How can we control the infection rates of MRSA in hospitals

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So what is MRSA? It stands for Methicillin-resistant Staphylococcus aureus; it is a bacterium which has become resistant to antibiotics, it is also known as multidrug resistant. Staphylococcus aureus is a common bacterium found in certain areas like skin and nose but is usually harmless at these sites. Although can result in infections causing pimples or conjunctivitis in the eye. More serious problems include pneumonia and heart disease. It is usually described as a ‘superbug’ [1] because the species includes strains of variable virulence-the ability to spread, colonise a host and cause disease.

An outbreak of infection occurs when a bacterium, fungus or virus is transmitted to susceptible hosts and causes disease. Outbreaks can be a small scale like family members or even pandemic. These bacteria carry genes encoding penicillinase, an enzyme that breaks down penicillin and prevents it from killing the S. aureus bacteria. They can do this because they have the ability to modify their DNA by mutation or by acquisition of DNA from other bacteria. The ways to prevent the infection spreading usually involve good hygiene, [2] anyone going into a hospital is advised to take sensible precautions.

These usually involve cleaning your hands very often; even if you are a visitor you must clean your hands before and after visiting. Also, hospitals usually have a lot of alcohol based gels to clean your hands with efficiently. Staffs are told to maintain high standards of hygiene and wear disposable gloves when they have contact with open wounds. Other ways hospitals prevent MRSA spreading include: keeping the hospital as clean and dry as possible, including floors, toilets and beds. They also isolate patients with a known or suspected MRSA infection and limit the transferring of patients.

The information here is mainly from Source [2] and I believe it’s reliable because it’s on the NHS site. As it is provided on the NHS website then the information provided should be correct, although this isn’t the only reason, because I found similar information on sources [3] and [7]. Source [2] was written in 2009 so it isn’t outdated information and therefore should still be valid. I would also consider the writers of this to be experts in the subject as they work for the NHS itself. Moving onto a more practical solution could be to use better management of the use of antibiotics; use selective prescriptions of antibiotics.

Find ways to reduce the rate of evolution in the bacteria. By keeping a good record of which antibiotics are used and when, we could also limit them to occasions when they are the only option, and not just because it’s the fastest way. Then we must also make sure the patient finishes their prescription and increase the length if the symptoms are still there. We could also use more than one type of antibiotic together, this has already been used before but maybe we should do it more often. We should only prescribe the newest and most effective antibiotics.

But the most serious solution should be to research new antibiotics or just new ways to cure people with MRSA or other ‘superbugs’. Another more technical way is to modify the antibiotics, so that it affects the bacteria in a different way. This has been [8] driving scientists to search for inhibitors of antibiotic-degrading enzymes. Some projects are being financed under FP5 (Quality of Life) and are now using genetically engineered micro-organisms to develop new or modified antibiotics and inhibitors.

In addition, researchers are looking for environmentally friendly synthesis procedures. This information is backed up in source [1] which also says that it is possible to modify the structures of the antibiotics so it produces an enzyme to destroy the penicillinase in the bacteria, so this proves it is a possible option. The information I got from source [1] was written by a lecturer at the University of Manchester, so I think the information provided is a reliable source and I would consider the author to be an expert in the subject.

The information provided isn’t too old as it was published in 2007. I think the article is very informative and goes into a lot of detail about MRSA. Also, the information I found in this source was backed up by information in other sources, like [3] and [5]. So this helps me decide on the validity of this source and I think it is reliable and valid. These biological methods used to provide a solution are appropriate because they involve hygiene and increasing amounts of bacteria is due to a lack of hygiene.

Each of the methods mentioned address the problem differently but all contribute to providing an effective solution to the problem. By keeping good hygiene it will reduce the amounts of infections in the hospitals, so each method which includes cleaning and washing is going to make a very effective solution. They are effective because they target the bacteria directly by attempting to remove them, this would mean less antibiotics would be needed and would slow down the evolution rate of Staphylococcus aureus.

So unless we start removing the bacteria the problem will always be a problem, because they will still evolve to resist new antibiotics, so for the solution to be effective it must directly affect the bacteria before they have time to become resistant to new drugs. This is what the solutions I have mentioned do and makes them appropriate in terms of providing an effective solution to the infection rates of MRSA in hospitals. The graph below also shows that there has been some improvement over the last few years which have caused the number of new cases to drop a bit:

Between the years 2004 and 2009, the number of new cases has dropped by more than half. This is probably because of the solutions being implicated into hospitals which have helped to improve hygiene and therefore reduce the number of MRSA infections. [6] Some of the implications of the solutions may cause more problems, so the risks must be analysed first. For example, staff screening may be quite useful but is also problematic as it needs to distinguish between transient carriage and longer-term colonisation.

The consequences of identification of MRSA-positive staff may have some important effects on morale and make problems including losing staff. Environmental contamination in MRSA infection is unclear, but screening may be helpful as an evaluation of hygiene procedures. In all situations, screening procedures and decolonisation carry a significant cost burden, the clinical value of these procedures needs to be carefully evaluated, to make sure they don’t cause more problems than they solve.

So this means that this solution could also be an economic problem. If the solution doesn’t work then a lot of money has gone to waste which could have been used on more well known and effective solutions. The potential cost to the drugs manufacturers is also a big issue due to researching, manufacturing and testing any new antibiotics which have been discovered. There are also the ethical issues if we were to deny someone full health by not allowing the use of antibiotics against a ‘minor’ infection.

Although, denying them these antibiotics would help to slow down the bacteria becoming resistant. This is a serious issue because should we restrain the use of any new or most effective antibiotics in case a new superbug arises? A tough decision is to be made here. The obvious benefits of some of these implications of solutions though, is that if we used screening we would know if someone was a carrier and would provide more effective solutions which could include taking more precautions when dealing with patients or knowing which patients to isolate.

Another benefit would be that the hospitals would be a lot more hygienic if some of these methods were used, like if hand gels provided were around the hospitals. These solutions may cost a bit to start off with but compared to the amount a patient with MRSA would cost it’s virtually nothing. In order to solve any problems caused by the solutions used, new or alternative solutions are needed. A few solutions involve the research of new forms of antibiotic. Here is where another question needs to be asked, should pharmaceutical companies in more developed countries be more actively researching?

Personally I think they should, they have more resources to their disposal and more workers available to help them. In less developed countries, they are still trying to help people with other less serious issues. So they don’t have as much time as a company in a developed country. This will be quite costly though which could cause another economic issue. Other solutions include [3] patient screening upon hospital admission (as mentioned before) with nasal cultures, this would prevent the cohabitation of MRSA carriers with non-carriers and prevent exposure to infected surfaces.

Then there’s decolonization: After the drainage of boils or other treatment for MRSA, patients can shower at home using chlorhexidine or hexachlorophene antiseptic soap. These solutions are more like precautions and help to prevent the spreading of the infection. So these alternative solutions help to control the infection rates in hospitals and shouldn’t be as costly as they don’t involve researching new drugs. So overall there are many solutions to the MRSA problem, none of which can completely wipe out these ‘superbugs’ like MRSA, but they help reduce and control the infection rates in hospitals and communities.

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