microsystem intro

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Introduction
Microsystem Background
Virginia Hospital Center’s Labor and Delivery unit, located in Arlington, Virginia, is part
of the Mayo Clinic Care Network where more than 4,500 babies are born each year (Virginia
Hospital Center [VHC], 2018). VHC manages a 64-bed unit with a family-model approach to
maternity care (VHC, 2018). This labor and delivery microsystem includes: obstetric providers,
registered nurses, anesthesiologists, obstetric techs, unit secretaries, nursing managers, and the
hospital director.
The aim of this project is to reduce to incidence of Methicillin-resistant Staphylococcus
aureus (MRSA) on VHC’s Labor and Delivery Unit.
Labor and Delivery Unit MRSA Problem
Approximately one-third of the world’s population colonize the Staphylococcus aureus
(S. aureus) bacterium (National Institute of Allergy and Infectious Diseases [NIAID, 2018). One
percent of those that colonize S. aureus are diagnosed with Methicillin-resistant Staphylococcus
aureus (MRSA) (NIAID, 2018). MRSA is found primarily on the skin and nares and is resistant
to penicillin-like beta lactam antibiotics (NIAID, 2018). Long-term prescription abuse and
overuse of broad spectrum antibiotics is cited as one of the causative factors of MRSA’s
resistance to most available drugs (NIAID, 2018).
Those that colonize MRSA do not necessarily have an active infection unless the
pathogen enters an opening in the skin or mucosa and impacts supporting structures (Centers for
Disease Control and Prevention [CDC], 2018). Symptoms of MRSA infection include an
erythematous, swollen, painful, warm lesion on the skin (CDC, 2018). The infection can also
become systemic and develop into osteomyelitis, endocarditis, pneumonia, or thrombophlebitis
(Ventola, 2015).
Treating an active MRSA infection is complicated for any patient, but it is especially
dangerous for neonates (NIAID, 2018). Neonates are particularly susceptible to MRSA
colonization and subsequent infection due to their immature immune system (Ventola, 2015).
Unlike adults who have had time to cultivate their immune responses over time, neonates have
only been exposed to the semi-allogeneic sterile environment of the mother’s womb (Basha,
Surendran, & Pichichero, 2015). After birth, they are thrust into a microbe-filled world with
limited physiological ability to exercise their adaptive and innate immune system (Basha,
Surendran, & Pichichero, 2015, page 1172). Acquiring early defense mechanisms is a normal
progression of development for the neonate, but the danger of antibiotic resistant bacterial
infections requires diligence on behalf of the nursing staff….
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