1. MRSA and VRE in a Rural Community Hospital Graduation Project 2008 Mehvish Ally

2. What is MRSA? MRSA (Methicillin-resistant Staphylococcus aureus ) is a type of staph infection that is responsible for human infections that are very difficult to treat. MRSA (Methicillin-resistant Staphylococcus aureus ) is a type of staph infection that is responsible for human infections that are very difficult to treat. MRSA was discovered in 1961 in the UK. It is now found worldwide. MRSA is often referred to in the press as a "super bug." 1 1. multi-resistant MRSA was discovered in 1961 in the UK. It is now found worldwide. MRSA is often referred to in the press as a "super bug." 1 1. multi-resistant An image of MRSA from an electron microscope

3. Purpose To ascertain whether or not there is a major difference in infection rates of MRSA and VRE among rural and urban hospitals and communities. The rural and urban areas used for comparison were Bradford and Pittsburgh, respectively. To ascertain whether or not there is a major difference in infection rates of MRSA and VRE among rural and urban hospitals and communities. The rural and urban areas used for comparison were Bradford and Pittsburgh, respectively.

4. What is VRE? Vancomycin-resistant Enterococci (VRE) are bacteria that have evolved from MRSA and have become resistant to the antibiotic vancomycin. VRE was not reported in US hospitals until 1989 Vancomycin-resistant Enterococci (VRE) are bacteria that have evolved from MRSA and have become resistant to the antibiotic vancomycin. VRE was not reported in US hospitals until 1989 An image of VRE from an electron microscope

5. Types of MRSA HA-MRSA: Hospital Acquired MRSA HA-MRSA: Hospital Acquired MRSA CA-MRSA: Community Acquired MRSA CA-MRSA: Community Acquired MRSA

6. Symptoms/Affects Staph infections, including MRSA and VRE, generally start as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Staph infections, including MRSA and VRE, generally start as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining.

7. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life- threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life- threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.

8. Causes Unnecessary antibiotic use in humans. Unnecessary antibiotic use in humans. Antibiotics in food and water. Antibiotics in food and water. Germ mutation. Germ mutation.

9. Risk Factors A current or recent hospitalization. - 1.2 million hospital patients are infected with MRSA each year in the United States. A current or recent hospitalization. - 1.2 million hospital patients are infected with MRSA each year in the United States. Residing in a long-term care facility. -more prevalent Residing in a long-term care facility. -more prevalent

10. Invasive devices. -dialysis -catheterization -feeding tubes Invasive devices. -dialysis -catheterization -feeding tubes Recent antibiotic use. -body becomes immune to antibiotic Recent antibiotic use. -body becomes immune to antibiotic

11. Screening and diagnosis Doctors diagnose MRSA by checking a tissue sample or nasal secretions for signs of drug-resistant bacteria. Doctors diagnose MRSA by checking a tissue sample or nasal secretions for signs of drug-resistant bacteria.

12. Treatment Both hospital and community associated strains of MRSA still respond to certain medications. Both hospital and community associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors generally rely on the antibiotic vancomycin to treat resistant germs. In hospitals and care facilities, doctors generally rely on the antibiotic vancomycin to treat resistant germs.

13. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains, but overuse of vancomycin has led to VRE outbreaks. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains, but overuse of vancomycin has led to VRE outbreaks. To help reduce the threat of VRE, doctors may drain an abscess caused by MRSA rather than treat the infection with drugs. To help reduce the threat of VRE, doctors may drain an abscess caused by MRSA rather than treat the infection with drugs.

14. Prevention HA-MRSA Ask all hospital staff to wash their hands or use an alcohol-based hand sanitizer before touching you — every time. Ask all hospital staff to wash their hands or use an alcohol-based hand sanitizer before touching you — every time. Wash your own hands frequently. Wash your own hands frequently. Make sure that intravenous tubes and catheters are inserted under sterile conditions, Make sure that intravenous tubes and catheters are inserted under sterile conditions,CA-MRSA Wash your hands. Wash your hands. Keep personal items personal. Keep personal items personal. Keep wounds covered Keep wounds covered Shower after athletic games or practices. Shower after athletic games or practices. Sanitize linens. Sanitize linens. Use antibiotics appropriately. Use antibiotics appropriately.

15. The impacts Mortality rate for patient without MRSA in 2004: 2.1% Mortality rate for patient without MRSA in 2004: 2.1% Mortality rate for patient with MRSA in 2004: 8.9% Mortality rate for patient with MRSA in 2004: 8.9% were four times as likely to die were four times as likely to die Had hospital stays more than two and a half times longer Had hospital stays more than two and a half times longer

16. In 2004, the average charge for a hospitalization without MRSA : $28, 711 In 2004, the average charge for a hospitalization without MRSA : $28, 711 Average charge for a hospitalization with MRSA: $87,900 Average charge for a hospitalization with MRSA: $87,900 Hospital charges were three times as much Hospital charges were three times as much

17. Recent developments http://www.cnn.com/2008/HEALTH/condit ions/03/12/cat.staph.ap/index.html?iref=n ewssearch http://www.cnn.com/2008/HEALTH/condit ions/03/12/cat.staph.ap/index.html?iref=n ewssearch http://www.cnn.com/2008/HEALTH/condit ions/03/12/cat.staph.ap/index.html?iref=n ewssearch http://www.cnn.com/2008/HEALTH/condit ions/03/12/cat.staph.ap/index.html?iref=n ewssearch

18. Results MRSA constituted 50% of all staph infections in Bradford and Pittsburgh. MRSA constituted 50% of all staph infections in Bradford and Pittsburgh. VRE – constituted about 57% of all staph infections in Bradford and Pittsburgh. VRE – constituted about 57% of all staph infections in Bradford and Pittsburgh.