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Methicillin-resistant Staphylococcus Aureus (MRSA)

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Methicillin-resistant Staphylococcus Aureus (MRSA) . Megan Shrum Concordia University. What Is MRSA?. Methicillin-resistant Staphylococcus Aureus : P otentially fatal staph bacterium that commonly causes skin infections. - PowerPoint PPT Presentation
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MEGAN SHRUM CONCORDIA UNIVERSITY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)
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Page 1: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

M E G A N S H R U MC O N C O R D I A U N I V E R S I T Y

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

(MRSA)

Page 2: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

WHAT IS MRSA?

• Methicillin-resistant Staphylococcus Aureus: • Potentially fatal staph bacterium that commonly

causes skin infections.• Challenging to treat because of its resistance to

certain antibiotics including methicillin, oxacillin, penicillin, and amoxicillin. (CDC, NCEZID, DHQP, 2012).

• Occur in both the community and healthcare setting.

Page 3: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

PUBLIC HEALTH DOMAINS

• Epidemiology

• Environmental Factors

• Biostatistics

• Biomedical Factors

• Social & Behavioral Factors

• Health Policies

Page 4: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

EPIDEMIOLOGY• MRSA can affect anyone in any given setting.• Historically, infections were commonly found in hospitalized patients• Now we are seeing more infections occurring within our

communities• People who are living in crowded living conditions are more

susceptible to MRSA• Those with weakened immune systems are more susceptible• Athletes who participate in sports which involve physical contact are

more susceptible • Patients in healthcare facilities, who undergo procedures and have

weakened immune systems, are at greater risk

(Pastagia, Kleinman, Lacerda de la Cruz, Jenkins, 2012).

Page 5: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

EPIDEMIOLOGY CONTINUED…

• Infections occur through• Indirect and direct contact with the bacteria• Skin-to-skin contact• Through Exposed wounds(Pastagia, Kleinman, Lacerda de la Cruz, Jenkins, 2012).

• Common MRSA infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia (CDC, NCEZID, DHQP, 2012).

• MRSA can cause hemorrhagic-necrotizing pneumonia and possibly death (Aldabagh, Tomecki, K. J, 2010).

Page 6: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

SOFT TISSUE MRSA INFECTIONS

• Soft tissue MRSA infections:• abscesses, • boils, • Cellulitis• folliculitis.

(Aldabagh, Tomecki, K. J, 2010).

Page 7: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

EPIDEMIOLOGY: STATISTICS

• Healthcare onset:• Infections which began in hospitals, declined 28% from

2005 through 2008. • A 17% drop in invasive MRSA infections that were

contracted outside the hospital within patients who recently left the hospital

• Bloodstream infections within hospitalized patients has dropped 50% from 1997 to 2007

• Community Onset:• Infections within the community are increasing rapidly

throughout the last decade.(CDC, NCEZID, DHQP, 2012)

Page 8: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

CA= community associated HACO=healthcare-associated community-onsetHO=hospital onset

Page 9: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

ENVIRONMENTAL FACTORS

• MRSA infections can occur in any geographic location, on any part of a person’s body and can affect anyone (Pastagia, Kleinman, Lacerda de la Cruz, Jenkins, 2012).

• Are seen in both community and healthcare settings

Page 10: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

ENVIRONMENTAL FACTORS: FACILITIES THAT ARE MORE SUSCEPTIBLE TO MRSA CONTAMINATIONS

• Athletic facilities• Dormitories• Military barracks• Correctional facilities• Daycare centers • Prisons• Facilities that experience crowded living

• Athletes may spread MRSA through their locker rooms in the showers, in whirl pools, through contact with each other and athletic equipment

(CDC et al., 2012).

Page 11: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

BIOSTATISTICS

Active Bacterial Core surveillance (ABCs) • Provides CDC and laboratories with demographic

information and bacterial isolates• Studies risk factors, evaluates vaccine effectiveness, and

monitores the effectiveness of prevention policies. (NCIRD, DBD, 2012).

Health departments, individual hospitals, and academic medical centers are working with the CDC to track MRSA

infections (CDC, NCEZID, DHQP, 2011).

The CDC is committed to several short- and long-term “surveillance projects”

Page 12: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

BIOSTATISTICS…

• MRSA Case Patient Report Form:• http://www.cdc.gov/abcs/downloads/MRSA_case_rpt_form_2010.pdf

• Forms are filled out for each MRSA patient at the healthcare facility and sent to the CDC.

Forms include:• Description of patient (age, gender, ethnicity, race etc.)

• Where treated• Was it Healthcare or community associated

• Severity • Type/location of infection• Underlying factors,]• Predisposing factors • Outcome of the patient.

(NCIRD, DBD, 2012).

Page 13: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

BIOMEDICAL FACTORS• MRSA…• Caused by the bacteria Staphylococcus Aureus

• Is a human pathogen• The pathogens contain toxins and virulence mechanisms

• have altered PBP’s that antibiotics cannot attach to

• Produce beta-lactams and lactamase

• causes resistance to certain beta-lactams antibiotics. • methicillin, amoxicillin, penicillin, and oxacillin.

• Hard to treat because of it’s resistance to antibiotics

(Shopsin, Kreiswirth, 2001) (Wang, Khan, Hines, Mediavilla, Zhang, Chen, Hoet, Bannerman, Pancholi, Robinson, Kreiswirth, Stevenson, 2012).

Page 14: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

BIOMEDICAL FACTORS…

• Community associated (CA) MRSA• Contain genes that are associated with skin and soft-

tissue infections. • Panton-Valentine leucocidin (PVL) • Exfoliative toxin

• Less resistance to methicillin • Hospital associated (HA) MRSA • larger resistance to methicillin• associated with urinary tract, respiratory tract, and skin

infections.

(Giudice, Blanc, Durupt, F., Bes, M., Martinez, J.., Counillon, E., Etienne, 2006).

Page 15: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

SOCIAL & BEHAVIORAL FACTORS: ECOLOGICAL MODEL

• The ecological model states that our social environment which includes intrapersonal,

interpersonal, institutional, community, and public policy factors, all influence the

behaviors we choose to partake in.

Page 16: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

BEHAVIORAL FACTORS THAT INCREASE SUSCEPTIBILITY:

• Poor hygiene• (biting nails, leaving wounds untended and open etc.)

• Participating in risky sexual behavior• Drug Use• Sharing of needles• Unsterile needles• Participate risky behaviors

• Using public facilities• Participating in sports• Living in a crowded living situation

(Cohen, Shuler, McAllister, Fosheim, Brown, Abercrombie, et al., 2007)

Page 17: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

ECOLOGICAL MODEL• Intrapersonal Factors: • Focuses on the individual and their knowledge and attitudes towards

certain behaviors (Schneider, 2011).• We need to educate people about what MRSA is and what behaviors make

them more susceptible so they are convinced to change their behaviors. • Interpersonal Factors:• Include peer pressure and family beliefs which influence a person’s

behaviors and tendencies (Schneider, 2011). • Educate peer groups and family members in order for individuals to

establish healthy beliefs, attitudes, behaviors, and tendencies. • Institutional factors:• Institutions must help educate employees and also set standards and

enforce regulations in order to prevent the spread of MRSA within the communities.

• Community:• Must educate the population all about MRSA and how to prevent it.

Communities are largely responsible for providing education to the public. (Kreisel, K. M., Johnson, J., Stine, O., Shardell, M. D., Perencevich, E. N., Lesse, Roghmann, 2010).

Page 18: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

ECOLOGICAL MODEL: PUBLIC POLICY• Federal:

• MRSA Prevention Collaborative works to address current MRSA issues

• Affordable Care Act (ACA) funds states to help prevent healthcare-associated infections (HAI).

• Require states to report HAI to the NHSN

• CDC Prevention Epicenter works to prepare and inform states about how to prevent and treat HAI

• Hand Hygiene Collaborative • NIOSH, HCSA and NORA are

organizations that establish standards within hospitals, the workplace, and also environmental and community settings

(Department of Health and Human Services, 2009)(CDC, NCEZID, DHQP, 2012).

Page 19: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

PUBLIC POLICIES CONTINUED• State• Have health departments in Emerging Infectious Diseases (EIP)• Enforce regulations set by the federal government within their state

(like the Hand Hygiene Collaborative)• Report MRSA cases to NHSN

• Local• Every community addresses MRSA differently• Awareness and educational programs are seen within schools, the

workplace and other community facilities• Implement the federal and state regulations within their communities• Use the CDC as an educational tool• Work within institutions to promote healthy living and hygiene

practices

(Department of Health and Human Services, 2009)(CDC, NCEZID, DHQP, 2012)

Page 20: Methicillin-resistant Staphylococcus  Aureus  (MRSA)

REFERENCES• Bo Shopsin and Barry N. Kreiswirth. (2001). Molecular Epidemiology of Methicillin-Resistant Staphylococcus

aureus. Retrieved September 29, 2012 from: http://wwwnc.cdc.gov/eid/article/7/2/pdfs/70-0323.pdf.• Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

Division of Healthcare Quality Promotion (DHQP). (2012). State-based HAI prevention. Received from: http://www.cdc.gov/hai/state-based/index.html.

• Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP). (2012). Methicillin-resistant Staphylococcus Aureus (MRSA) Infections. Retrieved September 15, 2012 from: http://www.cdc.gov/mrsa/.

• Centers for Disease Control and Prevention, National Center for Emerging and ZoonoticInfectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP). (2011). MRSA Statistics. Retrieved September 22, 2012 from: http://www.cdc.gov/mrsa/statistics/.

• Cohen AL, Shuler C, McAllister S, Fosheim GE, Brown MG, Abercrombie D, et al. (2007). Methamphetamine use and methicillin-resistant Staphylococcus aureus skin infections. Received October 5, 2012 from: http://wwwnc.cdc.gov/eid/article/13/11/07-0148.htm.

• Department of Health and Human Services. (2009). State of the Sector: Health Care and Social Assistance. Retrieved October 20, 2012 from: http://www.cdc.gov/niosh/docs/2009-138/pdfs/2009-138.pdf.

• del Giudice, P. P., Blanc, V. V., Durupt, F. F., Bes, M. M., Martinez, J. P., Counillon, E. E., & ... Etienne, J. J. (2006). Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections. British Journal

• Kreisel, K. M., Johnson, J., Stine, O., Shardell, M. D., Perencevich, E. N., Lesse, A. J., & ... Roghmann, M. (2010). Illicit Drug Use and Risk for USA300 Methicillin-Resistant Staphylococcus aureus Infections with Bacteremia. Emerging Infectious Diseases, 16(9), 1419-1427. doi:10.3201/eid1609.091802

• Schneider, Mary-Jane. (2011). Introduction to Public Health. (3rd Ed) Ontario, CA: Jones and Bartlett Publishers.• Shu-Hua Wang, Yosef Khan, Lisa Hines, José R. Mediavilla, Liangfen Zhang, Liang Chen, Armando Hoet, Tammy

Bannerman, Preeti Pancholi, D. Ashley Robinson, Barry N. Kreiswirth, and Kurt B. Stevenson. (2012). Methicillin-Resistant Staphylococcus aureus Sequence Type 239-III, Ohio, USA, 2007–2009. Retrieved September 29, 2012 from: http://wwwnc.cdc.gov/eid/article/18/10/pdfs/12-0468.pdf.

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