Methicillin-resistant Staphylococcus Aureus (MRSA) is a bacterium that has been used for curing numerous infections in humans which are difficult to treat via other methods. MRSA is most troublesome, in hospitals prisons and the nursing homes, where it affects patients with open wounds and weak immune system. MRSA advances significantly within a span of 24-48 hours after the occurrence of the symptoms and after that becomes resistant to treatment. The available literature consists of majorly of the observational studies which has inadequate controls for secular trends and confounding to back casual inference. Furthermore, there is inadequate evidence on other outcomes of universal MRSA screening, such as morbidity, harms, resource utilization and mortality rate. Hence, in this research proposal, the focus will be to incorporate the design features and also analytic strategies incorporating secular trends and confounding in MRSA screening. The design will give room for assessment of infection control interventions that will adequately address the outcomes such as morbidity, mortality and harms and also resource utilization.

Overview

The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) shows three important pillars that form the basis for professional nursing. These pillars are practice, education, and research. Practice refers to the nursing standards that the practitioner is required to abide within disseminating their duties. The American nurses association has identified six standards. Education refers to the basic nursing education at the undergraduate level, which steadily advanced through masters and doctorate. This education also includes the seminars and workshops. According to Hopkins, Nursing research should use the EBP approach fostered towards improving patient care and patient outcomes. The idea is backed by the fact that, with more than 5 million and practicing in most health care facilities, nurses make the largest number of the type quality and the cost of health care provided. (Johns Hopkins Medicine, 2012).

The center for disease control and Prevention (CDC) found that nearly 19,000 Americans died in 2005 from MRSA gotten from hospitals and other health centers. Better Screening of the patients will prove to be very effective since research has revealed that health workers can still get infected by coming into contact with surfaces touched by a patient suffering from MRSA. The contamination increases the chances of the doctor to patient transmission, through contaminated gloves and also patient to patient transmission via unwashed hands. The screening method usually employed is the use of active surveillance cultures.

Most hospitals in USA have reported below average results regarding the prevalence of MRSA. For example, a Veterans Health Administration’s (VHA) in Pennsylvania in 2001only brought down infections in the surgery unit by 30%. In this case, all the patients admitted to the hospital were subjected to a nasal swab, to screen for MSRA.

Practice Questions

Among the hospitalized patients:

1. What are the effects of general screening strategy for MRSA when compared to no screening?
2. What are the effects of screening the entire population as compared to screening selected patients

• What are the effects of screening the ICU patients?

1. What are the effects of screening surgical patients
2. What are the possible effects of screening high-risk patients?
3. What are the effects of expanded screening strategy?

PICOS (Population, Intervention, comparator, outcome, timing and setting) for the key questions

Population: All the outpatients and all the inpatients will be included in the survey. Besides, one ICU patient, two patients under surgery, and three patients at high risk of MRSA infection will be included in the survey.

Intervention: A MRSA screening will be carried out in all the patients in a setting or to specific wards or specific patients.

The testing methods that will be involved are the rapid turnaround where the results will be available on the same day. We will also use the intermediate turn around where the results will be available after two days. Lastly, we will employ the longer turnaround I which the results will be available more than two days after the testing.

Comparator: No screening or only the selected population is screened.

Timing: Follow up will be implemented for the purposes of intervention

Settings: Wards & intensive care units (ICUs)

Scope

Our survey will focus on the following eight major areas. We will carry out the assessment of MRSA risk, Conduct surveillance programs on MRSA and compliance with the primary infection prevention and control methods. We will also conduct social education to the prone parties, conduct antimicrobial stewardship and lastly enforce the MRSA decolonization strategies.

Statistics

The total number of MRSA infections that have been reported over the last fifteen years stands at 2,753, for high prevalence and 918 for the medium prevalence. Of these infections, the number averted by MRSA screening was 40% for high-risk prevalence and 57% for medium risk prevalence. Hence as we can see, this is still below average.Owing to the above statistics, we can, therefore, conclude that there is still a need to come up with a better and more effective strategy for dealing with MRSA.

The inter-professional team

The recommended infection control membership will include the hospital epidemiologist, infection prevention and the hospital administration. onerepresentative from the senior physician group, critical care unit,senior physician group, pharmacy, and nursing will be incorporated in the committee.

Responsibilities

The infection control committee will be reviewing the surveillance data and coming up with the intervention plans where needed and also formulation and approval of the infection control policies. The committee will also be in charge of reviewing outbreaks & formulating a response and approving the annual goals and objectives of the infection control program.

Evidence Sources

The research will concentrate on literature published between 2000 to date because this is the evidence most applicable to the current nursing profession. Our principal search terms will be methicillin-resistant Staphylococcus aureus and prevention & control. We will also search the registry of Cochrane Controlled Trials. Finally, we will search evidence from indexed and electronically searchable conference abstractsmajor professional societies such as the Interscience Conference on Antimicrobial Agents and Chemotherapy and the European Society of Clinical Microbiology and Infectious Diseases, among others.(Stetler, 2001; Titler, Cullen, &Ardery, 2002; Weaver, Warren, & Delaney, 2005)

Evidence appraisal

The retrieved sources will be assessed by three independent reviewers for validity to ascertain their credibility, prior to inclusion in the review. The quantitative papers selected for approval will be assessed using standard critical appraisal instruments and also using the assessment and review of the information package.

MRSA surveillance methodology

The purpose of the surveillance will be to identify the trends and the outbreaks so as to identify the incidence of MRSA in the patients.

The population may either be considered in general or maybe unit specific. The basis will be on previous studies that have shown that populations such as dialysis patients and those in ICU are highly prone to MRSA infection and colonization. The indicator will be MRSA infection or colonization in the targeted population

The period of the survey is estimated be one year so as to study a good number of cases to form a valid basis for analysis.

Data sources and selection

Two major pieces of research will be conducted, running for one year. While one will employ the randomized and the nonrandomized comparative studies, the other will concentrated on the randomized controlled trials approach, non-randomized comparative studies, and the case series approach. Both studies will use similar search tools. The titles and abstracts will be scrutinized for the studies that will evaluate the MRSA infection, morbidity, life expectancy, and resource utilization when screening for MRSA compared with limited or no screening at all.

Data extraction and quality assessment

The team of reviewers will abstract the data and later the data will be fact checked by another independent reviewer. Any disagreement will be resolved through a discussion by the team of reviewers.

Data synthesis and analysis

We will use the Fisher’s exact test to see if there is substantial evidence that the distribution of genotypes varies for clinical and employees. We will also employ the Poisson regression analysis of the data collected to verify if there was a statistically significant variation in the number of Ventilator-associated pneumonia post carrying out of universal screening.

Translation

Basedon the evidence from the validated sources, the project results revealed that body hygiene n. Hence, the implementation of this project will assist in curbing the prevalence of the infection to a great extent.

Next steps

We look forward to the approval of the project so that we can embark on the data collection, to assist us in the analysis

Conclusion

Since, there is inadequate evidence on other outcomes of universal MRSA screening, such as morbidity, harms, resource utilization and mortality rate. There is also inadequate evidence to back the efficiency of MRSA screening on any outcomes in the other settings. The available literature consists of majorly of the observational studies which has inadequate controls for secular trends and confounding to back casual inference. The basis of our argument is because other inventions are bundled together with MRSA screening in an inconsistent manner

Hence, future research in MRSA screening should incorporate the design features and also analytic strategies incorporating secular trends and confounding. The design should give room for assessment of infection control interventions that will adequately address the outcomes such as morbidity, mortality and harms and also resource utilization.

Recommendations

1. Active surveillance should be implemented to identify the reservoir for spread
2. Surveillance cultures should be indicated at the time the patient is admitted

• Surveillance cultures should use stool samples or swab samples

1. Surveillance cultures for MRSA should include samples from the nose especially the anterior vestibula

Limitation

The available literature is limited in terms of the evidence that can be used to support the claims that MRSA screening reduces the chances of infection.future comprehensivedelocalization therapy.

References

Dearholt, S., & Dang, D. (2012). Johns Hopkins Nursing Evidence-based Practice: Models and Guidelines. Sigma Theta Tau.

Institute of Medicine (U.S.), In Eden, J., In Levit, L. A., In Berg, A. O., & In Morton, S. C. (2011). Finding what works in health care: Standards for systematic reviews. Washington, DC: National Academies Press.

Liu, C., Bayer, A., Cosgrove, S. E., Daum, R. S., Fridkin, S. K., Gorwitz, R. J., … & Chambers, H. F. (2011). Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clinical infectious diseases, ciq146.

Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) – Executive Summary | AHRQ Effective Health Care Program. (2015.). Retrieved from http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1551

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