Methicillin-resistant Staphylococcus aureus (MRSA) is an infection that arises when a staph bacterium becomes resistant to most of the antibiotics used in treating ordinary bacterial infections. There are various classes of MRSA depending on the place of acquisition. For example, MRSA acquired in health care centers is referred to as HA-MRSA while the community-acquired is CA- MRSA ( Mayo Clinic, 2019) . Health workers are the key agents of spreading HA-MRSA mainly by touching an uninfected patient with unclean hands. In contrast, CA- MRSA enters the body via cuts or scrape. In the beginning CA- MRSA appears as a spider bite usually red, swollen, and painful skin boil. High school wrestlers, and Child care workers are some of the high-risk populations of CA- MRSA.
MRSA results in serious life-threatening complications as the bacterium become more resistant to ordinary antibiotics. Such complications can affect the bloodstream, heart, lungs, Bones, and Joints. However, the spread of HA- MRSA can be prevented through isolation of affected patients, wearing protective clothes, and proper disinfection of hospital rooms and surfaces ( Mayo Clinic, 2019) . Likewise, combating the spread of CA- MRSA entails regular washing of hands, covering of wounds, and avoiding sharing of personal items like razors and towels.
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Lastly, MRSA affects people of all ages; however, CA- MRSA is highly prevalent among people within 18 to 29 and 40 to 49 years. Similarly, males account for the majority of the CA-MRSA patients according to Payne (2009).
Determinants of Health
According to the healthy people 2020 (HP 2020), several features are used as the main determinants of health. They are categorized into four main branches, policy making, social factors, health services, and biology and genetics. The interrelation between these factors is essential in establishing the health of an individual. In accordance with the HP (2020) diagnosis and treatment guidelines, intervention programs rely on these determinants to become effective. In clinical practice, the determinants of health reach a relatively beyond the boundaries of the conventional healthcare as well as public health sectors such as sectors such as education, housing, transportation, agriculture, and environment which play an integral secondary but essential role in improving population health. The determinants are discussed below:
Policy making: These refer to policies made by different authoritative organs based on their administration structure. For instance, they include policies relating to healthcare measures made at the local, state, and federal level and how they affect individual and entire population health. For example, if a state increases tax on tobacco and alcohol sale, this policy can help people in reducing the number of people using tobacco and alcohol. As such, the state will have reduced the potential number of people who would have fallen victims to tobacco and alcohol use. However, some policies can be made that affect the entire population while simultaneously expecting change in behavior. For instance, in the United States of America (US), the federal government passed the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorizing the Federal Government to set and regulate standards for motor vehicles and highways ( U.S. Department of Health and Human Services, 2020) . This move was essential in promoting the general health of the population since it increased safety standards for cars, including seat belts, which consequently reduced rates of injuries and deaths from motor vehicle accidents.
Social factors: According to HP (2020), social factors are health determinants that reflect on the social factors and physical conditions of the environment. In perspective, the environment is always related to places where individuals were born, live, learn, play, work, and age. These social and physical determinants of health impact on a wider variety of issues related to health such as the functionality of healthcare systems, and quality-of-life outcomes after diagnosis and treatment. Examples of determinants under the social factors include availability of resources for meeting the daily needs of the people such as access to education, job opportunities, minimum wages and healthful food. Secondly, the exposure to crime, violence and social disorder and access to social support and social interactions among others. The physical environment consists of determinants such as the natural environment consisting of natural resources such as sunlight, trees, water, weather and climate change. The second determinant is housing, homes and supportive neighborhoods. Also, exposure to hazardous substances is also assessed within the physical environment paradigm.
Health Services: The HP (2020) proposes that people need to have access to quality health services. However, lack of access or unlimited access to quality healthcare services prompts the poor health literacy and this becomes detrimental to the wellness of individuals. For example, individuals without the most basic medical insurance cover may fail to access preventive care services and delay their treatment. Some of the barriers to quality healthcare include high costs of medication, language barrier and lack of health insurance ( Pestka et al., 2020) . People can fail to seek medical counsel due to factors such as unmet medical needs, delay in receiving the appropriate medical care and inpatient services that could have been prevented due to medical errors.
Individual Behavior: This plays a critical role in the medical register of a person. For example, serial smokers might increase their vulnerability to lifestyle diseases such hear failure, diabetes and throat cancer. Most of the medical diagnosis and treatment are based on individual behavior such as diet, substance abuse, and physical activity.
Biology and Genetics: Some patient populations are affected by biological and genetical factors while others are not. For instance, older people are prone to diseases due to a weakened immune system compounded by the physical and cognitive effects of aging. Example of biological and genetical factors that influence an individual’s health include gender, age, their HIV/AIDS status, inherited conditions such as sickle cell anemia, cystic fibrosis, hemophilia and family history of heart diseases.
Epidemiological Triad
MRSA is a leading cause of bloodstream infections with an incidence of 20% to 50% cases in every 100,000 people per year. MRSA has mortality rate of about 40% based on factors such as site of acquisition and resistance rates to methicillin ( Healthy People, 2020) . However, the mortality rate of MRSA is estimated be at 30% with increased knowledge concerning the disease. The infections caused by MRSA have proved to carry double mortality rates characterized with higher hospitalizations rate, increased healthcare costs and in-hospital complications. The environmental factors related to MRSA remains unknown. However, exposure to contaminated surfaces and exposure to colonized people can easily contribute to the spread of the disease among the elderly in long term care facilities.
Role of an NP
Nurse Practitioners have huge task in combating the spreading of MRSA among the elderly in long term care. For instance, the nurses can set apart an isolation room for people diagnosed with MRSA and ensure contact precaution sign is available for everyone. This will drastically reduce infections in healthcare facilities. Nurses and patients should embrace hand hygiene using the defines WHO 5 moments for hand hygiene; use soap and water and/or alcohol gel as appropriate; offer patient hand hygiene opportunities as appropriate; encourage patient to keep fingernails short and clean, and encourage visitors to decontaminate hands before and after visiting. Nurse practitioner can use PPEs when coming in contact with the patients. Lastly, they can track and monitor infection rates so that they can develop a feasible treatment plan to promote quality patient outcomes. These practices will help in the development of an evidence-based practice model for treating MRSA among the elderly in long term healthcare facilities.
References
Healthy People (2020). Determinants of Health. Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
Mayo Clinic (2019). MRSA Infection Retrieved from: https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336#:~:text=Methicillin-resistant%20Staphylococcus%20aureus%20(MRSA,to%20treat%20ordinary%20staph%20infections .
Payne, O. (2009). Combating Methicillin-resistant Staphylococcus aureus. Retrieved from: http://web.mit.edu/angles/Oran_Payne.htm#:~:text=The%20average%20age%20of%20infected,%2D29%20and%2040%2D49
Pestka, D. L., Espersen, C., Sorge, L. A., & Funk, K. A. (2020). Incorporating social determinants of health into comprehensive medication management: Insights from the field. Journal of the American College of Clinical Pharmacy , 3 (6), 1038-1047.
U.S. Department of Health and Human Services. Draft report of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 on Social Determinants; revised 2009 Sep 9.
