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MRSA and other resistant bacteria: prevalence, patient and staff experiences, wounds and infection control
Sophiahemmet University.ORCID iD: 0000-0002-9803-3542
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Antibiotic resistance has become a major and serious global problem in healthcare. Limited treatment options for infections caused by these organisms can lead to increased morbidity and mortality. Sweden has a low prevalence of antibiotic resistance compared to most other countries but this presents an increasing problem for society and healthcare even in Sweden. The overall aim of this thesis was to illuminate potential problems related to antibiotic resistance from different perspectives: assessing the prevalence of resistant bacteria methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) or other resistant bacteria, and associated wound types, patient and health staff experiences when confronted with resistant bacteria infection, and the occurrence of such infections in the nursing home environment. In the first study a total of 2172 patients admitted to hospital or as out-patient visit at a University hospital during one day were examined with the purpose to identify all wounds, wound types and wound characteristics, and to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gramnegative rods. Four hundred and eight (19%) patients had a total of 668 wounds. Of these, 248 wounds, from 216 patients were cultured. Two unknown MRSA-patients were identified. No patient with VRE was found and there was a low prevalence of other multi-resistant bacteria. In the second study fifteen patients with MRSA infected wounds were interviewed. The aim was to ascertain and describe patients’ knowledge, perceptions and experiences of being MRSA-positive. The interviews were analyzed according to qualitative content analysis. From the analysis three categories and one overall theme were identified. Results showed that information about the MRSA diagnosis often caused a shock-like reaction. The patients’ perception of being MRSA-positive was that it was stigmatizing like the plague or leprosy; they felt dirty and a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. Knowledge and empathy from staff involved in their care was crucial to optimise patients’ experiences. Staff’s needs of education to meet patients’ demands for information, and to prevent spread of antibiotic contamination was essential. In the third study eight nurses and seven assistant nurses from different hospital wards and nursing homes were interviewed regarding their experiences of caring for MRSA-positive patients. Qualitative content analysis was carried out when analysing the data and three themes were identified during the process. Stress and too high workload were factors which were described to cause concerns in the caring situation. A major concern was that nurses felt at risk of becoming infected themselves and then transmitting the infection to other patients and to family members. Knowledge and ignorance about MRSA affected the nurses’ caring; ignorance made them afraid and insecure while knowledge and understanding shaped confidence in their role as caregivers. In the fourth study 560 residents in a total of 67 wards, in nine nursing homes were investigated for prevalence of MRSA, VRE and extended-spectrum β-lactamase (ESBL) - producing Enterobacteriaceae and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors and/or staff´s adherence to guidelines for infection control. In all 296 staff members were interviewed and observed. No resident was positive for MRSA or VRE. Fifteen residents were found to be ESBL-positive. Usage of antibiotics was higher in wards where ESBL-positive residents were detected and there was an indication that there was transmission of ESBL between residents. Staff´s adherence to infection control guidelines sometimes revealed shortcomings but no significant difference regarding adherence to the guidelines could be found. In conclusion: Prevalence of MRSA appears low in both hospitalized patients, out-patients and nursing home residents. Adherence to infection control guidelines among healthcare staff, however, needs further improvement. MRSA colonized patients experienced psychological pressure and stigmatization. Knowledge and empathy from staff involved in their care is crucial to optimise patients’ experiences. Staff education to meet patients' demands for information and the prevention of contamination is essential

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2012. , 58 p.
Keyword [en]
MRSA, VRE, ESBL, Colonization, Infection control, Wound, Patient experiences, Staff experiences, Nursing care, Qualitative interview, Qualitative content analysis
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-1140ISBN: 978-91-7457-823-2 (print)OAI: oai:DiVA.org:shh-1140DiVA: diva2:555467
Public defence
2012-09-14, Erforssalen, Sophiahemmet Högskola, Valhallavägen 91, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-20 Created: 2012-09-20 Last updated: 2016-06-09Bibliographically approved
List of papers
1. Wounds scrutiny in a Swedish hospital: prevalence, nursing care and bacteriology, including MRSA
Open this publication in new window or tab >>Wounds scrutiny in a Swedish hospital: prevalence, nursing care and bacteriology, including MRSA
2005 (English)In: Journal of Wound Care, ISSN 0969-0700, Vol. 14, no 7, 313-9 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To identify all wounds, wound types and wound characteristics; to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gram-negative rods;. METHOD: All patients admitted to or visiting hospital clinics were examined. If the patient had a wound, a questionnaire was filled in by a nurse, and if the wound met the inclusion criteria swabs were taken. RESULTS: A total of 2172 patients were admitted to or visited the hospital; 408 (19%) had a total of 668 wounds. Of this number, 248 were cultured. Thirty-seven patients had pressure ulcers, 83 had leg and foot ulcers and 288 patients had other types of wounds. Nursing care varied according to wound type and ward. Fifty-eight different types of wound dressings were used. Cleansing was performed with saline in 58% of the wounds. The mean number of dressing changes was once daily. Wounds were painful in 37% of the cases, with a predominance of leg and foot ulcers (51%). Many patients did not receive analgesia. MRSA was identified in two patients. No VRE was identified, and there was a low prevalence of multi-resistance in Enterobacteriaceae and Pseudomonas aeruginosa. CONCLUSION: The study provided important information for future improvement of wound care in a university hospital. Fewer resistant bacteria, particularly MRSA, were identified than expected.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-13 (URN)16048217 (PubMedID)
Available from: 2010-03-04 Created: 2010-02-19 Last updated: 2014-12-01Bibliographically approved
2. MRSA - global threat and personal disaster: Patients' experiences
Open this publication in new window or tab >>MRSA - global threat and personal disaster: Patients' experiences
2011 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 58, no 1, 47-53 p.Article in journal (Refereed) Published
Abstract [en]

ANDERSSON H., LINDHOLM C. & FOSSUM B. (2011) MRSA - global threat and personal disaster: patients' experiences. International Nursing Review58, 47-53 Aim:  To ascertain and describe the patients' knowledge, perceptions and experiences of being methicillin-resistant Staphylococcus aureus (MRSA) positive. Background:  Antibiotic resistant bacteria are a serious global threat. MRSA can cause wound infection, pneumonia, septicaemia and mortality. This qualitative study has focused on patients' experiences of living with MRSA. Methods:  Fifteen patients with MRSA-infected wounds were interviewed. All data were transcribed verbatim and analysed according to content analysis. Findings:  Information about the MRSA diagnosis often caused a shock-like reaction. Patients' perception of being MRSA positive was stigmatizing as plague or leprosy; they felt dirty and felt that they were a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. The key findings emerged as a theme: Being exposed to others' shortcomings and being a threat to others' health. Three categories were identified: understanding and emotional reactions, treatment by the healthcare professionals and consequences and expectations. Gaps in both patient and staff knowledge of MRSA led to unnecessary misunderstandings, causing fear, social isolation and suffering. Conclusions:  Living with MRSA can be extremely stressful for the patients. Knowledge and empathy from staff involved in their care is crucial to optimize patients' experiences. Staff education to meet patients' demand for information and prevent contamination is essential.

Keyword
Content Analysis, Infection, Methicillin-Resistant Staphylococcus aureus, MRSA, Patient Experience, Qualitative Interviews, Sweden, Wounds
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-315 (URN)10.1111/j.1466-7657.2010.00833.x (DOI)21281293 (PubMedID)
Available from: 2011-02-25 Created: 2011-02-25 Last updated: 2017-12-11Bibliographically approved
3. Emotional reactions when caring for MRSA-positive patients: ignorance and fear versus knowledge and security
Open this publication in new window or tab >>Emotional reactions when caring for MRSA-positive patients: ignorance and fear versus knowledge and security
(English)Article in journal (Refereed) Submitted
Keyword
MRSA
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1139 (URN)
Available from: 2012-09-20 Created: 2012-09-20 Last updated: 2015-08-13Bibliographically approved
4. Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: healthcare staff knowledge of and adherence to principles of basic infection prevention
Open this publication in new window or tab >>Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: healthcare staff knowledge of and adherence to principles of basic infection prevention
Show others...
2012 (English)In: Scandinavian journal of infectious diseases, ISSN 1651-1980, Vol. 44, no 9, 641-649 p.Article in journal (Refereed) Published
Abstract [en]

Abstract Background: The aims of this study were to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in residents living in Swedish nursing homes, and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors, and/or staff's adherence to guidelines for infection control. Methods: Five hundred and sixty residents from 9 nursing homes on a total of 67 wards participated in the study and had microbiological cultures taken. Faecal samples were obtained from 495 residents (88.3%). ESBL-positive residents were followed for 2 y with repeated sampling. Two hundred and ninety-six staff members were interviewed and observed regarding familiarity with and adherence to infection control guidelines. Results: No resident was positive for MRSA or VRE. Fifteen of the residents were found to be ESBL-positive. Residents living on wards where ESBL-positive residents were identified had been treated more frequently with antibiotics (42%), compared to those on wards where no residents with ESBL were found (28%; p = 0.02). ESBL-positive Escherichia coli isolates from residents living in adjacent rooms were found to be closely genetically related when analysed by pulsed-field gel electrophoresis, indicating transmission between residents. Staff adherence to infection control guidelines sometimes revealed shortcomings, but no significant differences regarding compliance to the guidelines could be found. Conclusion: Carriage of resistant bacteria was uncommon and only ESBL-producing Enterobacteriaceae were identified in Swedish nursing homes. Usage of antibiotics was higher on wards where ESBL-positive residents were detected and there was an indication of transmission of ESBL between residents.

Keyword
Antibiotic resistance, Resistant bacteria, Nursing homes, Infection prevention guidelines
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1128 (URN)10.3109/00365548.2012.671956 (DOI)22680834 (PubMedID)
Available from: 2012-08-22 Created: 2012-08-22 Last updated: 2014-12-01Bibliographically approved

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