Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) has long been the focus of discussion regarding preventative measures in the hospital environment. MRSA is highly transmissible from patient to patient and nurse to patient. Every hospital has concerns about MRSA infection from a health perspective. Even aside from the most important factor of proper patient care, it is costly to manage individuals who suffer from MRSA. As such, many have explored ways to limit its transmission. While handwashing may be both the oldest and most effective way to limit the spread of MRSA in the hospital environment, a greater focus on this in the day to day environment is important to ensure that healthcare professionals are in compliance with handwashing procedures. The more that leadership supports this goal by using redundancy, the more likely professionals are to comply with handwashing measures. It is important that healthcare environments change to allow this redundancy and make handwashing a typical and consistent part of healthcare.

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Meticillin-resistant Staphylococcus aureus (MRSA) has received a great deal of attention in the medical literature in recent years because it is a highly transmissible bacteria with sometimes serious consequences. Particularly in a hospital environment MRSA, which is found in the nostrils and on the skin of even healthy individuals, can become particularly dangerous when an ill individual is exposed to the bacteria and it makes its way into their bloodstream. Similarly, this bacteria is also dangerous because it can live for many weeks if an area is not properly cleaned with an antibacterial wash or soap (Robinson & Morrell, 2014).

Since MRSA can live on barriers such as the skin, healthcare workers are often one of the primary sources of transmission for the disease. In an attempt to help patients manage other symptoms, if workers make contact with a patient and do not properly wash their hands diligently, they may inadvertently carry the bacteria from one individual to another which can propagate it throughout the ward and greater hospital environment. As such, decolonization measures are important to remove the bacteria from their skin (Robinson & Morrell, 2014). One of the most prevalent and widespread methods of decolonization is regular handwashing with antibacterial soap (Humphreys, Grundmann, Skov, Lucet & Cauda, 2009). This is true not only of nursing staff, but also visitors and even other patients. And, evidence suggests that the more people understand the dangers of MRSA and its transmission, the more likely they are to take preventative measures against the bacteria (Humphreys, Grundmann, Skov, Lucet & Cauda, 2009; Robinson & Morrell, 2014).

Handwashing has always been a huge part of managing the spread of MRSA in a hospital environment; however, there are many other ways to limit the danger of MRSA. For example, some hospitals have dress code policies that prevent clothing from being near patients’ mouths or faces to avoid both picking up and transmitting MRSA to others (Humphreys, Grundmann, Skov, Lucet & Cauda, 2009). While preventative measures are key in this realm, there are also times in which MRSA is transmitted to a patient. When this does occur, other measures must be considered to prevent the spread from getting worse. In such cases some have proposed that the, isolation of the patient may be the best way to avoid additional spread of the disease; however, this has not always held to be true in every study (Cepeda et al, 2005). Cepeda et al reported in a 2005 study that there are still risks to patients who are in isolation. They proposed that this may be due not to the patient him/herself but again to the healthcare workers who might not maintain effective handwashing and/or wear the suggested barriers and robes recommended in conjunction with isolation procedures (Cepeda et al, 2005; Humphreys, Grundmann, Skov, Lucet & Cauda, 2009; Robinson & Morrell, 2014).

Some have argued that screening for MRSA as individuals enter specific hospital wards may be the best idea. Yet, this has been shown to be costly and not as effective as it was once presumed to be in theory (Roth et al, 2016). While screening every single new individual patient who enters a hospital might not be cost effective, it is important to recognize that historically one of the first methods of avoiding transmission of MRSA is also one of the most effective and least costly (Walker, Peto, O’Connor, Crook & Wyllie, 2008). What needs to change regarding control for MRSA is how we promote compliance with handwashing. Promoting handwashing practices in the hospital setting seems simple but it is an essential means of patient safety. And, this must occur from the leadership in the hospital before it can trickle down to other employees. Leaders should be observed washing their own hands and, consistent reminders regarding handwashing practices are also important (Walker, Peto, O’Connor, Crook & Wyllie, 2008). This can be extremely beneficial if reminders are redundant, i.e. promoted in modules, posters and practice. Helping nurses, patients, doctors and other individuals who grace the hallways of a hospital setting should continue to be made aware of the importance of handwashing because from this knowledge, compliance follows (Robinson & Morrell, 2014).

    References
  • Cepeda, J. A., Whitehouse, T., Cooper, B., Hails, J., Jones, K., Kwaku, F., … & Kibbler, C. (2005). Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two centre study. The Lancet, 365(9456), 295-304.
  • Humphreys, H., Grundmann, H., Skov, R., Lucet, J. C., & Cauda, R. (2009). Prevention and control of methicillin‐resistant Staphylococcus aureus. Clinical microbiology and infection, 15(2), 120-124.
  • Robinson, J., Edgley, A., & Morrell, J. (2014). MRSA care in the community: why patient education matters. British journal of community nursing, 19(9).
  • Roth, V. R., Longpre, T., Coyle, D., Suh, K. N., Taljaard, M., Muldoon, K. A., … & Forster, A. (2016). Cost Analysis of Universal Screening vs. Risk Factor-Based Screening for Methicillin-Resistant Staphylococcus aureus (MRSA). PloS one, 11(7), e0159667.
  • Walker, S., Peto, T. E., O’Connor, L., Crook, D. W., & Wyllie, D. (2008). Are there better methods of monitoring MRSA control than bacteraemia surveillance? An observational database study. PLoS One, 3(6), e2378.