The aim of this essay is to discuss and analyse the fundamental issues of infection control which underpins Adult Nursing. The topic for discussion is infection control/nosocomial infections in particular Methicillin-resistant Staphylococcus aureus (MRSA). There are varying degrees of the strain Staphylococcus aureus (S. aureus) and some strains are classed as MRSA (National Health Service (NHS) Plus, 2005). Not all strains of the bacterium will cause an epidemic.
Epidemic causing MRSA is classified as EMRSA, most notably EMRSA-15 and EMRSA-16, which can be more difficult to control (Department of Health (DH), 2004). However, for the purpose of this essay, the author will focus on MRSA in an acute setting, which has become a major problem around the world, causing hospital acquired infections and, more recently, infections in the community (Ayliffe et al, 2000). Applying current research, the essay will indicate that there is an increase of the transient infection and look at its modes of transmission throughout a hospital ward.
This essay will also draw attention to the implications MRSA has towards patients and staff, plus what precautions can be established to prevent or to contain the spread of this particular infection. Due to word limit of this essay, good use will be made of appendices. MRSA is deserving of its second name the ‘super bug’, as it has been shown to survive four months in dry conditions (Duckworth & Jordens, 1990, cited by Wiseman, 2004). With pathogens being able to survive under such basic conditions, many implications for patients’ basic health care are raised in a hospital or a primary care setting.
It appears that for MRSA to live in a human body there must be a susceptible host with a compromised or depressed immune system (Cohen et al, 2000). MRSA is classified as an opportunistic infection, because, it takes hold of host whom has been weakened (Cohen et al, 2000). Further indicating patients who are debilitated and have devices which puncture the skin, such as intravenous and intra-arterial lines, the unusual ability of this organism to spread, colonise and infect the recipient, meaning it can gain entry to the bloodstream and cause septicaemia which is rapidly fatal (MacKenzie et al, 1997).
Patients in hospital under the care of all health professional, especially nurses, whom have more personal contact with patients, close attention must be given to methods in which micro-organisms can be transmitted, whether it is through direct or indirect contact. Therefore, the role of the nurse should always be aware of and practice universal precautions (See Appendix 1) and aseptic technique (See Appendix 2) where necessary to assure the well being of their patients.
Modes of transmission can be from a simple skin to skin contact, for example a handshake, to sexual intercourse, to a patient lying in a hospital bed with a surgical wound while hospital cleaning staff clean another hospital bed 4 feet away (Cohen et al, 2000) (See Appendix 3). Consequently, the nurse’s role of using the process of assessing, planning, implementing and evaluating patients must be an ongoing procedure in order to always have an insight into how a patient is progressing and to deem their level of susceptibility.
Also, using the Roper-Logan-Tierney Activities of Living (AL’s) as a tool will ensure the patient’s basic health care needs are met. Nevertheless, the nurse must look at their portal of entry and exits, micro-organisms may enter the body via the skin post surgery or through the respiratory tract, the digestive system and the urinary and reproductive systems (Heath, 2003 & Cohen et al, 2000), especially if mobility is compromised and nutrition intake is poor.
Control of infectious disease involves breaking the ‘chain of infection’, therefore, the nurse should take a swabbing of the nose, throat, eyes and wound as a tool to detect if the patient has been or is exposed to MRSA and send to pathology. Therefore indicating, a part of the nurse’s role is to promote nutrition for wound healing and to repair damaged cells. However, consideration must be given to patients who are diagnosed with an infectious disease as this can send them on a downward spiral towards being malnourished (Dougherty & Lister, 2004 and Heath, 2003).
Signifying, poor nutrition in an already very ill patient can further compound their ill health with adverse effects. Although it is discussed that for prevention of infecting other patients, a patient diagnosed with MRSA must be isolated immediately, but how does the patient feel being stigmatised for being ill, the effect of being diagnosed with an illness that is potentially life threatening, and a fear that the care they will receive may be compromised by staff. To be stigmatised is to be viewed as an outcast of society. Goffman (1963) states stigma is a study of situations where the normal and abnormal meets.
Which lends itself to the question, how does an ill patient feel knowing that they are being viewed as ‘abnormal’. Therefore, to be diagnosed with MRSA and to in turn be subjected to isolation, where they are withdrawn from other patients, and may only see Nurses and Doctors while they are doing their rounds, leaves a patient feeling alone and possibly depressed (Madeo, 2003 and MacKenzie et al, 1997). Madeo (2003) states patients requiring source isolation as a result of an infectious disease are exposed to further stress that can lead to emotional and behavioural manifestations.
Infectious isolated patients are prone to loneliness and depression as well as feeling stigmatised (Oldman, 1998; Knowles, 1993; MacKellaig, 1987 cited by Madeo, 2003). Indicating, being in isolation is for patients to be away from all things that are routine and familiar. Their daily living and independence is disrupted which may evoke fear, anxiety, depression and rapid mood changes. Although being isolated can have a negative impact on patients, most patients welcome the thought of being isolated, so they can have a restful night and more privacy.
Madeo (2001) and Wilkens et al (1988) cited by Madeo (2003) found that patients admitted to an infectious disease unit do not develop any deleterious mental changes attributed to isolation, and found that a number of patients preferred the solitude of isolation as they were guaranteed a good nights sleep. Therefore, a part of the nurse’s role may incorporate a couple of nursing theories, to ensure the patient’s needs are met. For the psychological aspect, the Abdellah’s nursing theory is appropriate. George (2002) states.
Abdellah’s Nursing Theory emphasizes delivering nursing care for the whole person to meet the emotional and social needs of the patient. Therefore, encouraging family and friends to visit, while providing education on how to protect them and may alleviate the patient from being anxious, and patients continued progress to recovery. Neuman’s nursing theory suggest addressing the psychological affects of HAI or the threat of acquiring an infection is that the best defence is offence, tackle the situation before there is a situation.
Neuman’s theory focuses on prevention of various degrees, primary, secondary and tertiary prevention (Heath, 2003). Primary prevention is to strengthen a line of defence by identifying actual and potential risk and using isolation precautions (See Appendix 4). Secondary prevention strengthens internal defences and tertiary prevention is to strengthen resistance to stressors through patient’s education and to assist in preventing a recurrence of stress response (Chinn et al, 1987; Marriner-Tomey, 1997; Torres, 1986; Neuman, 1982 cited by Heath, 2003).
Even though nurses have many tasks to accomplish within a shift, maybe some thought can be given to incorporate a greet session to say hello to their patients in isolation and not just to medicate them. Madeo (2003) states frequent visits from staff during the day help to relieve boredom and remove feelings of neglect. The Health Secretary, John Reid has stated that he expects MRSA bloodstream infection rates to be halved in United Kingdom (UK) hospitals by 2008 (DH, 2004 and Hill, 2004).
However, MRSA rates have been growing in UK hospitals, and the rates of death caused by MRSA increased from 8% to 44% from 1993-1998 (Crowcroft et al, 2002 cited by Hill, 2004). Therefore, more preventative practice by nurses is needed, for example; good hand washing practice, which is the single most important measure in preventing the transmission of HAI’s, including MRSA (Winter, 2005). Hand washing by nurses and other healthcare staff is vitally important in the control of infection.
However, it is widely believed that the failure of healthcare workers to wash their hands between each patient contact is due to laziness or carelessness. Research evidence shows hand hygiene have been identified and do relate to the individual healthcare worker (e. g. poor knowledge of guidelines or lack of education) but other important factors are inadequate facilities, lack of time and a paucity of hand hygiene agents.
Only by tackling all these factors will the problem of low levels of hand washing be successfully resolved. Although using these precautions will not eliminate the transmission of infection completely, it will minimize the effect.
One way of tackling the issue of HAI is having Matrons ask their ward staff a series of questions regarding cleanliness set out in the Matron’s Charter (DH, 2004). Within the Charters various questions are listed that can be used as tools to assist in eradicating MRSAand other HAI’s. Hill (2004) states the government’s emphasis for tackling MRSA has been placed firmly within the remit of the nursing role. Hand-washing and cleanliness are of vital importance in stopping the spread of infection (Hill, 2004 and Meers et al, 1997).
However, MRSA and other HAI’s cannot solely be the responsibility of Nurses. Hill (2004) relates that the target to reduce MRSA could not be achieved by hand washing and cleanliness alone and that a multi-factorial approach to addressing the problem is required. Naidoo and Wills (1998) states multifactor should encourage communication and problem solving skills when preventing infection. Tiemersma et al (2004) suggest to reduce MRSA is to introduce screening of patients in hospital.
The surveillance approach is used in the Netherlands and in 1999-2002 the percentage of MRSA isolates was just 0. 6% compared to 41. 5% found in UK hospitals (Tiemersma et al, 2004 and DH, 2003). The Netherlands demonstrates that the search and destroy approach is effective; indicating that people in UK hospitals with MRSA needs early detection to isolate and protect other patients from exposure. Health Protection Agency (HPA) (2005) suggests in order to lower MRSA is the effective use of antibiotics for example, vancomycin, rifamplin and gentamicin.
However, as the NHS is always mindful of its financial status, this search and eliminate may prove to be costly. Nevertheless, the government must judge monetary gain against the welfare of people in UK hospitals. Although nurses have an important role in preventing or containing the spread of infection by ensuring and encouraging the highest standards of cleanliness, hand washing and the appropriate use of gloves, it is not just the nurses role that should be emphasized by the Government, as the issue of MRSA is a lot more complex (DH, 2004 and Hill, 2004).
Albeit that the Netherlands and other European Countries have a low rate of MRSA, there are indications that alternative methods of managing patients must be researched. World Health Organization (WHO) (2002) states implementation of patient care practices for infection control is the role of the nursing staff. Therefore, nurses should be familiar with practices to prevent the occurrence and spread of infection and maintain appropriate practises for all patients throughout the duration of their hospital stay.
Concluding that, health professionals, in particular the Infection Control Nurse, patients, family, friends and the general public all have a role to play in preventing the spread of infection and this can be done through education, which is the key component of primary, secondary and tertiary prevention. To promote good health and to alleviate fear of infection or coping with infection education through leaflets or public announcements should be considered.