Research Proposal on "MRSA in the Long-Term Care Resident"

Research Proposal 8 pages (2999 words) Sources: 6 Style: APA

[EXCERPT] . . . .

Risk Factors for MRSA in Long-Term Care Facilities

This research proposal will propose a study on the prevalence of MRSA colonization among older residents in the nursing home setting and associated risk factor for infection in the long-term care resident. The work will first briefly introduce MRSA infection, outline the general and specific vulnerabilities of patients in LTCFs and demonstrate a possible way to research this population with regard to this disease in a long-term qualitative study. In brief the proposal is for long-term study of all patients entering a local LTCF for incidence of MRSA (done by nasal mucosal swab, visible infection site swab or positive MRSA culture on any given fluid causing infection). The work will then state and develop criteria for "colonization" of MRSA either in benign or infected form and develop a set of vulnerability criteria that raise the risk factors of certain patients in the LTC setting.

Research Proposal: Incidence & Risk Factors for MRSA in Long-Term Care Facilities"

Nosocomial infections are a common occurrence in hospitalized patients and often such infections are resistant to treatment. "70% of hospital-acquired bacterial infections in the United States -- which kill 90,000 Americans a year -- are resistant to at least one drug, according to the Centers for Disease Control and Prevention." (Wenner, 2008, p.11) Challenges to the immune system, open wounds, previous exposure to antimicrobial treatments, and open systems associated with treatment such as chest tubes and more commonly in long-term care facilities Foley urinary catheters all increase the opportunity to acquire one of the highly concentrated infectious diseases that are floating around and to be found on surfaces within institutions such as hospitals and long-term care facilities seems to rise significantly. A particularly vulnerable human population is the elderly as they often have additional physical challenges that yet again increase the occurrences of opportunistic infections both in the community and in hospitals. Long-term care facilities are also often populated by patients who need longer periods of recovery, physical, occupational therapy, dietary therapy and assistance with activities of daily living than the few days of hospital treatment can afford them, for any given disease or surgical recovery period. These people, often elderly then end up in long-term care facilities as their post treatment limited mobility and infirmary cannot be sustained in a home setting, either for support reasons or individual reasons of need. It is therefore fair to assume that these patients would have a greater incidence of transferring hospital acquired infectious diseases into long-term care facilities, where they are then spread to yet others. Strausbaugh, Crossley, Nurse & Thrupp suggest that in the LTC setting person to person contact, between health care workers hands and patients is the most common means of transport for these "super bugs," whether they enter via colonized patient or mutate into antibiotic resistant strains while at the LTCF. Strausbaugh, Crossley, Nurse & Thrupp also stress that patients at greatest risk for colonization of MRSA and other resistant bacteria are "serious underlying disease, poor functional status, wounds such as pressure sores, invasive devices such as urinary catheters, and prior antimicrobial therapy." (Strausbaugh, Crossley, Nurse & Thrupp, 1996, p. 129) Most importantly the researchers suggest that many LTCF do not have systems and procedures in place to help eliminate these bacteria and that there are even cases where they become aggressive and rapidly populate the LTCF population, including patients as well as high functioning staff. (Strausbaugh, Crossley, Nurse & Thrupp, 1996, p. 129)

Staphylococcus aureus and several other infectious agents are therefore a frequent occurrence in the LTC setting and increasingly these agents are antibiotic resistant. The danger then becomes one of logical adaptive bacterial behavior, as the diseases are treated with wide spectrum antibiotics, eradicating only weak non-adaptive strains and leaving behind those increasingly capable of adapting beyond the scope of known treatments. These strong bacteria then become capable of colonization in the body, where not unlike a cancer they work through the transport systems of the body and occur in traditional (skin eruptions) or worse attack deeper organ and bone systems, all while failing to respond to more and more antimicrobial medications.. (Hughes & Andersson, 2001, p. 16) Colonized patients then experience near constant outbreaks of the disease for the rest of their lives or are eventually killed by the bacteria as the disease attacks virulently to vital functioning areas of the body. One of the most unpredictable and destructive of these known "super bugs" is MRSA or Methicillin-resistant Staphylococcus aureus, which frequently colonizes in patients and is resistant even to the strongest of antibacterial treatment. (Hughes & Andersson, 2001, p. 1)

Statement of the Problem

Due to the high incidence of nosocomial infections in LTCF as well as antibiotic resistant strains of bacteria, the most troubling of which seems to be MRSA, for its unpredictability, given that it can do little harm but a topical skin infection, show no symptomology whatsoever or systematically attach vital systems of the body ending in serious illness or even mortality LTCFs are in need of specialized research. One other issue with regard to MRSA is that community acquired or CAMRSA as well as known and historical strains of MRSA are intermingling in institutions and developing even more resistant strains of disease. (Gorak, Yamada & Brown, 1999, pp. 797-800) (Rutledge, 2007, NP) LTCF residents are also in a situation that is helpful for research, in that they are concentrated, generally spend significant periods of time in facilities, as apposed to high turnover rates in hospitals and clinics and are likely to allow limited research to improve their own situation and that of others. This vulnerable population is then demonstrative of a good research base to help better understand how MRSA (and other "super bugs") evolve in these settings and how they can be better dealt with there and elsewhere. Despite this situation only limited research has been conducted on this population and a great deal more could and should be done to decrease the odds of infection, further disease compromises and most importantly mortality from secondary infections such as MRSA.

Background and Significance of the Study

Bacteria have a natural capacity to adapt to treatment, as the weak non-adaptive strains of disease are killed off by standard treatment leaving behind those that are adaptive and therefore capable of resisting all or most antibiotic treatment. These resistant bugs then reproduce in the original host or in new hosts repeatedly as a simple means of normal functioning. When hosts deposit these adaptive bacteria on surfaces, in the air or directly to new hosts the bacteria then goes through the whole process again, and each time the new bacteria that emerges is more capable of resistance to standard treatment. Hughes and Andersson in fact argue that if antibiotic treatment were never introduced into the system bacteria would not have needed to adapt microbiologically to survive and might never have become capable of resistance to treatment. (Hughes & Andersson, 2001, p. 16) in other words they argue that resistance is largely our own fault for repeatedly exposing rather benign bacteria to antibiotics when it might have been possible for our own immune systems to fight off the infection naturally. The number of strains of resistant bacteria are simply doing what they are programmed to do and if we had been more restrictive of antibiotic use and less reliant on the "miracles" of modern medicine the world would not be in such a threatened state at this time. If we had simply treated only those infections that we knew to be life threatening and/or permanently damaging with antibiotics then most would likely still be effective. "There would be no need for bacteria to accumulate mutations or acquire extrachromosomal DNA specifying resistance mechanisms if it were not for the use of antibiotics." (p. 16)

Statement of the Purpose

Knowledge of the prevalence of MRSA colonization is important to controlling the spread of infection. Determine the prevalence of MRSA colonization among older residents in the LTC setting and to identify resident risk factors for colonization are of high priority in the development of treatment, both prophylactic and primary.

Research Question

What is the Incidence of MRSA in LTCF patients and among these patients who are at highest risk for infection and spreading of it?

Review of the Literature

Though there are several empirical studies on MRSA, there are only limited numbers on LTCF patients. This work will therefore review those available studies on all populations, including but not limited to LTC patients. This will offer a broader look at the problem and close with a more specific look at LTC incidence and susceptibility to MRSA. It has been previously stated that LTC studies on MRSA are limited, even more limited are those which develop case studies on treatment and eradication of the problem in individuals and facilities. One of the most important aspects of the disease epidemiology is understanding how it has evolved through the whole of the health care system to… READ MORE

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