Methicillin-resistant Staphylococcus aureus in critical care areas.
In recent years the mainstay of treatment for hospital-associated MRSA infections has been vancomycin, but now vancomycin intermediate S aureus strains are beginning to emerge. Complete vancomycin resistant S aureus can develop, possessing the same vanA gene as vancomycin-resistant enterococcus. Four such isolates have been reported, three of which have been in the United States. There are new antibiotics being developed, but there is always a risk of resistance developing. There are some promising new ideas such as staphylococcal conjugate vaccines that reduce the rates of S aureus bacteremia for up to 10 months postimmunization in patients who have end stage renal disease receiving hemodialysis, but studies are ongoing. With all the uncertainty surrounding treatment, at least one medium has remained consistent and effective if used properly--infection control. But this requires complete support of all healthcare workers and hospital administration from the chief medical officer to doctors and nurses to environmental services personnel to take ownership of an effective infection control program. Who will advocate for more stringent infection control policies and for the equipment to successfully carry them out? Who will take the lead by ensuring implementation of infection control policies on a unit is effective? Who will hold themselves and other health care workers including physicians accountable to comply with these infection control policies every time they enter a patient's room? Nurses are on the front lines in the battle against antibiotic-resistant nosocomial infections such as MRSA, and we should not be apathetic or feel we are helpless. It is our duty as patient advocates not to take a spectator role but to answer these questions: "I will."
Dunlap
John Travis
JT
Adult Nurse Practitioner Program, Vanderbilt University School of Nursing, 461, 21st Avenue South, 367 Frist Hall, Nashville, TN 37240, USA. travis.dunlap@vanderbilt.edu
D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000451:nursing; D006801:Humans; D016106:Methicillin Resistance / Q000502:physiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000451:nursing; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D014774:Virulence