HAIs are unnecessary tragedies, increasing morbidity and mortality figures and adding to healthcare costs. As such, guidelines were provided by the Department of Health which hospitals later on adopted. However, the guidelines did not provide directives which precisely address how healthcare providers can either evaluate their ability to comply with professional guidelines on this topic or resume that their procedures are effective. As such, the research seeks to identify the prevalence MRSA and VRE in HAIs at the Assir Central Hospital and Khamis Mushait Hospital and identify how MSRA and VRE strains are resistant to vancomycin.
Results of such will be significantly related on how Assir Central Hospital and Khamis Mushait Hospital evaluated their guidelines and how effective are they in terms of combating MRSA and VRE in HAIs through vancomycin. Research Hypothesis and Questions The evaluation methods of Assir Central Hospital and Khamis Mushait Hospital have a significant relationship on the effectiveness to combat MRSA and VRE in HAIs. The independent variable for this research is the evaluation methods of Assir Central Hospital and Khamis Mushait Hospital in terms of combating MRSA and VRE in HAIs through vancomycin.
The dependent variable is the effectiveness of the said hospitals in terms of successfully combating MRSA and VRE in HAIs. Intervening variables that could affect the outcome of the research are the health practitioner’s level of awareness and education in terms of combating MRSA and VRE. Significance of the Study The problem of HAIs is significant because of its cost in human suffering and morality. In addition HAIs also represents a huge financial burden on healthcare institutions. In a 2004 study that focused on hospitals in Pennsylvania, 12,000 patients were found to develop HAIs during a hospital stay (Houghton, 2006).
This translates into $2 billion in additional care costs and also at least 1500 preventable deaths (Houghton, 2006). These infections are frequently problematic because of the microorganisms involved have become resistant to antibiotics (Broadhead, Parra and Skelton, 2001). More significantly, there is not a simple or facile answer on how to handle the dangers inherent antibiotic resistant organisms and their spread. Roughly 10 to 20 percent of all healthy individuals carry Staphylococcus aureus in their “anterior nares at any given time,” which indicates the prevalence of this pathogen in the environment (Zaoutis, Dawid and Kim, 2002, p.
313). Acerbating the problem, other organisms also have developed resistance to the use of antibiotics and therefore constitute a similar threat to public health (Wiseman, 2006). MRSA and vancomycin-resistant Enterococcus (VRE) are the primary causes of HAIs and are significant factors in increased morbidity and mortality rates. According to Furuno, et al (2005), these microbes are currently endemic in many healthcare institutions, and are particularly problematic in intensive care units (ICUs). Infections from VRE have become increasingly prevalent in American hospitals over the last decade (Ridwan, et al, 2002).
In the national nosocomial infection surveillance study, the “proportion of vancomycin resistant enterococci among entercoccal bloodstream infections rose from 0 percent in 1989 to 25. 9 percent in 1992” (Ridwan, et al, 2002, p. 666). Vancomycin is the antibiotic frequently used to treat infections caused by MRSA, but recent years have seen the emergence of Staphylococcus aureus infections that have high-resistance to vancomycin, which makes the future effectiveness of this drug questionable (Furuno, et al, 2005).
All known variants of the vancomycin-resistant Staphylococcus aureus (VRSA) isolates have possessed the vanA gene, which carries with it resistance to vancomycin. This development is believed to have been acquired “when the MRSA isolate conjugated with a co-colonizing VRE isolate” (Furuno, et al, 2005, p. 1539). This means that patients who suffer co-colonization from MRSA and VRE have an increased risk for colonization and infection by VRSA (Furuno, et al, 2005).
Furthermore, Zirakzadeh and Patel (2006) state that VRE has become a major concern due, in part, to its ability to transfer vancomycin resistance to other bacteria, which includes MRSA. Infection of susceptible patients typically occurs in environments that have a high rate of patient colonization with VRE, such as ICUs and oncology units (Zirakzadeh and Patel, 2006). In these healthcare settings, VRE has been known to survive for extensive periods and research has also observed that VRE has the ability to contaminate virtually every surface (Zirakzadeh and Patel, 2006).
Efforts to control HAIs, such as VRE, have focused on prevention, such as through hand hygiene, as the first line of defense. Hand hygiene has been improved through the use of “user-friendly, alcohol-based hand cleansers, but there still remains the goal of achieving consistently high levels of compliance with their use” (Carling, et al, 2005, p. 1). Screening-based isolation practices have likewise improved transmission rates of MRSA and VRE; however, logistic issues and the cost-effectiveness of these practices are still being analyzed (Carling, et al, 2005).
Additionally, despite isolation practices, outbreaks and instances of environmental contamination have been documented in regards to MRSA, VRE and Clostridium difficile, which cannot be screened with any practicality (Carling, et al, 2005). The numerous obstacles that exist in regards to effective screening practices suggest that a focus on improving existing cleaning/disinfecting practices may prove to be more effective in halting the spread of HAIs (Carling, et al, 2005.