have already displayed, the cause of MRSA, is linked to our Hospitals. But should our, over stretched resources and inadequately trained hospital staff be blamed, or should the management behind the NHS take the bullet.
It is fair to say, that the real victims of this are patients, and their families, that have been affected, by death or injury, as a result of the spread of MRSA, but legislation has been put in place to stop the spread of this terrible disease, if any? And why wasn’t the nation’s healthcare fully prepared for a super bug of this scale? MRSA is an infection, and like many other infections can be treated by a completed course of antibiotics but in this case lately it has been fuelled by antibiotic resistance. The diagram to the left displays the affects of antibiotic resistance compared to normal affects of antibiotics. Antibiotic resistance is a specific type of drug resistance when a micro-organism has the ability to withstand the effects of antibiotics. The diagram shows how the bacteria continue to multiply, resulting in higher death and infection rates. Antibiotic resistance evolves via natural selection acting upon random mutation, but it also can be engineered by applying an evolutionary stress on a population. Once such a gene is generated, bacteria can also then transfer the genetic information between individuals. If a bacterium carries several resistance genes, it is also called multi-resistant or, informally, a super bug.
What Can Stop The Spread Of MRSA? NHS GUIDELINES
After reading many protocol leaflets obtained from the NHS website and my local doctors surgery there are a few main steps that professionals seem keen to enforce to help control the spread of the super-bug MRSA. They are as follows:
- Hospital staff should wash their hands scrupulously before and after having physical contact with patients, using soap or rapidly acting antibacterial alcohol solutions.
This, as you would think, is an important routine in hospital life, and having to re-enforce this shows that standards of care and cleanliness are slipping in British hospitals.
- Patients that are colonised or infected with MRSA may be kept away from other patients by being placed in separate rooms, either alone or with other patients who also have MRSA.
The guidelines also stated that there should be restricted access to these rooms to minimise the spread of MRSA.
- Hospital staff should wear gloves and disposable gowns prior to having physical contact with MRSA patients. Before leaving the room they should discard these safely and wash their hands.
This shows that there are protocols in place that are making hospitals safer places, but if it is a particular bust shift or the department is understaffed these measures can quickly be disregarded for no-one is going to be checking where you bin your gloves.
- Visitors and carers likely to have a lot of physical contact with patients should also wear disposable gloves and gowns. All visitors should wash their hands before leaving the room.
I fail to see how this is going to be imposed properly, for it is up to the visitors sense of personal hygiene and most carers are over worked, and move around a fair bit, so they cannot be monitored.
- MRSA can survive on inanimate objects or surfaces such as linen, sinks, floors and even mops used for cleaning. For this reason, areas where MRSA patients are nursed should be thoroughly cleaned using disinfectants.
I think that this should be a normal occurrence for hospitals, but it does show that hospitals are looking into and updating their cleaning regimes to make them safer places, and free from MRSA.
Why Hospitals Should Be Liable For the Spread of MRSA
Evidence to show a correlation between hospitals, and MRSA
It’s fair to say that there is enough substantiated logic to state that MRSA is incubated and progressed with the help of unclean hospitals, a few poor staff members and irregular hygiene standards. But is there enough hard evidence to prove a correlation that answers my case study title, in a negative manner. A concluding extract from a peer reviewed scientific journal investigating MRSA correlations explains their findings below.
FROM ARTICLE FIVE:
They’re results suggest that there isn’t a correlation and cause between hospitals and the spread of MRSA in the community, but there is a strong link that suggests prior mis-use of antibiotics leads to higher infection rates. I believe that this studies finding are very important and reliable as they were carried out over a long period of time, on a large hospital and community, by 10 medical officials. To make it more reliable they should have carried the study out on other hospitals at the same time, this is to ensure the average reliability of the correlation.
Why the spread of MRSA, can only be linked to Hospitals.
The spread of MRSA can only be linked to hospitals because of the nature of the disease. It causes, boils and sores and fevers, and where do you go when you’re that ill?.. Hospitals. Where are they a large number of people with weak or non-existent immune systems?.. Hospitals. Where are they’re people with open wounds and catheter sites?.. Hospitals. Where is there staffing, and cleanliness issues?.. Hospitals. Where do you go to get prescriptions for antibiotics after getting MRSA, and if not used correctly, where do you back to the hospital where you were diagnosed! All of these factors contribute to why MRSA is causing Hospitals to be unsafe places. You may ask why aren’t there traces of MRSA in public places that can cause infection, such as trains, buses and GP surgeries. This is because not many people walk around with possible infection sites such as wounds, and if you have a low immune system you would avoid these places at all costs, but hospitals you would not, as they offer treatments and diagnosis. There is evidence to suggest that the spread of MRSA, has evolved to suit hospital and community environments, so therefore only certain strains of the infection can be properly linked back to hospitals, but then some scientists suggest that MRSA has only evolved into these two strains as it has been allowed to escape from the regular hospital environment by un-treated or un-clean staff/carers, and this would of course allow the spread to be linked to hospitals yet again.
The Legislations regarding hygiene in Hospitals –
What Legislation and Hygiene rules are in place?
Out of the posters shown above, which one offers more information regarding how to wash your hands in a better way with a more successful germ killing technique? The one on the left obviously as it has good diagrams and information, it is not eye catching, but hand washing shouldn’t just be done if reminded by a bright poster, it should be part of a routine. So obviously you would assume as poster such as the one on the left would be in hospitals, however this is not the case, the poster on the right is in fact the one on display on wards, its situated next to alcohol gel for the ease of the staff members and visitors. As I have already mentioned cleanliness is a main part of hospital’s protocol, to cut infection rates and to stop the spread of disease. There must of course be legislation regarding what protocols and contingency plans are in place to enforce hand washing, impeccable hygiene standards and safe treatment for the patients and staff members, but is it helping to stop the spread of MRSA? I found a study, named article seven in my bibliography, it carried out research on actual wards in the UK, so see if legislation was working. Ensuring health professionals follow simple rules of hygiene like hand washing is key to stopping bacteria spreading. But observed practice shows very poor rates of adherence to guidelines and reveals that staff fail to take account of risk, even with patients with MRSA. The findings published in The Journal of Hospital Infection showed that 38 per cent of the research sample of health professionals failed to wash their hands after contact with MRSA patients, while 25 per cent failed to wash their hands after contact with faeces and 38 per cent failed to wash their hands after contact with blood. The study observed healthcare professionals on hospital wards and compared their hand hygiene behaviour with self-reports of their actions, taking particular note of practice when working with patients infected or colonised with MRSA. Hand hygiene among the healthcare professionals involved in the study was poor despite the knowledge that they were being observed. Also, self-reported behaviour was totally unrelated to actual observations. Observed practice was not rational. For example, hands were only cleaned on 14 per cent of occasions before wound care, when the aim should be to prevent the patient from developing an infection. On average only 12 per cent washed their hands both before and after treatment of an MRSA patient, putting other patients and him/herself at high risk of cross infection. The research examined the implications of inadequate hand hygiene in hospitals, its role in the spread of infection, such as MRSA, and the effectiveness of practical demonstrations and hand hygiene posters in carrying the message. So obviously the current legislation isn’t working, but what exactly is it?
The following pages are extracts from a legislation manual in a Devon Hospital. (See Bibliography)
FROM ARTICLE SIX:
Table A. Guide for Hand Hygiene Decision-making
The above extracts from PDF protocol manual show that there has been devised routines for the staff to follow. The following page explains how the above hand-washing protocol can be improved and how it failing patients, and allowing MRSA to infect hospitals more
How they are failing? And How Are They Succeeding?
That extract, shows very clearly how to wash your hands, what with, when, and why. This explains to staff of all minimal intelligence the important of continuous hand washing. The rest of the protocol explains very well where you can use certain products, it fully explains why and the risk of doing so.
However, the only flaw that i found with this protocol list, is that it is only displayed on the website for the Hospital said in re-fined terms “This protocol is for student and revision aids, for staff are trained using this every 3 years, unless necessary”. This shows me that the staff, once passes their induction have no obligation to follow this out to the letter, also as I have already mentioned it is in complex terms and layout that may confuse staff. Many argue that policies such as this are not completed in busy ward situations, and perhaps in situations where there are no wounds the hand washing, or changing of gloves is thought not to be needed, and this would lead to staff relaxing the regulations even more and only changing gloves or washing their hands when they have time, which is largely impossible when in a ward such as accident and emergency, when staff have to deal with a large volume of patients and different cases. Subsequently an extract below argues that many hospitals cannot meet hygiene standards, even remote and specialised hospitals who do not have a large volume of in-patients as they deal with out-patient care, this means that lack of hygiene cannot always be put down to under-staffing and over-populating.
FROM ARTICLE SEVEN:
What new rules I would impose, if in charge of the Nation’s Hospitals.
The protocol seems fine, how it is imposed or lack of enforcement is not. I would make the following changes:
- Make regular glove changes, give staff an allocated swipe card to count how many times they change their gloves.
- Hand out hand sanitizers to all patients, visitors and staff freely to prevent cross-infection.
- Make sure that all MRSA vulnerable have the MRSA infection swab, and have carried out the cleansing routine before being admitted, if this is not possible, for example in an emergency, and there is an open wound, let there be a sterile room available for treatment on each ward.
The changes above I feel would make hospitals much safer places from MRSA, but they would cost time and money, but would ultimately save lives which is the vital thing.
Conclusion –
Assessment of the Articles, Supporting the fact that MRSA is a problem, and articles stating that MRSA is not a problem within hospitals;
In my conclusion I will also aim to deliberate upon the scientific facts, and off my interpretation of these facts.
I have used selected parts of articles to support my defined sections in my case study. This is in order to give a full understanding regarding the set-up of Hospitals and a background of how the spread of MRSA is linked to them. My case study title is ‘Is It Safe to Go to Hospital? Or Is MRSA a Problem? My research into MRSA has clearly shown that it is a potent threat to all of us, not only in hospitals, but also in the community. I feel I have answered my original question extremely well, as i have explored all the possible extras regarding MRSA & Hospitals, and have highlighted the link between the two. Ultimately I feel that MRSA is a growing threat, incubated by failing hospital standards and the fate of evolution. As I discovered the MRSA bacteria has evolved into strains both suited to hospital and community environments this shows that it has been growing and strengthening for a long time, long enough for us to stop it, but no. Hygiene and hand washing is the only vital factor that we can control that relates to the control of MRSA, for it has already developed antibiotic resistance. The scientific facts show that MRSA is a more complex version of other regular bacterial infections, but with nastier consequences. Most of the articles that I have used have been written from a perspective that is accustomed to the affects of MRSA, i.e. a medical professional, or a journalist immersed in the details of MRSA. This means that sometimes the reality of MRSA is lost in translation, which can lead busy hospital staff to not carry out duties, and patients to not be worried by this.
Bibliography –
List of Sources that I have used, with references to websites; with a reliability scale; I will also talk about how relevant the articles were, and from what context I took the extracts that I have included in my Case Study.
When choosing and researching information I assessed the sources on a reliability scale out of 5, to see when they were last edited, by who, and who they were originally written by, and on what facts. The sources i used all had a reliability of 4/5 or more to make my case study very accurate.
As I used pieces off of the internet/medical journals I have listed what article they are from, the information regarding the articles are as follows. Before deciding to use these resources i looked at many other websites, but found these to be unreliable sources of information. The other websites are in the brackets. (; ; ).
ARTICLE ONE: SCALE 4/5; MEDICAL JOURNAL
ARTICLE TWO: SCALE 5/5; CASE STUDY PUBLISHED BY GENUINE PROFESSOR
ARTICLE THREE: SCALE 5/5; MEDICAL PROFESSIONAL DIAGNOSIS WEBSITE
ARTICLE FOUR: SCALE 4/5; MEDICALLY EDITED ONLINE LIBARY
ARTICLE FIVE: SCALE 5/5; MRSA SUPPORT GROUP
ARTICLE SIX: SCALE 4/4; MEDICAL PROTOCOL CENTER
ARTICLE SEVEN: 5/5; NEWS REPORT REGARDING HYGIENE
