MRSA and VRE in a Rural Community Hospital

1. MRSA and VRE in a Rural Community Hospital Graduation Project 2008 Mehvish Ally

2. What is MRSA? • MRSA (Methicillin-resistant Staphylococcus aureus ) is a type of staph infection that is responsible for human infections that are very difficult to treat. • MRSA was discovered in 1961 in the UK. It is now found worldwide. MRSA is often referred to in the press as a "super bug."11. multi-resistant An image of MRSA from an electron microscope

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

4. What is VRE? • Vancomycin-resistant Enterococci (VRE) are bacteria that have evolved from MRSA and have become resistant to the antibiotic vancomycin. VRE was not reported in US hospitals until 1989 An image of VRE from an electron microscope

5. Types of MRSA • HA-MRSA: Hospital Acquired MRSA • CA-MRSA: Community Acquired MRSA

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

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

8. Causes • Unnecessary antibiotic use in humans. • Antibiotics in food and water. • Germ mutation.

9. Risk Factors • A current or recent hospitalization.-1.2 million hospital patients are infected with MRSA each year in the United States. • Residing in a long-term care facility. -more prevalent

10. Invasive devices. -dialysis -catheterization -feeding tubes • Recent antibiotic use. -body becomes immune to antibiotic

11. Screening and diagnosis • Doctors diagnose MRSA by checking a tissue sample or nasal secretions for signs of drug-resistant bacteria.

12. Treatment • Both hospital and community associated strains of MRSA still respond to certain medications. • In hospitals and care facilities, doctors generally rely on the antibiotic vancomycin to treat resistant germs.

13. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains, but overuse of vancomycin has led to VRE outbreaks. • To help reduce the threat of VRE, doctors may drain an abscess caused by MRSA rather than treat the infection with drugs.

14. HA-MRSA Ask all hospital staff to wash their hands or use an alcohol-based hand sanitizer before touching you — every time. Wash your own hands frequently. Make sure that intravenous tubes and catheters are inserted under sterile conditions, CA-MRSA Wash your hands. Keep personal items personal. Keep wounds covered Shower after athletic games or practices. Sanitize linens. Use antibiotics appropriately. Prevention

15. The impacts • Mortality rate for patient without MRSA in 2004: 2.1% • Mortality rate for patient with MRSA in 2004: 8.9% • were four times as likely to die • Had hospital stays more than two and a half times longer

16. In 2004, the average charge for a hospitalization without MRSA : $28, 711 • Average charge for a hospitalization with MRSA: $87,900 • Hospital charges were three times as much

17. Recent developments • http://www.cnn.com/2008/HEALTH/conditions/03/12/cat.staph.ap/index.html?iref=newssearch

18. Results • MRSA constituted 50% of all staph infections in Bradford and Pittsburgh. • VRE – constituted about 57% of all staph infections in Bradford and Pittsburgh.