{"id":42,"date":"2010-06-02T10:51:25","date_gmt":"2010-06-02T10:51:25","guid":{"rendered":"http:\/\/thewoundcentre.com\/a\/?p=42"},"modified":"2010-11-29T02:03:17","modified_gmt":"2010-11-29T02:03:17","slug":"methicillin-resistant-staphylococcus-aureus-%c2%a9","status":"publish","type":"post","link":"http:\/\/thewoundcentre.com\/a\/42\/methicillin-resistant-staphylococcus-aureus-%c2%a9\/","title":{"rendered":"Methicillin-resistant Staphylococcus aureus"},"content":{"rendered":"

There is a lot of talk around the world about introducing new categories to describe the degree of infection in chronic wounds e.g. \u2018critical colonisation.\u2019<\/p>\n

I wonder if we should just get an understanding of the basics i.e. transmission of organisms and cross-infection and correct that first because it is a lack of understanding that kills patients!<\/p>\n

A major culprit in cross-infection in all types of healthcare facilities is methicillin-resistant\u00a0Staphylococcus aureus <\/em>(MRSA). It is endemic in tertiary referral hospitals in the developed world. [1] The first Australian isolation was made at the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia , in 1965. [2]<\/p>\n

So what is MRSA and how can we stop the spread of this potentially deadly nosocomial (hospital acquired) pathogen that has become resistant to so many antibiotics? It is a problem particularly for susceptible patients: neonates, immune suppressed and those undergoing surgical procedures. It can cause infection in wounds, urinary tract, blood and\u00a0lungs to name but a few sites in the body.<\/p>\n

Staphylococcus aureus, <\/em>which ordinarily lives in the nose and skin of humans, is a harmless berry-shaped (cocci) organism.<\/p>\n

Staphylococcus aureus <\/em>causes problems when it enters what is normally a sterile body site e.g. the bloodstream, urinary tract and wound tissue. If the host (the patient) cannot destroy the numbers of bacteria the result may be, for example, a bloodstream infection (bacteraemia), a urinary tract infection or a wound infection. A wound may exude frank pus as seen in this pressure ulcer.<\/p>\n

In fact\u00a0Staphylococcus aureus <\/em>was discovered in pus from surgical abscesses in Scotland in 1880 by Sir Alexander Ogston, a surgeon but it was many decades before penicillin became available to treat patients.<\/p>\n

PENICILLIN<\/strong><\/p>\n

When penicillin became available in the early 1940s the prognosis for patients with staphylococcal infection improved radically. Unfortunately within a couple of years the first penicillin-resistant staphylococci were recognized, first in hospitals and subsequently in the community. [3] Resistance to penicillin continued to grow, prompting scientists to develop methicillin, the first semi-synthetic penicillinase-resistant penicillin in 1961. Soon after its introduction however, there were reports of methicillin-resistant\u00a0Staphylococcus aureus <\/em>(MRSA). [4]<\/p>\n

HOW IS MRSA SPREAD?<\/strong><\/p>\n

You are probably all aware that one of the main ways that cross infection occurs is poor hand hygiene. When healthcare workers move from one task or patient (e.g. bed-making) to another (e.g. changing a wound dressing) without hand-washing or hand-rubbing with an alcohol based solution*, pathogenic (disease causing) organisms such as MRSA can be spread\u00a0and<\/em>can be deadly!<\/p>\n

(* see\u00a0 hand hygiene, infection control and bed-making )<\/a><\/p>\n

But when you think about it,\u00a0unclean hands <\/strong><\/em>are only one mode of spread. Anything; bed-linen, clothing, sphygmomanometer cuffs, tourniquets, rolls of tape used to secure dressings \u2014 any object that can harbor pathogenic microorganisms (e.g. MRSA) can serve as an agent of transmission of infection.<\/p>\n

Collectively these objects are known as \u2018fomites\u2019. Look at all the fomites that are used on patient after patient and\u00a0NEVER CLEANED!!! <\/strong><\/em>\u2014- tourniquets and sphygmomanometer cuffs\u2026<\/p>\n

Mary Beard demonstrated, in 1969, how new sphygmomanometer cuffs became highly contaminated with pathogenic micro-organisms soon after their introduction into wards at RPAH. [5] Still, they are\u00a0never <\/strong><\/em>washed between patients. I have never known of any healthcare facility where routine practice is for patients to have their own\u00a0clean <\/em>sphygmomanometer cuffs (until they acquire MRSA- then they are isolated with their own equipment) <\/em>\u2026..Strange!!! Seems a bit back-to-front to me!!<\/p>\n

\u2018When such a potential source of sepsis is unrecognized the risks of transmission become magnified as no steps are taken to minimize them.\u2019 <\/em><\/strong>[5]<\/cite><\/p>\n

We give patients clean sheets and clean gowns. There would be an outcry if ever we used the same unwashed gown on\u00a0two patients <\/em>never mind hundreds or thousands of patients! Yet the same sphygmomanometer cuff is wrapped around arm after arm after arm\u2026 gathering more and more bugs.<\/p>\n

And 40 years after Beard\u2019s [5] research , testing again carried out at RPAH, showed MRSA to be present not just on sphygmomanometer cuffs and tourniquets, but on scissors, sink basins, taps, soap dispensers and the nurses station. [1] So even the most diligent healthcare worker who washes his or her hands has no hope of stopping cross-infection if they have to handle dirty equipment!<\/p>\n

References<\/strong><\/p>\n

1. Barakate MS. Harris JP. West RH. Vickery AM. Sharp CA<\/strong>. Macleod C. Benn RA. A prospective survey of current methicillin-resistant Staphylococcus aureus control measures. Australian and New Zealand Journal of Surgery<\/em>. 1999; 69(10):712-6, Oct.<\/p>\n

2. Barakate MS. Yang YX. Foo SH. Vickery AM. Sharp CA.<\/strong> Fowler LD. Harris JP. West RH. Macleod C. Benn RA. An epidemiological survey of methicillin-resistant Staphylococcus aureus in a tertiary referral hospital. Journal of Hospital Infection<\/em>. 2000; 44(1):19-26, Jan.<\/p>\n

3. Rammelkamp CH, Maxon T. Resistance of Staphylococcus aureus<\/em> to the action of penicillin. Proc. Royal Soc. Exper. Biol. Med.<\/em> 1942;51:386\u2013389.<\/p>\n

4. Jevons MP. \u201cCelbenin\u201d-resistant staphylococci. Br. Med. J.<\/em> 1961;1:124\u2013125.<\/p>\n

5. Sphygmomanometers as a reservoir of pathogenic bacteria. Beard MA. McIntyre A. Rountree PM. The Medical Journal of Australia <\/em>1969; 2: 758<\/p>\n","protected":false},"excerpt":{"rendered":"

Mary Beard demonstrated, in 1969, how new sphygmomanometer cuffs became highly contaminated with pathogenic micro-organisms soon after their introduction into wards at RPAH. [6] Still, they are never washed between patients. I have never known of any healthcare facility where routine practice is for patients to have their own clean sphygmomanometer cuffs (until they acquire MRSA- then they are isolated with their own equipment) \u2026..Strange!!! Seems a bit back-to-front to me!!<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-42","post","type-post","status-publish","format-standard","hentry","category-wound-management-articles"],"_links":{"self":[{"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/posts\/42","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/comments?post=42"}],"version-history":[{"count":10,"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/posts\/42\/revisions"}],"predecessor-version":[{"id":209,"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/posts\/42\/revisions\/209"}],"wp:attachment":[{"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/media?parent=42"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/categories?post=42"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/thewoundcentre.com\/a\/wp-json\/wp\/v2\/tags?post=42"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}