Nursing Home Acquisitions: A Case Study

Preventable infections regardless of the causative agent, have become major triggers of unintended patient outcome, increased morbidity, and mortality (Arias, 2010). Methicillin Sensitive Staphylococcus Aureus (MSSA) and Methicillin Resistant Staphylococcus Aureus (MRSA) are the most common causes of healthcare associated infections (HAI) and outbreaks in acute care hospitals and community settings (CADTH, 2010). The widespread infection with the MRSA pathogen is believed to have increased from 2.4 percent in 1975 to 29 percent in 1991 and 2003 in hospitals across the United States (U S) (CADTH, 2010). The prevalence is even greater among Intensive Care Unit (ICU) patients at 53 percent (CADTH, 2010) and continues to rise due to the widespread

Fit Adult Care Home LLC is a residential care home located in the beautiful city of Gresham, Oregon, which is Multnomah County. Our historic community is the fourth largest in the state with wonderful restaurants and shops. Gresham is a wonderful place to live with lots of events and activities for family and friends to enjoy when visiting.

Howard Terry Newman is 67 year old retired printer who suffered from Parkinson’s disease as well as arthritis, voice impairment, hiatal hernia, and heart trouble. Mr. Newman, the appellee, is contesting his stay between September 19, 1968 and November 11, 1968 at the appellant’s facility, Big Town Nursing Home. The plaintiff was admitted voluntarily by his nephew to the facility with the ability to leave as he pleased. However, on September 22nd, when Mr. Newman attempted to leave the facility, he was told that he could not use the phone or entertain visitors without the administrator’s permission. He proceeded to walk out; he was brought back and restrained on Wing 3 with “senile patients, drug addicts, alcoholics, mentally disturbed, incorrigibles and uncontrollables” according to the administrator testimony.

Hospital-acquired infections (HAIs), specifically those involving multi-drug resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are associated with increased morbidity and mortality, as well as higher cost of healthcare and longer length of hospital stays for patients. Each year, millions of people acquire infections while receiving care, treatment, and services in hospitals and other health care organizations.

Each state can compare its statistical data to the standardized infection ratio (SIR), a summarized ratio of the culmination of national data; this is an excellent method to track the progress in the goal of reducing and eventually eradicating HAIs. The report for the state of Kentucky on HAIs in the state’s acute care hospitals was based on information received from a total of 116 hospitals that provided data for this survey. Unfortunately, the incidence of reported HAIs associated with Methicillin-resistant Staphylococcus aureus (MRSA), a type of laboratory identified hospital-onset bloodstream infection, is extremely high. Kentucky’s reported incidences in 2014 of patients infected with MRSA while being treated in acute care hospitals is 25% higher than the national baseline. This information is a red flag for the state’s epidemiology experts and healthcare professionals, that infection control protocol in place should be reviewed and researched to determine what can be done, either on a hospital-to-hospital based level or a state-wide level, to improve the efficiency of reducing or eliminating HAIs that are associated with MRSA infections. One area that the state’s statistical data rates very well is in Central Line-Associated Bloodstream Infections (CLABSIs). Kentucky’s number of reported incidences of this type of infection is 45% lower than the national baseline, suggesting that the protocol used for this type of infection is very effective compared to what is practiced in other

According to Herman, Kee, Moores, and Ross (2008), “there is no data to support use of mupirocin or antiseptic body washes to eliminate colonization in people with community acquired MRSA (p.223).” Furthermore, they advise that proper hand washing, good personal hygiene, and appropriate wound care should be sufficient. However, advises provider to consult an infection disease specialist to discuss measure to discuss colonization (p.223).

Healthcare is an ever-evolving field. The debate over whether contact isolation precautions for patients who have either a methicillin-resistant Staphylococcus aureus (MRSA) infection or a vancomycin-resistant Enterococcus (VRE) infection is one of the most recent inquiries that healthcare facilities are currently focused on. Healthcare-associated infections (HAIs) – infections patients can get while receiving medical treatment in a healthcare facility, are a major, yet often preventable, threat to patient safety. On any given day, approximately one in 25 hospital patients has at least one healthcare-associated infection (Center for Disease Control [CDC] and Prevention, 2010, para 1-2). The category of protective isolation, was eliminated in the 1983 revision of the CDC’s Guidance for Isolation Procedures in Hospitals. This was based on evidence that simple protective isolation offered no advantage over routine care for most immunocompromised patients (Wigglesworth, 2003, para 6). However, some studies have identified a reduced risk of infection and improved outcomes associated with the routine use of barrier precautions, such as wearing gloves and gowns in high-risk populations.

My organization is currently using targeted MRSA surveillance of only those patients who meet the predetermined criteria such as screening those patients who are from the nursing home, ICU patients, and patients who have a history of MRSA. The practice of universal MRSA surveillance presents a great opportunity for decreasing the incidence and risk of MRSA transmission and hospital acquired infection. It is a great tool to improve and implement measures designed at providing a higher quality of care and improving patients’ outcome. I believe that these types of evidence should prompt hospitals or healthcare organizations to take the opportunity and take advantage of the data that was gathered to utilize the use of universal MRSA screening.

Healthcare-associated MRSA is an infection that you get during a stay in a hospital, rehabilitation facility, or nursing home.

Methicillin Resistant Staphylococcus Aureus (MRSA) is a strain of staph bacteria which has developed resistance to the antibiotics designed to treat common staph infections (Winterstein, 2009, p.189). Originally viewed as a hospital pathogen, MRSA has now begun to appear in the community. Hence, the infection is now distinguished by its origin, defined as hospital-associated MRSA (HA-MRSA), or community-associated MRSA (CA-MRSA). The close proximity of athletes, who often share soap, towels, and other items commonly used in the dressing room, as well as the vigorous physical contact involved in sporting activity (both practice and competition), have led to MRSA becoming a concern in athletics. MRSA is a concern because it can lead to severe infection and even morbidity (Indeed, athletes have become a target population for MRSA. A recent study of 377 varsity college athletes at Vanderbilt University confirms that those involved in contact sports were more than twice as likely to carry MRSA (Jiminez-Truque, 2014). It is believed that the higher prevalence of MRSA in contact sports is a result of the increased skin-to-skin contact which can lead to abrasions and cuts, which permit the superbug to enter the body and colonize it (Jiminez-Truque, 2014). Treatment of MRSA involves draining of abscesses, combined with administration of powerful antibiotics, usually intravenously (Winterstein, 2009, p.187). Since MRSA is resistant to the antibiotics developed to treat it

The Nursing home (NH) residents are at a higher risk of carrying MRSA than others because of the high pervasiveness of comorbidities, sustained skin sores, and recurrent exposure to antibiotics (Bellini et al., 2015, p. 401). Social activities in nursing homes can attribute the cross-transmission of MRSA among the residents, as well as nursing homes and hospitals influence each other due to the frequent admissions from one site to another (Bellini et al., 2015, p. 401). NH residents typically display various comorbidities and more prominent functional reliance, requiring more involved, contact care from health care workers, and they are more exposed to health care worker interaction than hospitalized patients due to the fact they stay longer in NHs compared to

Everyone is at risk to get the MRSA infection, especially if you have commonly done any of the above. "Two in 100 people carry MRSA." (CDC, MRSA) The risk of contracting MRSA is higher if you, have a low immune system, are in a hospital a lot (inpatient care), if you have had a catheter/IV, if you are sharing personal items, and if you are in close contact with others a lot. So how can you reduce your risk? "By maintaining good hand and body hygiene, keep cuts and scrapes covered until healed, avoid sharing personal items, get care early." (CDC, MRSA)

MRSA is no longer solely transmitted throughout the health care setting, it is within the community. The risk factors of MRSA within the health care setting is being hospitalized because patient are more vulnerable, having an invasive medical device implanted because it allows MRSA easier access into the body and staying in a long-term care facility because even carriers of MRSA may spread the disease(Methicillin Resistant Staphyloccus aureus (MRSA), 2016). The risk factors within the community is partaking in contact activities because of the skin to skin contact and the cuts and abrasion which MRSA can get into and living in a crowded area or unsanitary conditions because MRSA can easily be spread (Methicillin Resistant Staphyloccus aureus (MRSA),

As nurses, taking care of patients with MRSA can be seen in everyday practice. It can be seen in patients with sepsis from an infected wound, patients who have pneumonia, or patients who only have a colonization for it (“Methicillin-resistant Staphylococcus aureus (MRSA), 2015”). Regardless if it’s colonization or an active infection, and the source of the infection, proper policies and procedures are in place to reduce the transmission of MRSA to other patients in the hospital or nursing home setting. This includes performing proper hand hygiene and standard precautions, as well as wearing protective gown and gloves when entering the patient’s room. It is very important to adhere to these policies and procedures and educate others on the importance of these policies and procedures to reduce the transmission of MRSA to others.

The major barrier to implementation of improving MRSA management through MRSA decolonization strategies is economic in nature. Financial costs are associated with both MRSA screening and decolonization strategies (Nelson, Samore, Smith, Harbarth, & Rubin, 2010). As an APN, the author was trained to analyze healthcare policies and submit recommendations that could further improve patient healthcare outcomes. The author believes that the hospital business administrators will be alarmed once she submits the proposal for adding MRSA screening and decolonization guidelines to the hospital’s policy on SSI prevention. Typically, hospitals try to avoid spending money on things that they do not see immediate