RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / AAKASH CHAVDA
GAYATHRI COLLEGE OF NURSING
KOTTIGEPALYA
MAGADI MAIN ROAD, BANGALORE – 91
2 / NAME OF THE INSTITUTION / GAYATHRI COLLEGE OF NURSING
3 / COURSE OF STUDY AND SUBJECT / FIRST YEAR M.Sc. NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 24.10.2008
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF STRUCTURAL TEACHING PROGRAMME (STP) ON PREVENTION AND CONTROL OF METHICILLIN–RESISTANT STAPHYLOCOCCUS AUREUS IN TERM OF KNOWLEDGE AND PRACTICE AMONG STAFF NURSES OF SELECTED HOSPITAL AT BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Silent Killer”

“Infection is the painful fact of life and chief cause of death, It’s often and infection that turns disability to motility”

Clients in health care setting may have an increased risk of acquiring infections. Nosocomial infection results from delivery of health services in a health care facility. A hospital is one of the most likely places for acquiring an infection because it harbors a high population of virulent strains of micro organisms that may be resistant to antibiotics. Unfortunately, many nosocomial infections are transmitted by health care workers.

Iatrogenic infections are a type of nosocomical infections resulting from a diagnostic and therapeutic procedure. A urinary tract infection that develops after catheter insertion is an example of an iatrogenic nosocomial infection. The incidence of nosocomial infection can be reduce if Nurses use critical thinking when practicing aseptic techniques. The nurse should always consider the clients risks for infection and anticipate how the a: Pproach to care may increases or decreases the cause of infection transmission.

Nosocomial infection significantly increases costs of health care. Older adult have increase susceptibility to these infection because of their affinity of chronic disease and the aging process itself. Extended stay in health care institution, increase disability, increased cost of antibiotics and prolonged recovery time add to the expenses of the clients, as well as the expenses of the health care institution and funding bodies (eg: medi care). Often cost of nosocomial infection is not reimbursed: as results, the prevention has a beneficial financial impact and is an important part of managed care. The risk of infection is influenced by number of health care employees having direct contact with a client, the type and number of invasive procedures, the therapy received, and length of hospitalization and major sites for nosocomial infection include surgical and traumatic wounds, urinary and respiratory tracts infection and the blood stream.

Nosocomial infection other wise known as hospital acquired infection (HAI) is one which was not present or incubating at the time of admission to the hospital. Hospital acquired infection are a world wide problem. Prevalence studies in serval countries have shown that any one time between 6 percent and 12 percent hospital inpatient acquires an infection after admission. Infection control is the responsibility of health care professionals (plowman, 2000).

Nosocomial infection has existed since the time there have been hospital, but attention was not focused on them until the middle of the 19th century. The hygiene practice of semmelweis in obstetrics, joseph lister in surgery and Florence nightingle in nursing strengthened the foundation of infection controls. They began to transform hospital from sites of pestilence and septic death to places of potential healing they made significant contribution to sanitation, isolation practices and better hospital design (Ananthanarayan and panicker 2000).

In 19th century, louis Pasteur founded the science of bacteriology and joseph lister overcome surgical infection with phenol sparys, the concept of asepsis and its a: Pplication in hospital practice reduce the incidence of infection, but hospital infection still cause considerable mortality and morbidity (Ananthanaryana and Panicker 2000).

Nosocomial infection is a major problem both in term of the cost to the health services and more importantly because of the consequent increase in morbidity and mortality. Nosocomial infection complicates the course of the original illness, increased cost of the hospital stay delay recovery. The infections have increased along with advances in medical technology and therapy.

Nosocomial infections may be exogenous or endogenous. An endogenous infection arises from micro organisms external to the individual that do not exist as normal flora: examples are salmonella organisms and clostridium tetani. An endogenous infection can occur when part of the client’s flora becomes altered and overgrowth results examples: are infections caused by enterococci, yeasts and streptococci.

Nosocomial infection is an important public health problem in developing countries as well as in other developed countries. It has been estimated that over 2.1 million nosocomial infection occurs annually in United States and a: Pproximately one third of these infections can be prevented by adhering to established infection control guidelines (Jarvis 1996).

Nosocomial infection occurs is about 5-10 percent of hospital admission, world wide. In India, the nosocomial infection rate is alarming and is estimated at about 30-55 percent of all hospital infection (Mukherjee, 2000).

Adult inpatient in common specialties who developed hospital acquired infection remained in hospital 2.5 times longer,incurred hospital cost almost three times higher than uninfected patient. The large costs associated with hospital acquired infection were for nursing (42 percent) and management (33 percent). (Plowman 2000)

Each year numerous hospital outbreaks occur and provide an o: Pportunity to identify new agents, sources or Mode of transmition. More than 25.000 Primary blood stream infection ( BSIs ) were identified by 124 National Surveillance system. Hospital performing hospital wide surveillance during the 10 year’s period 1980 – 1989. About 8 percent of All Hospital acquired infection in united states were primary blood stream infections ( Bannerjee,Emori, Culver,1991

Methicillin resistant staphylococcus aureus (MRSA) is a major problem in hospital in industrial nation. It is significant cause of morbidity and cost of health services. Three hundred strain of staphylococcus aureus isolated from different clinical specimen from patients treated at GTB hospital, New Delhi, India between may 1995 to April 1996.

MRSA was first described in 1959, although it was relatively rare during the 1960s and 1970s. There was a major increase during the 1980s and 1990s throughout Britian, North America and Australia, it was probably detected in these countries first due to better surveillance system, but MRSA is now a problem in hospital world wide (Enright et al, 2002).

Various strains of MRSA are now endemic throughout Britain and they are especially concentrated in hospitals because people who are ill are more vulnerable to infection (Health protection agency, 2006). Recognized as a health care associated infection, MRSA infection is most likely to occur in areas such as intensive therapy units, orthopedic wards, burns units and general surgical wards (RCN, 2005)

Over the last two decades MRSA has also become an increasing problem in long term care facilities, particularly affecting older and more vulnerable people with underling medical conditions (RCN, 2005). In addition around 30 percent of general population is colonized by staphylococcus aureus, so increasing number of people carry by MRSA (DH, 2000). This means it is now frequently imported into hospitals from the community (Guleri et al, 2007). Screening at lewisham hospital in south London found that 40 percent of elderly patient arriving from nursing homes carried MRSA and at university college hospital, London, half of all patients were carrying MRSA before they reached the ward (hinsliff, 2005)

MRSA is mainly spread on the hand of staff caring for infected patients. It may also be airborne, especially it dust contain scales. There fore, hand washing is the most important factor in preventing cross infection. Infected patients are nursed in a side room, where possible to minimize the risk of airborne spread (Coia et al, 2006). Measure to reduce the introduction of MRSA from outside sources have also been considered, including patients with a previous history MRSA, reducing visiting times and encouraging visitors to wash their hands when arriving and leaving the hospital (coia, 2006, RCM, 2005).

The general public receives dramatic and sensational message about the spread and effects of MRSA rather than factual information and balance debut (hamour at al, 2003). Wilson (2004) observed that the UK media have developed a fascination with MRSA. There fore, headlines such as ‘wards of filth’ (cox, 2003), ‘superbug crisis worse than feared’ (Marsh, 2004) and ‘Battle against the super bug’ (Hawkes, 2005) have become all too familiar.

During the course of recent years , as the bacteria have managed to evolve, MRSA has developed a resistance to the main antibiotics used to treat it and has left little else to try and treat patients with .Left to spread in unsuspecting patients , MRSA can infect the lungs causing instances of pneumonia, infect the heart ,bones ,and liver , and even cause septic shock .Each and every one of these complication is very serious and can even to death among patients who are not able to recover from a serious infection of that type.

6.1  NEED FOR THE STUDY

Hospital acquired infection remains an important in medical institution today. These infections may involve patient, health care workers and visitors. Inspite of increase morbidity, they also account for a considerable financial and personal burden. Though their prevention is simple extremely cost effectively and easy to practice, yet it is often over looked. This is turn, leads to distressing consequences for both health care workers and their patients minimum standard safety precaution therefore need to be adopted to ensure compliance with the guidelines of the infection control programme, awareness need to be created among the staff nurses about infection control.

M .Nixon, B.Jackson, P. Varghese, D. Jenkins and G. Taylor (2007) conducted a study to examine the rates of infection and colonization by Methicillin - Resistant staphylococcus aureus (MRSA) Between January 2003 and May 2004. Result in 2004 they screened 1795 of 1796 elective admissions and MRSA was found in 23 (1.3 percent). They also screened 1127 of 1147 trauma admissions and 43 (3.8 percent) were carrying MRSA. The incidence of MRSA in trauma patients increased by 2.6 percent per week of inpatient stay (r=0.97, P<0.001). MRSA developed in 2.9 percent of trauma and 0.2 percent of elective patient during that admission (P<0.001).

M Mathur, S Taklikar, S Sarkar, D D’ Souza (2007) conducted a study to find the prevalence of Methicillin - Resistant staphylococcus aureus (MRSA) in different specialties as hospital various clinical sample (Pus, Blood, Urine, CSF) were processed and the pathogens were identified as per the standard bacteriological techniques. The Results – A total 4847 (8.89 percent) staphy lococcus aureus isolated were isolated from 54,486 clinical specimens. Amongst these, MRSA were 40.21 percent. Majority of the MRSA were from wound swab (68.19 percent). Amongst Indoor patients, 91.49 percent MRSA were found from wards and 8.51 percent were found from intensive care units.

Summaiya Mulla, Manish Patel, Latika Shah, Geetha Vaghela (2007) conducted a study on antibiotic sensitivity pattern amongf Methicillin – Resistant and Methicillin - sensitive Staphylococcus Aureus at Government Medical College, Surat, INDIA. There objective was to determine the prevalence and pattern of antibiotic sensitivity among MRSA. They collected the sample of Pus, Urine, Blood, Sputum, throat swabs. The Result shows that Total 135 staphylococci were isolated, out of which, 48 (35.55 percent) were coagulase positive. Methicillin resistance among the staphylococcus aureus isolated was 39.5 percent. Resistance to all antibiotic tested among the Methicillin – resistance and Methicillin Sensitive, Staphylococci was found to be 26.3 percent and 6.8 percent respectively.

MC Veigh, S.F. Fitz Gerald, L. E. Fenelon (2007) conducted a study on prevalence of of Methicillin - Resistant Staphylococcus Aureus infection among patients with MRSA. Patients were divided into two Groups; those who were colonized only and those who were being treated for of Methicillin - Resistant Staphylococcus Aureus infection. Result – 41 Patients were colonized with MRSA (9 percent of all inpatients) on the day of study – 22 (54 percent) were Male, 19 (46 percent) Female and the average age were 68.4 years. 13 (32 percent) patients were being treated for MRSA infection of which 7 (17 percent of MRSA – Colonized patient and 1.5 percent of all inpatients), had definite infection according to CDS Criteria.

Clark J., Archibald J., Kearns A., Barnass S. etal (2007) conducted a study on prevalence of Methicillin -Resistant Staphylococcus Aureus among Staff Nurses at district general hospital. They included 120 members of Staffs (21 Medical Staff, 54 Nursing Staff, 11 Health Assistants, 15 Student Nurse, 19 Non-clinical Staff). Result – 10 (8.33 percent) were found to be carrying MRSA. All the isolates were from nursing staff of varying grade.

R Monina Klevens, Melissa A. Morrison, Joelle Nadle, Susan Petit etal (2007) conducted a study to describe the incidence and distribution of invasive Methicillin -Resistant Staphylococcus Aureus disease in 9 US Communities Result – there were 8987 observed cases of invasive Methicillin - Resistant Staphylococcus Aureus reported during the surveillance period. Most MRSA infection was health care - associated: 5250 (58.21 percent) were community - onset infection; 1234 (13.70 percent) were community - associated infection and 114 (1.30 percent) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100,000 (interval estimate, 24.4-35.2). Incidence rate were highest among 65 year and olders (127.7 per 100,000: interval estimate 92.6 – 156.9).

Murugan S., Mani KR., Uma Devi P (2008) conducted a study about prevalence of methicillin - resistant staphylococcus aureus among diabetic patients at Arts and Science College, Coimbatore, Tamilinadu, INDIA. The Result shows that out of 2314 (37.82 percent) Strains as Staphylococcus aureus isolated from diabetic foot ulcers, 992 (42.86 percent) were found to be methicillin - resistant.

S. J. Roche, D. Fitzgerald, A. O. Rourke, J. P. Mccabe (2006) conducted study a on incidence of Methicillin -Resistant Staphylococcus Aureus in an Irish orthopedic centre, Galway, Ireland, this prospective five - year study analysis the impact of Methicillin - Resistant Staphylococcus Aureus on and Irish orthopedic unit. Result – they identified 318 cases of MRSA, representing 0.76 percent of all admissions (41971). A total of 240 (76 percent) cases were colonized with MRSA, while 120 (37.7 percent) were infected. Patients were admitted from home (218: 68.6 percent), Nursing homes (72: 22.6 percent) and other hospitals (28 ; 8.8 percent). A total of 115 cases (36.6 percent) were colonized or infected on admission.