Bookmark this RN Journal Article or Manuscript

Digg Facebook Google Bookmarks Stumbleupon Livejournal Twitter

TO GOWN OR NOT TO GOWN? FOR MRSA PREVENTION THAT IS THE QUESTION. WHAT IS MRSA?

by Amanda Zapka, SN
Co-author: Paula Bylaska-Davies, BSN, MSN
Massachusetts College of Pharmacy and Health Sciences

  Methicillin-resisitant Staphylococcus aureus (MRSA) is a staph infection that has become resistant to the beta-lactams antibiotic group, such as methicillin and other penicillin related medications. This antibiotic resistance can make MRSA a difficult infection to treat. In hospitalized patients, MRSA tends to be a life-threatening infection because of prolonged hospital stays, immunocompromised states, and invasive procedures. It can be spread through close skin to skin contact or from items that came in contact with the infection. In the hospital setting, MRSA is generally spread from the unclean hands of health care workers and the improper cleaning of shared equipment. Therefore, it is especially important that healthcare workers follow infection control policies and proper hand washing techniques to prevent the development and spread of MRSA (CDC, 2010).

WHAT IS RECOMMENDED?

The Center for Disease Control (CDC) states that standard precautions should be used for all patients and should be enough to prevent the spread of most MRSA cases. However, in acute-care settings the CDC recommends additional contact precautions be implemented when there are ongoing MRSA transmissions, current infections, previous colonization, and in other special circumstances. The basis of this recommendation was made by a “general consensus and was not necessarily evidenced-based” (Siegel, 2006, p. 26). Therefore, there is still an ongoing debate about the optimal strategies for controlling these multi-drug resistant organisms (MDROs). When there is a lack of evidenced-based research, it causes a predicament when deciding which level of precautions should be implemented in the hospital setting.

The general guideline is that standard precautions include: hand hygiene upon entering patient rooms, after coming in contact with any bodily secretions, after removing gloves, when leaving patient rooms; gloving when the likelihood of contacting infectious materials or blood is high; masks and/or goggles for procedures when an increased risk of being splashed with bodily fluids or blood is present; gowning if contamination of clothing is reasonably anticipated (CDC, 2010). While contact precautions include: single-patient rooms when available, otherwise cohorting like patients; gloving upon entering patient rooms; gowning upon entering patient rooms; the use of disposable or patient-dedicated equipment; removal and disposal of all person protective equipment before leaving the patient room (CDC, 2010).

However, large medical centers have begun implementing the use of standard precautions for MRSA infections or colonizations. These transmission-based precaution policies list that contact precautions are not instituted unless the MDRO is deemed epidemiologically significant by the infection control department.

LOOKING AT THE LITERATURE

              The Center for Disease Control (CDC) recommends that contact precautions be implemented for multidrug resistant organisms (Siegel, 2006). However, large medical centers have recently changed their transmission-based precautions policies on multidrug resistant organisms (infection or colonization) to standard precautions. These precaution policies have an essential role in minimizing the risk for contracting an infection such as MRSA in hospital patients, employees, and visitors. The following literature review examines the inconsistencies related to the continuous use of protective barriers (contact precautions) for MRSA or negating these barriers (standard precautions) as a means to finding the appropriate precaution level for controlling this potentially life-threatening infection.  

Grant, Ramman-Haddad, Dendukuri, and Libman (2006) examined the role of gown use versus a new protocol of non-gown use in preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a community teaching hospital. Researchers concluded that, “although there was a slightly greater decrease in the number of transmissions in wards where the new protocol was implemented, this number did not significantly differ from the number of transmission in wards where the new protocol was not used” (Grant et al., 2002, p.192). However, it is important to note that a hospital-wide outbreak of Clostridium difficile diarrhea occurred during the study, possibly enhancing hand-washing compliance, and thereby making it hard to distinguish the true reason for the decrease in MRSA transmissions. 

<< Previous    [1]  2    Next >>