Thesis on "Preventing VRE"

Thesis 7 pages (1874 words) Sources: 5 Style: APA

[EXCERPT] . . . .

Preventing VRE

ALL MEASURES to the FULL EXTENT

VRE is a "superbug," a bacterial strain that resists the action of antibiotics. For its versatility, VRE is difficult to treat or is even life-threatening. Prevention is also much more inexpensive and less draining of resources. Hospitals, clinics and offices are strongly encouraged to formulate their own strategies to prevent or reduce the spread of VRE through all possible means. Respective guidelines should be provided for the strict adherence by health care workers, patients and visitors towards the common end.

The enterococci bacteria naturally inhabit the intestinal tract (Department of Health, 2006). Some enterococci strains have become resistant to an antibiotic called Vancomycin. These strains are referred to as Vancomycin-resistant enterococci or VRE. Neither antibiotic-resistant nor non-resistant strains are alarmingly harmful. They become a cause for serious concern when they affect the urinary tract, the surgical wounds or the bloodstream of hospitalized patients. Treatment becomes difficult or even life-threatening in these cases. Specifically vulnerable patients are those hospitalized for severe conditions such as cancer, blood disorders, kidney diseases or immune deficiencies. While good health protects, VRE may be transmitted by health care workers who care for patients with the disease and do not observe proper precautions. VRE is transmissible by direct hand contact and through infected surfaces and medical equipment (Department of Health).

Health care workers in all settings are instructed to use disposable gloves and wash their hands with an antibacterial soap after tending to infected patients (Department of Health, 2006). These gloves are specifically needed when washing or turning the patient or changing diapers. A bleach solution or hospital-grade disinfectants should be used by workers who perform routine cleaning of bed rails, toilets and commodes. Rectal thermometers, blood pressure cuffs and similar equipment in hospitals should be used exclusively with infected patients. Health care workers tending to patients in the home setting should observe standard precautions as regards hand washing and using gloves. These include washing dishes and eating utensils in a dishwasher or by using warm soapy water and then rinsed well. The patient's clothes and linen should be laundered in a washing machine, using ordinary detergents (Department of Health).

The Threat of "Superbugs" -- as a result of overuse of antibiotics, several "smart" strains of bacteria have learned how to adapt and resist the action of many antibiotics overuse (Capriotti, 2007). Bacteria are versatile organisms that can mutate to adapt to environmental conditions. Antibiotic overuse or abuse affords them the condition in which to mutate genetically into resistant strains. Each time a new antibiotic is used, some bacterial organisms "figure out" how to fend off its effects. Some succeed and some do not. Those, which succeed produce new antibiotic-resistant organisms. They can also transfer their new and resistant genes to other bacterial species through a process called conjugation. As this happens, new strains, which can resist the action of existing antibiotics, are created. These strains include staphylococci, enterococci and pneumococci and they are contagious and deadly. They are also called "superbugs." The best known among them is the methicillin-resistant staphylococcus aureus or MRSA. Up to the 90s, MRSA could be effectively eradicated by the Vancomycin antibiotic until the bacteria became resistant (Capriotti).

Impact

This new infection, which used to be confined in clinical settings, has spread to the community and the health care sector (Capriotti, 2007). The community strain, called CA-MRSA, can cause severe necrotizing pneumonia even in healthy persons. A study of emergency room patients in Los Angeles, California showed that skin and soft tissue infection cases increased by 29% to 64% from 2001 to 2004 alone. The rapid rise in the number of cases was interpreted as a vital threat to population survival. MRSA has managed to transfer its vancomycin-resistant gene to the enterococci bacteria. The resulting strain is called Vancomycin-Resistant Enterococcus or VRE, which creates a new whole range of problems for the clinician. VRE is among the major "superbugs (Capriotti)."

New Antibiotics - New antibiotics have been synthesized to counteract the new strains. These include teicoplanin, streptogramins, dalba vancin, oritavancin, tigecycline, linezolid, telihromycin, ceftobiprole, and a new conjugate vaccine (Akins & Haase, 2005). But most of them were soon overturned by the actions of bacteria or revealed significant disadvantages in use. These new chemicals must also be used with precision. They interact with the body in different ways and have different routes of administration and probable side effects. To complement their use, health care providers must take all precautions to contain the infection. These include wearing gloves and gowns and isolating infected patients and specific equipment used on these patients. In addition, nurses must constantly review specific and new information on new antibiotics. Those who work in medical-surgical and critical care settings are particularly required to be updated on these new antibiotics and new developments on infection control procedures (Akins & Haase, Capriotti 2006).

Prevention of Transmission in Offices and Clinics - the same principles of cleaning, disinfecting and sterilizing medical equipment in hospitals should be observed in offices and clinics (Mattlow and Morris, 2009). Hospitals use chlorinated germicides to prevent infection. A regular cleaning program for every office should include disinfecting surfaces often touched and likeliest to be infected, such as doorknobs and toilet seats. Carpets should be removed from thickly-populated clinics and offices to prevent spills and transmission of infection when patients stay long to wait. If these cannot be removed, they should be subjected to deep cleaning. The furniture in these places should be the type that is easy to clean, especially when infected patients come into contact with them. Common toys should be removed or cleaned with bleach solution, washed with soap and water and thoroughly dried at the end of each day (Mattlow and Morris).

Administrative support for the prevention of VRE transmission is paramount. It should include and emphasize policies and guidelines and the availability of protective tools and equipment (Mattlow and Morris, 2009). Education and strict compliance are just as necessary. Everyone should be knowledgeable about the policies and proper use of antibiotics. And infection-control practices should be strictly followed (Mattlow & Morris).

The lack of commitment by the physician or clinic director, improper or inefficient allocation of financial resources, lack of information or education of personnel on prevention and the difficulty in undertaking precautionary measures are the major barriers to the implementation of a prevention program (Mattlow & Morris, 2009). Hospitals are better able to prevent and control infection because of better compliance to infection-control measures. Although difficult to execute, these measures are essential and should be incorporated into routine practice to prevent outbreaks (Mattlow & Morris).

Costs Involved -- a large outbreak of VRE in a German university incurred an estimated 1 million Euros (Sagel, Heeg & Morgan, 2008). The study conducted a breakdown of the costs. VRE incidence has been increasing in Germany, most of it in the form of extended outbreaks. VRE not only threatens the life of a patient but also asserts disastrous effects on healthcare as a whole. Controlling it entails huge cost and time. The 2003 outbreak showed that prevention could have avoided or reduced the costs incurred. The study recommended the easy-to-use statistical models to detect and avoid outbreaks at the soonest possible time. More than the estimated 1 million Euros lost could have been saved (Sage, Heeg & Morgan).

Implications -- the principal goals of healthcare infection control and prevention in any setting are to protect the patient, protect the healthcare worker, and to fulfill these goals in the most cost-effective way possible (White, 2003). The healthcare worker needs to understand the risk factors and their importance in order to avoid the transmission of infection. Then she can proceed to perform proven common-sense and scientific practices (White).

Good hand hygiene alone is insufficient to prevent the spread of infections like VRE (White, 2003). Common-sense practice has shown that isolating undocumented high-risk patients from another facility in a private room until the infection or colonization is ruled out. This measure reduces the risk of transmission, determines if the infection is acquired in the setting or elsewhere and prevents delays in securing results. Proper patient placement is another initial measure concerning spacing and separating an infected patient from a clean, surgical patient. The nurse to tend should also be carefully selected. The nurse should also teach proper hygiene to the patient. This includes proper hand hygiene, body washing technique, oral hygiene, and genital cleansing. Proper hygiene reduces the risks of infection (White).

Corollary measures involve proper housekeeping procedures; sound engineering practices and systems; dietary methods; standard disinfection of patients' equipment are just as important in reducing the risk of VRE infection (White, 2003). Contagious employees should be sent off-duty. Guidelines should also be issued for visitors. They should be encouraged to observe proper hand hygiene. Alcohol-based hand cleansers or soap and water should always be available for their use. Those suffering from contagious diseases should not be allowed entry, especially in the nursery (White).

Summary and Conclusion

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