Running head: METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
MRSA: An Emerging Infectious Disease
Anna M. Cunningham
Ferris State University
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Abstract
Methicillin-resistant staphylococcus aureus (MRSA) is an emerging infectious disease that
causes many infections. The purpose of this paper is to discuss the treatments and symptoms of
MRSA, and how it can be prevented. The evidence that will be presented will show how MRSA
is spread and how healthcare providers can work to educate the public and make the population
more aware of how to prevent this infectious disease.
Keywords: MRSA, disease, treatment, healthcare
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MRSA: An Emerging Infectious Disease
MRSA is an emerging disease that affects many people. To treat this disease the public
needs to be able to site the symptoms, and know how to treat MRSA. The public needs to know
in what settings they can come in contact with MRSA, and how to take precautions. MRSA can
be life-threatening, and can be hard to cure. There are many ways people themselves can take
steps to help prevent the spread of MRSA, and prevent contracting the disease themselves. To
make the public more aware of this disease, and how to prevent it, hospitals and other healthcare
providers can educate the public.
What is MRSA?
MRSA is an emerging infectious disease that is caused by bacterium that can cause
infections of the blood, skin, lungs, and other parts of the body. “Clinical syndromes associated
with MRSA disease include skin and soft tissue infections (SSTI), bacteremia and endocarditis,
pneumonia, bone and joint infections, and central nervous system (CNS) infections” (Liu et al,
2011). There are many diseases and infections that can be caused and associated with MRSA.
Infections associated with MRSA can be mild to life threatening. Infectious diseases such as
MRSA are
“emerging and reemerging infectious diseases are classified as category C biological
agents by the Center for Disease Control and Prevention because of their potential for
high rate of contagion, ability to cause widespread morbidity and mortality, and society’s
lack of immunity toward them” (Veenema, 2007, p 439).
MRSA and infections associated with MRSA need to be detected soon, and treated before they
can become a serious problem. MRSA can appear as a severe infection or a skin infection.
Severe infections would be “bloodstream infections, surgical site infections, or pneumonia”
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(CDC, 2010, Symptoms). These infections can be life-threatening, and need to be treated
quickly. Skin infections may appear as “pustules or boils which often are red, swollen, painful,
or have pus or other drainage” (CDC, 2010, Symptoms). These types of infections most
commonly occur at sites of visible skin trauma, and areas of the body covered by hair. Skin
infections may not be as life-threatening, but also need to be treated quickly before they spread.
Skin infections, as well as, other infections may be easily spread within the body and to other
people.
How to Treat MRSA
MRSA is highly contagious and can be hard to treat. There are not many antibiotics that
are able to treat MRSA. There are however, several that can help with the treatment of MRSA
and other infections. Someone who may have a MRSA related infection should seek the help of a
medical professional. Home treatment may cause the infection to worsen or may cause the
spread of the disease to others. The treatment may include having a healthcare professional drain
the infection, or prescribe an antibiotic. Skin infections need to be kept clean and properly
bandaged. This way the infected area does not come in contact with other people. If sores come
into contact with cuts or abrasions on other people’s skin it could cause the infection to spread to
other people. If an antibiotic is prescribed all of the doses need to be taken to make sure the
infection is completely cleared up. Also because the infection was cured does not mean that it
cannot be contracted again. No immunity will be built up to prevent the same infection again
(CDC, 2010, Treatment). Not many antibiotics are able to be used for various reasons, depending
on patient history and allergies. Also depending on what type of MRSA infection a patient has
acquired. When treating MRSA, cultures must be taken to make sure that the diagnosis is
correct. There are different types of MRSA and different strains that need to be treated in
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different ways. The uncommon strains may be harder to treat and may spread easier, than the
traditional hospital based MRSA strains (CDC, 2010, Diagnosis & Testing). This is what makes
treating MRSA related diseases and infections difficult.
Who is at Risk?
Most of the population is at risk for contracting MRSA. People that are most likely to
contract MRSA are patients in healthcare settings, visitors of infected patients, and in the
community. Patients in healthcare settings have weakened immune systems and are at greater
risks to contract MRSA. A common way MRSA is spread in a healthcare setting is because of
surgery and the use of catheters. “Common infections include surgical would infections, urinary
tract infections, bloodstream infections, and pneumonia” (CDC, 2010, People at risk). Visitors of
infected patients should make sure they follow proper hand washing procedures and do not touch
wound sites or touching catheters. Skin infections in the community can be spread easily. This is
more common when people are living in close courters such as: “dormitories, military barracks,
correctional facilities, and daycare centers” (CDC, 2010, People are risk). Other populations that
are at risk for contracting a MRSA related disease are people who have an HIV infection,
hemodialysis, and people in long-term care facilities. Individuals who have the HIV virus are at
risk for MRSA. Skin infections were more easily spread because of advanced
immunosuppression. In a case-control surveillance study 5 per 100 patients who developed a
MRSA related infection had the HIV infection (Anderson, 2011). “Patients with long-term
catheters for hemodialysis are at a higher risk for invasive catheter-related infections due to
MRSA and other pathogens” (Anderson, 2011). After reviewing cases of invasive MRSA
infection, out of 5287 patients, “15 percent occurred in dialysis patients” (Anderson, 2011).
Catheters are draining urine and other waste from the body, so it makes it hard to keep it clean,
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which invites infections to the site of the catheter. Patients at long-term care facilities are also at
a high risk because patients are “transferred between hospitals and long-term care facilities”
(Anderson, 2011). Each patient that is constantly transferred from medical facilities for different
ailments is more likely to catch other infections and diseases. This can be because their immune
systems are not suppressing infections and diseases like they should be. Also other medications
and other medical problems factor into what diseases and infections people are more likely to
acquire. About 15 percent of patients out of a 120 bed facility acquired infections related to
MRSA in a five year observational study (Anderson, 2011). These are numbers that can
decrease, if more preventive steps were taken to prevent patients from acquiring these infections.
Healthcare workers (HCW’s) are also at a high risk for contracting MRSA related infections.
This is an occupational hazard, as many HCW’s are exposed to these infections and bacteria on a
daily basis at work. Factors that play a role in contracting a MRSA related infection are
occupation, workplace, and workplace exposure (Haamann, 2011). Over a 2 year period, 389
cases of MRSA related infections were reported. “The recognized cases were predominately
among staff in hospitals and nursing homes. The most frequent infection sites were ears, nose,
and throats, followed by skin infections” (Haamann, 2011). HCW’s are exposed to these diseases
on a daily basis, and HCW’s that work in nursing homes are around patients who are constantly
transported to and from the hospital for many different ailments. This leaves patients open to
contract many more diseases and infections, which can be passed onto HCW’s who come into
contact with them. Most HCW’s are vaccinated, but they cannot be protected from all diseases
and infections.
MRSA Treatments and Studies
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There are several antibiotics that can be used to treat forms of MRSA. There is “an
increasing proportion of MRSA isolates are resistant to additional antimicrobial agents, which
complicates therapy: (Kaplan, 2012). To treat children who have MRSA related diseases the
drug vancomycin can be used to treat MRSA.
“Vancomycin is a glycopeptide antibiotic that inhibits cell wall synthesis. It is the drug
of choice for the treatment of many invasive infections caused by MRSA, given its
efficacy, safety profile, and convenient dosing” (Kaplan, 2012).
It also is the drug that has the most clinical experience in treating a variety of invasive clinical
syndromes such as: pneumonia, endocarditis, and meningitis. However, vancomycin can be
harmful when it is used to treat patients with high vancomycin MIC (Anderson, 2011). Mortality
was increased when patients were treated for MRSA bacterium when their isolates had elevated
MIC. There is also a problem with vancomycin resistance. There are cases where vancomycin
therapy did not work for patients. The use of the drug mupirocin was tested and used in several
ways. Mupirocin could be used as a topical ointment for five days, three times daily. While
using this topical ointment, it is important to keep the wound clean and use clean and sterile
dressings. Mupirocin could also be used twice daily as an intranasal treatment, along with a daily
bleach bath for five days. Patients were told to use ¼ cup of bleach to one tub full of water. Also
doctors educated people on proper hygiene, how to prevent MRSA, and how to treat it. The
intranasal mupirocin, plus the daily bleach baths were more effective, than education alone. Both
treatments were helpful, but did not demonstrate efficacy. A vaccine was also used to try and
prevent against S. aureus capsular polysaccharide, but failed to show long-term efficacy (Kaplan,
2012).
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A study was done in the Netherlands in 2008 pertaining to livestock farmers and retail
meat, from the results of the study, it can be concluded that people who work in slaughterhouses
or around large populations of animals are at a higher risk for MRSA infections, than the rest of
the population. Three large slaughterhouses in the Netherlands were studied using human and
environmental samples. The slaughterhouses were for pigs and the case study was looking at
nasal carriage, when people are working with pigs. Many people that worked with these pigs
were positive for MRSA and were able to pass this disease onto the animals as well. Not only
were the workers getting sick, but they were able to pass the infections onto the animals. This
means that the meat that was sold to consumers had small traces of MRSA in the meat. This can
be a hazard because people who eat the meat may get sick, as well as, the people who are
working with it. This has to do with working conditions and the actual work itself. Workers in
these slaughterhouses are around live animals and dead livestock. It is also a problem because of
the environment that these workers are working in. The study showed that 5.6 percent of workers
had nasal MRSA from working with the animals that is 14 out of 249 people. This is one more
way that MRSA is transferred, and knowing this information can help business owners take more
precautions for their workers to help prevent the spread of disease. This way their workers are
healthy and the meat that they are selling is healthy for consumers (VanCleef, et al 2010).
How to Prevent MRSA
There are many ways that MRSA can be prevented. By understanding the burden of
MRSA people will be more likely to follow preventive steps. By routinely cleaning and
disinfecting homes, germs that cause MRSA can be prevented. Many cleaners, detergents,
sanitizers, and disinfectants can help with the prevention of MRSA. Cleaning and sanitizing
surfaces will remove “soil, dirt, dust, organic matter, and germs (like bacteria, viruses, and
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fungi)” that can cause infections (CDC, 2010, Environmental). Many disinfectants can be used to
prevent germs and bacteria. The labels can be read and will tell the consumer what germs will be
killed by using a certain product. The label should be read and the cleaner should be used
accordingly. Not using cleaners properly could cause bacteria and other germs to not be removed
from surfaces. No cleaner will get rid of 100 percent of germs, but most cleaners are able to get
rid of most of the germs that can cause many daily illnesses and infections. Laundry should also
be done on a regular basis to prevent clothing and towels from being contaminated by infectious
material. Clothing and other laundry should be bleached and washed according with the right
detergents. When infections do occur it is important to make sure that hard and soft surfaces are
clean and disinfected, to make sure the infection does not spread. The important surfaces to
clean are the ones that touch people’s bare skin each day and any surfaces that could come into
contact with uncovered infections (CDC, 2010, Environmental). It is also important to make sure
public surfaces are clean as well, such as, ones used in gyms or tanning salons. These are places
where many people are coming into contact with surfaces with their bare skin and that many
people use on a daily basis. It is good to make sure these surfaces are clean, but people can also
take preventive cautions to make sure that they do not contract a disease. Such as when using a
weight bench in a gym, a person could put a towel down so that their skin does not touch the
bench itself. Little things such as this can help prevent the spread of diseases among the general
public.
People can also prevent the spread of MRSA by using good personal hygiene. This can
be done by following good hand washing procedures. Using antibacterial soap with warm water,
and making sure that people wash their hands for two minutes, this would be the length of
singing “Happy Birthday” twice. Keeping cuts and scrapes clean and protected is important, as
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well. Also MRSA can be prevented by avoiding contact with other people’s wounds, and by
avoiding sharing personal items such as towels or razors (CDC, 2010, Personal Prevention).
There are also five ways to prevent the spread of MRSA, if the disease has already been
contracted. These steps would be: cover your wound, clean your hands, do not share personal
items, maintain a clean environment, and talk to your doctor. Wounds should be covered and
kept clean at all times. Fresh bandages and proper ointments should be applied daily to make
sure that the wound will heal properly. Proper hand washing procedures should be followed with
an antibacterial soap. Personal items should not be shared such as: “towels, washcloths, razors,
clothing, or uniforms” (CDC, 2010, Personal Prevention). By sharing these items bacteria and
other germs can be spread from one person to another. Maintaining a clean environment is
important for frequently touched surfaces, so that germs and bacteria are not spread throughout
the home. Germs spread every time a surface is touched, it can be handy to keep disinfecting
wipes around the home to prevent the spread of germs. Also talking to a healthcare professional
can give people tips on how to treat infections and the steps to take to prevent the spread of
infections. Also they can seek treatment from their doctor to take care of infections before they
worsen.
Conclusion
It is important to know what MRSA is and how to prevent it. There are many ways
infections can be acquired and it is good to know ways to prevent it. By keeping good hygiene
and a clean living space, it is possible to prevent some types of MRSA. It is also important to
know how MRSA can be contracted in other settings. Knowing how to prevent it and treat it is
important to keep diseases from spreading.
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References
Anderson, D., (2011). Epidemiology of methicillin-resistant Staphylococcus aureus infection in
adults. UpToDate. Retrieved from http://www.uptodate.com
Centers for Disease Control and Prevention [CDC]. (2010, August 9). Environmental Cleaning
& Disinfecting for MRSA. Retrieved from http://www.cdc.gov
Centers for Disease Control and Prevention [CDC]. (2010, December 2). Diagnosis and Testing
of MRSA Infections. Retrieved from http://www.cdc.gov
Centers for Disease Control and Prevention [CDC]. (2010, August 9). People at Risk of
Acquiring MRSA Infections. Retrieved from http://www.cdc.gov
Centers for Disease Control and Prevention [CDC]. (2010, August 9). Personal Prevention of
MRSA Skin Infections. Retrieved from http://www.cdc.gov
Centers for Disease Control and Prevention [CDC]. (2010, August 9). Symptoms of MRSA.
Retrieved from http://www.cdc.gov
Centers for Disease Control and Prevention [CDC]. (2010, August 9). Treatment of MRSA
Infections. Retrieved from http://www.cdc.gov
Haamann, F., Dulon, M., & Nienhaus, A., (2011). MRSA as an occupational disease: a case
series. Int Arch Occup Environ Health. doi:10.1007/s00420-010-0610-7
Kaplan, S., (2012). Prevention and control of methicillin-resistant Staphylococcus aureus in
children. UpToDate. Retrieved from http://www.uptodate.com
Liu, C., Bayer, A., Cosgrove, S., Daum, R., Fridkin, S., Gortwitz, R., Sheldon, K., Karchmer, A.,
Levine, D., Murray, B., Rybak, M., Talan, D., & Chambers, H., (2011). Clinical Practice
Guidelines by the Infectious Diseases Society of America for the Treatment of
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Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children. Clinical
Infectious Diseases. doi: 10.1093/cid/ciq146
VanCleef, B., Broens, E., Voss, A., Huijsdens, X., Zuchner, L., VanBenthem, B., Kluytmans, J.,
Mulders, M., & VanDeGiessen, A., (2010). High prevalence of nasal MRSA carriage in
slaughterhouse workers in contact with live pigs in the Netherlands. Epidemiol. Infect.
doi:10.1 17/S0950268810000245
Veenema, T.G.(2007). Disaster nursing and emergency preparedness for chemical, biological
and radiological terrorism and other hazards. New York, NY: Springer Publishing Co.
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Grading Rubric for the Evidence-based Paper r/t Emerging Infectious Disease
A. Introduction
B. Descriptive
summary of the
relevant and best
evidence related to
an emerging
infectious disease in
the areas of
transmission/isolatio
n, clinical
presentation,
diagnosis, and
therapy
C. An analysis of the
evidence (this is a
critical appraisal of
the evidence and
what the evidence
suggests)
D. Identify factors
and/or situations that
may promote this
emerging disease
that
are supported with
the
literature.
E. Conclusion or
Summary
(2 points)
The introduction is
below average or
missing. The focus
of the paper is not
clear as well as
what will be
discussed in the text
of the paper
(14 points)
There is a below
average description
of relevant and best
evidence related to
an emerging
infectious disease
that includes
transmission/isolatio
n, clinical
presentation,
diagnosis, and
therapy. Three or
more areas may not
be clearly
addressed.
(14 points)
There is a below
average critical
appraisal of the
evidence and what
the evidence
suggests about this
emerging infectious
disease. There is a
description rather
than an analysis.
(14 points)
The identification of
factors and/or
situations that may
promote this
emerging disease is
below average. It is
not clear as to what
biological,
environmental,
societal, or behavior
factors/situations
may promote this
disease. There is
minimal or no
support
from the literature
for
the identified
factors/situations.
(2 points)
There is a below
average summary
(3 points)
There is an average
introduction to the
paper. The focus of
the paper may be
somewhat unclear as
well as what will be
discussed in the text
of the paper
(16 points)
There is an average
description of relevant
and best evidence
related to an
emerging infectious
disease that includes
transmission/isolation
, clinical presentation,
diagnosis, and
therapy. Two of the 4
areas may not be
clearly addressed.
(4 points)
There is a good
introduction to the
paper that includes
a clear focus to the
paper and what will
be discussed in the
text of the paper
(18 points)
There is a good
description of
relevant and best
evidence related to
an emerging
infectious disease
that includes
transmission/isolatio
n, clinical
presentation,
diagnosis, and
therapy.
(5 points)
There is an
excellent
introduction to the
paper that includes
a very clear focus of
the paper and what
will be discussed in
the text of the paper
(20 points)
There is an
excellent description
of relevant and best
evidence related to
an emerging
infectious disease
that includes
transmission/isolatio
n, clinical
presentation,
diagnosis, and
therapy.
(16 points)
There is an average
critical appraisal of
the evidence and
what the evidence
suggests about this
emerging infectious
disease. The analysis
of the evidence may
not be clear or indepth.
(16 points)
There is an average
identification of
factors and/or
situations that may
promote this
emerging disease.
Only a few biological,
environmental,
societal, or behavior
factors/situations are
identified that may
promote this disease.
Support from the
literature is not
provided for several
of the identified
factors/situations.
(18 points)
There is a good
critical appraisal of
the evidence and
what the evidence
suggests about this
emerging infectious
disease.
(20 points)
There is excellent
critical appraisal of
the evidence and
what the evidence
suggests about this
emerging infectious
disease
(18 points)
There is a good
identification of
factors and/or
situations that may
promote this
emerging disease.
Some biological,
environmental,
societal, or behavior
factors/situations
are identified that
may promote this
disease. Support
from the literature
may not be provided
for a few of the
identified
factors/situations.
(20 points)
There is an
excellent
identification of
factors and/or
situations that may
promote this
emerging disease.
Many biological,
environmental,
societal, or behavior
factors/situations
are identified that
may promote this
disease. Clear
support from the
literature is provided
for all identified
factors/situations.
(3 points)
There is an average
summary or
(4 points)
There is a good
summary or
(5 points)
There is an
excellent summary
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
F. Data & Information
G. APA Format;
Spelling & Grammar;
Clarity of ideas
or conclusion
related to the key
points in the paper.
All new information
is introduced or
conclusion is
missing.
(14 points)
Less than 3
resources beyond
the textbook are
used to support your
plan. Less than 50%
are current within
the last 5 years.
(4 points)
APA format is below
average; >15 errors
in grammar or
spelling; Ideas are
not clearly
presented
14
conclusion related to
the key points in the
paper. Mostly new
information is
introduced.
conclusion related
to the key points in
the paper. Some
new information
may be introduced.
or conclusion
related to the key
points in the paper.
No new information
is introduced.
(16 points)
A minimum of 3
resources beyond the
textbook are used to
support your plan.
50% are current
within the last 5
years.
(6 points)
APA format is
average; 11-15 errors
in grammar or
spelling; Ideas are
almost always clearly
presented
(18 points)
A minimum of 4
resources beyond
the textbook are
used to support
your plan. 75% are
current within the
last 5 years.
(8 points)
APA format is good;
5-10 errors in
grammar or
spelling; Ideas are
clearly presented
(20 points)
A minimum of 5
resources beyond
the textbook are
used to support
your plan. All are
current within the
last 5 years.
(10 points)
APA format is
excellent; <5 errors
in grammar or
spelling; Ideas are
clearly presented
Comments:
Great job overall on your paper. You selected a good disease to report on. You fulfilled all criteria and
elements of the paper above and beyond expectations. Your content was well researched and
documented with accurate information and facts. Data and evidence-based information was well
prepared from sources and articulated clearly to reader.
Good formatting, but see paper for minor notes on abstract.
Overall, great work!