Internet sites are buzzing with questions about MRSA these days (National Patient Safety List, Perinatal Nursing List, Ob-Gyn Nursing, and even an MRSA blog at http://www.mrsanotes.com/), most likely because MRSA is no longer confined to hospitals but has emerged in the community. Although nosocomial healthcare-associated MRSA strains are related to traditional risk factors (e.g., previous antibiotic use, surgery, medical devices, and hospital, ICU, or nursing home admission), the community-associated MRSA strains are related to different risk factors (e.g., close person-to-person contact, child care centers, contact sports, prisons, and military personnel). Fortunately, the community strains are more likely to be sensitive to methicillin and other antibiotics.
MRSA is a global concern, as evidenced by the many publications from European and Asian locations. In the United States, studies report increasing cases of MRSA in young children (Jernigan et al., 2006), newborns, and babies in neonatal ICUs. Anecdotal and empirical reports confirm substantial MRSA colonization in pregnant women (Chen, Huard, Della-Latta, & Saiman, 2006). Staphylococcus aureus (S. aureus) can cause many serious infections in the maternal-child population, including skin, soft tissue, respiratory, bone, and wound infections; breast abscesses; toxic shock; and nursery outbreaks.
Prevention, Screening, and Treatment
Required screening and reporting of MRSA are not imminent, although many locations outside the United States and a few in the United States are routinely screening and reporting. In Tennessee, MRSA is now the third most common reportable condition, following chlamydia and gonorrhea (Jernigan et al., 2006). The nasal cultures commonly used for screening are not predictive of vaginal or rectal colonization, however (Chen et al., 2006). Screening pregnant women is not the current standard of care, and currently, no experts in the United States recommend screening pregnant women. Furthermore, development of an S. aureus vaccine is still in early phases. Additional information on recommended treatment approaches and specific antibiotics for decolonization and infection are available (Jernigan et al., 2006).
Implications for Nurses
Nurses post more questions on listservs than answers regarding routine screening, isolating asymptomatic colonization, and preventing infection transmission, especially from infected surgical wounds to newborns. Approaches to help prevent MRSA transmission are discussed.
Infection Control
This core nursing intervention includes diligent handwashing, eliminating artificial fingernails, and ensuring thorough environmental cleaning (e.g., hospital cleaning of everything from computer keyboards to terminal cleaning of rooms after discharge and school cleaning of athletic facilities). With a known colonization or infection, isolate the patient, limit visitors, and use contact precautions (gloves and gown, with mask for aerosol-generating procedures). On perinatal units, isolate the baby with the mom or in an isolette. Do not readmit infected mothers or surgical cases to maternity units and do not bring a newborn to a surgical unit. Cohort nurses to care for colonized and infected cases. Vigilant asepsis with umbilical cord care and breastfeeding is essential. Some nurses report resumption of triple dye cord prophylaxis.
Teaching
Teach prevention and surveillance measures to individuals at risk (basic hygiene and early recognition of infection: boils, pustules, "spider-bites"). Instruct family and visitors in institutions where MRSA is detected. Teach women at increased risk for exposure, such as pregnant women who care for children and women in prisons. Instruct schools and athletic programs.
Communication
Information about screening and outbreaks should be communicated among and within healthcare settings. Nurses are key professionals in infection control. Learn more about MRSA and lead best practices in your setting.
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