1. Anti-Microbial Resistance
Ranson Thomas
Santa Fe College 2014

2. 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

3. 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

4. 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

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

6. 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.

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

8. 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?

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

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. QUESTIONS?

17. 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:
World Health Organization, (2005). Containing Antimicrobial Resistance. WHO Policy Perspectives on Medicines, No. 010, April 2005