As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) in Neonatal Nurseries
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
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