Anti-Microbial Resistance Ranson Thomas Santa Fe College 2014

Nosocomial Infections Hospital acquired infections Our Fault Over 700,000 in 2011 (Magil, et.al. 2014) Some estimates as high as 2 million per year

What Are Anti-Microbial Agents? Anti-Microbial Agents – Either kill or slow the growth of microbes Bacteriostatic-slows or inhibits Bactericidal-Kills certain microorganisms Antibiotics – Made from bacteria which help kill or slow the growth of other bacteria

What is Resistance? Anti-microbial agents have seen increasing use over the past several decades Very effective at curing and controlling diseases Widespread use has caused microbes to mutate and adapt, becoming resistant to certain agents Agents become less effective or ineffective Intrinsic Resistance

Resistance Microbes can be resistant to one, several, or even all agents designed to inhibit or control their growth (WHO, 2005)

But Why Mr. Thomas? Why??? There are many reasons for the increasing prevalence of drug resistance in certain infectious micro-organisms. Take a moment and discuss with your neighbors some potential causes for this phenomenon.

The Role of Nursing Now, identify ways you in your professional nursing practice can help control the spread of drug resistant microorganisms.

MRSA Staphylococcus Aureus-Gram + bacteria that lives on skin Most Staph is resistant to some form of antibiotics i.e. methicillin, penicillin, etc. How is it transmitted/what kind of precautions should we take?

MRSA cont. Lives on environment for days Treatment-Bactroban Bactrim Septra Rifampin Vancomycin

VRE Vancomycin Resistant Enterococcus Faecalis Gram + bacteria found in bowel and female genital tract as normal flora Oral-fecal transmission Lives in environment for weeks

Clostridium Difficile Gram+ spore forming bacteria Part of normal bowel flora in 2-5% of people Lives in environment for up to 10 weeks MUST wash hands even though not 100% effective, no sanitizer

Case Study L.B. is a 73 year old white female with chronic renal failure who lives in a nursing home. 1 Week ago she had a fall and fractured her right hip. She was admitted to the hospital and had an ORIF procedure. She was scheduled to be discharged tomorrow however her surgical incision has been red, with slight swelling and recently, purulent discharge. A culture of the wound revealed that it is infected with MRSA.

Which of the following is most likely, the largest contributing factor to L.B.’s MRSA infection? A. She lives in a nursing home B. Her history of chronic renal failure C. The recent admission to a hospital D. Her advanced age

When delivering your routine nursing care for L. B When delivering your routine nursing care for L.B., what personal protective equipment will you use? A. Gloves, Gown, Goggles B. Mask, Gown, Gloves C. Gloves, Gown D. Gloves, Gown, Mask, Goggles

A. Her history of chronic renal failure The physician has decided against administering Vancomycin to L.B. in favor of a different antibiotic. Which of the following is the most likely reason for this? A. Her history of chronic renal failure B. Vancomycin cannot be administered to treat her infection except via IV C. Her advanced age D. L.B. does not have a central line catheter

QUESTIONS?

References Magill S., Edwards, J., Bamberg, W., Beldavs, Z., Dumyati, G., Kainer, M., Lynfield, R., Maloney, M., McAllister-Hollod, L., Nadle, J., Ray, S., Thompson, D., Wilson, L., Fridkin, S. (2014) Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med 2014;370:1198-208. World Health Organization, (2005). Containing Antimicrobial Resistance. WHO Policy Perspectives on Medicines, No. 010, April 2005