MRSA and VRE in a Rural MRSA and VRE in a Rural Community HospitalCommunity Hospital

Graduation Project 2008Graduation Project 2008

Mehvish AllyMehvish Ally

What is MRSA?What is MRSA?

MRSA (Methicillin-MRSA (Methicillin-resistant resistant Staphylococcus Staphylococcus aureusaureus ) is a type of ) is a type of staph infection that is staph infection that is responsible for human responsible for human infections that are very infections that are very difficult to treat. difficult to treat.

MRSA was discovered in MRSA was discovered in 1961 in the UK. It is now 1961 in the UK. It is now found worldwide. MRSA is found worldwide. MRSA is often referred to in the often referred to in the press as a "super bug."press as a "super bug."11

1. multi-resistant 1. multi-resistant An image of MRSA An image of MRSA from an electron from an electron microscopemicroscope

PurposePurpose

To ascertain whether or not there is a To ascertain whether or not there is a major difference in infection rates of major difference in infection rates of MRSA and VRE among rural and MRSA and VRE among rural and urban hospitals and communities. urban hospitals and communities. The rural and urban areas used for The rural and urban areas used for comparison were Bradford and comparison were Bradford and Pittsburgh, respectively. Pittsburgh, respectively.

What is VRE?What is VRE?

Vancomycin-Vancomycin-resistant Enterococci resistant Enterococci (VRE) are bacteria (VRE) are bacteria that have evolved that have evolved from MRSA and have from MRSA and have become resistant to become resistant to the antibiotic the antibiotic vancomycin. VRE vancomycin. VRE was not reported in was not reported in US hospitals until US hospitals until 19891989

An image of VRE from an electron microscope

Types of MRSATypes of MRSA

HA-MRSA: Hospital Acquired MRSAHA-MRSA: Hospital Acquired MRSA CA-MRSA: Community Acquired CA-MRSA: Community Acquired

MRSAMRSA

Symptoms/AffectsSymptoms/Affects

Staph infections, including MRSA and Staph infections, including MRSA and VRE, generally start as small red VRE, generally start as small red bumps that resemble pimples, boils bumps that resemble pimples, boils or spider bites. These can quickly or spider bites. These can quickly turn into deep, painful abscesses turn into deep, painful abscesses that require surgical draining.that require surgical draining.

Sometimes the bacteria remain Sometimes the bacteria remain confined to the skin. But they can confined to the skin. But they can also burrow deep into the body, also burrow deep into the body, causing potentially life-threatening causing potentially life-threatening infections in bones, joints, surgical infections in bones, joints, surgical wounds, the bloodstream, heart wounds, the bloodstream, heart valves and lungs. valves and lungs.

CausesCauses

Unnecessary antibiotic use in Unnecessary antibiotic use in humans. humans.

Antibiotics in food and water. Antibiotics in food and water. Germ mutation. Germ mutation.

Risk FactorsRisk Factors

A current or recent hospitalization.A current or recent hospitalization.--1.2 million hospital patients are infected 1.2 million hospital patients are infected with MRSA each year in the United States. with MRSA each year in the United States.

Residing in a long-term care facility. Residing in a long-term care facility. -more prevalent-more prevalent

Invasive devices. Invasive devices. -dialysis -dialysis -catheterization -catheterization -feeding tubes-feeding tubes

Recent antibiotic use. Recent antibiotic use. -body becomes immune to antibiotic-body becomes immune to antibiotic

Screening and diagnosisScreening and diagnosis

Doctors diagnose MRSA by checking Doctors diagnose MRSA by checking a tissue sample or nasal secretions a tissue sample or nasal secretions for signs of drug-resistant bacteria. for signs of drug-resistant bacteria.

TreatmentTreatment

Both hospital and community Both hospital and community associated strains of MRSA still associated strains of MRSA still respond to certain medications. respond to certain medications.

In hospitals and care facilities, In hospitals and care facilities, doctors generally rely on the doctors generally rely on the antibiotic vancomycin to treat antibiotic vancomycin to treat resistant germs. resistant germs.

CA-MRSA may be treated with CA-MRSA may be treated with vancomycin or other antibiotics that vancomycin or other antibiotics that have proved effective against particular have proved effective against particular strains, but overuse of vancomycin has strains, but overuse of vancomycin has led to VRE outbreaks. led to VRE outbreaks.

To help reduce the threat of VRE, To help reduce the threat of VRE, doctors may drain an abscess caused by doctors may drain an abscess caused by MRSA rather than treat the infection MRSA rather than treat the infection with drugs. with drugs.

PreventionPrevention

HA-MRSAHA-MRSA Ask all hospital staff to Ask all hospital staff to

wash their hands or use wash their hands or use an alcohol-based hand an alcohol-based hand sanitizer before sanitizer before touching you — every touching you — every time. time.

Wash your own hands Wash your own hands frequently. frequently.

Make sure that Make sure that intravenous tubes and intravenous tubes and catheters are inserted catheters are inserted under sterile conditions, under sterile conditions,

CA-MRSACA-MRSA Wash your hands. Wash your hands. Keep personal items Keep personal items

personal. personal. Keep wounds covered Keep wounds covered Shower after athletic Shower after athletic

games or practices. games or practices. Sanitize linens. Sanitize linens. Use antibiotics Use antibiotics

appropriately. appropriately.

The impactsThe impacts

Mortality rate for patient without Mortality rate for patient without MRSA in 2004: 2.1%MRSA in 2004: 2.1%

Mortality rate for patient with MRSA Mortality rate for patient with MRSA in 2004: 8.9%in 2004: 8.9%

were four times as likely to diewere four times as likely to die Had hospital stays more than two Had hospital stays more than two

and a half times longerand a half times longer

In 2004, the average charge for a In 2004, the average charge for a hospitalization without MRSA : $28, hospitalization without MRSA : $28, 711711

Average charge for a hospitalization Average charge for a hospitalization with MRSA: $87,900with MRSA: $87,900

Hospital charges were three times as Hospital charges were three times as muchmuch

Recent developmentsRecent developments

http://www.cnn.com/2008/HEALTH/cohttp://www.cnn.com/2008/HEALTH/conditions/03/12/cat.staph.ap/index.htnditions/03/12/cat.staph.ap/index.html?iref=newssearchml?iref=newssearch

ResultsResults

MRSA constituted 50% of all staph MRSA constituted 50% of all staph infections in Bradford and Pittsburgh.infections in Bradford and Pittsburgh.

VRE – constituted about 57% of all VRE – constituted about 57% of all staph infections in Bradford and staph infections in Bradford and Pittsburgh.Pittsburgh.