How to prevention of Methicillin-resistant Staphylococcus aureus (MRSA) infections

MRSA is associated with,

1.      Ventilator-associated pneumonia – Pneumonia can be life threatening especially when it occurs in intensive care patients. These patients’ immune system is already compromised and infection with resistant bacteria multiplies the risks.

2.      Bloodstream infection associated with central venous catheters, and surgical-site infections – Hospitalized patients undergo various invasive procedures that involve access to the blood stream. This leads to introduction of resistant bacteria to the systemic circulation. 

These have become major problems in health sector because they are associated with significant amount of morbidity and mortality. These infections are acquired from the hospital a, because the resistant bacteria present in the hospital. A system called “MRSA BUNDLE” is used to prevent MRSA associated infections in the health care facilities.

This bundle consists of following guidelines.

1.      universal nasal surveillance for MRSA colonization

2.      contact precautions for patients who were carriers of MRSA

3.      hand hygiene

4.      institutional culture change whereby infection control became the responsibility of everyone who had contact with patients

Studies done show that MRSA infection rates have been reduced significantly when above guidelines are followed.

Control of Resistant Bacteria in Intensive Care

Intensive care unit is a place where a lot of antibiotics are used. Also most of the patients transferred for intensive care have already been treated with most of the potent antibiotics available. The therapeutic interventions such as mechanical ventilation also favor this matter. All these factors contribute for the acquisition of resistant bacteria. This has been a major problem because treating such infections is very hard. 

The most common resistant bacteria found are,

1.      Methicillin-resistant Staphylococcus aureus (MRSA)

2.      vancomycin-resistant enterococcus (VRE)

They colonize in,

1.      mucous membranes

2.      skin

3.      wounds

4.      gastrointestinal tract

How do patients acquire these infections?

1.      Through the hands of health care providers

2.      Through contaminated fomites and environmental surfaces

3.      By direct transmission from colonized health care providers.

Standard interventions to prevent the transmission of such infections are,

1.      Hand hygiene – Health care personnel and everybody who touch the patients in the intensive care are advised to wash their hands before handling the patients. They are also advised to clean their hands in between patients.

2.       Use of gloves and gowns

3.       Isolation of patients with resistant bacterial infection.

4.      Active surveillance — some patients may have acquired the infection but still could be asymptomatic. They are silent carriers. It is very important to find these carriers as they can harbor bacteria and spread them to other patients. Therefore, there should be an effective surveillance system to identify such asymptomatically colonized patients.

5.      Topical antimicrobial treatments

Why Patients in the ICU are made unconscious?

People are admitted to the ICU (Intensive care unit) due to various reasons. They are all critically ill people who need continuous care, support and monitoring. Out of these people, some are brought to the hospital when they are still conscious. They may be having difficulty in walking, talking and doing things, but they are still conscious. For example, people with head injury. But, after surgery, they are brought to the ICU and they remain unconscious for days. 

Some times this is not because they are actually unconscious. Sometimes they are unconscious because they are made unconscious. Now, you might think why? To understand this you should know what happens in head injury and after surgery.

If we take a brain hemorrhage, that is bleeding in side the brain, there is accumulation of blood and edema fluid within the skull. As the brain is in a confined cavity, the brain tissue gets compressed and herniated. If the pressure goes very high, the herniation can even cause death. Therefore the anaestherists take measures to reduce further brain edema. Meanwhile they should also prevent further brain damage by maintaining good blood flow to the brain.

The measures they take to achieve these targets involves 2 kinds of actions.

• Brain protection by maintaining -  

•  normal oxygen level
•  normal carbon dioxide level 
• normal pressure
• normal glucose level
• normal temperature
• normal blood volume

• Brain relaxation by – 

• Sedation                                  
• Paralyzing and ventilation
• Giving antiepileptics
• Positioning the patient in 20⁰ angle
• Neutral position of the neck and head
• Flexing the hip

As you can see the some of the above measures includes sedation and paralysis. The artificial ventilation also needs the patient to be in an inhibited state, so he/she won’t feel the uncomfortable instruments that are put in to their throats.  

As their conditions gradually starts to improve, the anaesthetists will slowly reduce the sedating drugs and make the patient able to talk. Then he/she is fit enough to go to a ward and get treatments.

                                   

 Emergency & Critical Care Pocket Guide 

Icu Intern Pocket Survival Guide (INTERN POCKET SURVIVAL GUIDE SERIES) 

Why we can’t give 100% Oxygen for People with Chronic Lung Diseases?

Some people suffer from chronic lung diseases like bronchiactasis, chronic obstructive pulmonary disease (COPD) etc. As the lung functions are compromised in these patients, there oxygen saturation of blood is decreased. Most of these people face acute exacerbations of the disease where the respiration becomes hard. 

IF you have chronic lung disease and face such situation, you may crave for oxygen. Some people ask for oxygen, sometimes the physician may not let you have any oxygen. Many patients become irritated when they face such problem. But, they should understand that it is the best way to manage. 

Why?

Now you must be wondering why. To understand it you should have a clear understanding about the physiology of respiration and how it is controlled. 

How the respiratory rate is maintained. 

The respiration is controlled by the respiratory centre situated in the brain stem. There are several inputs to this respiratory centre. They are,

• Inputs from the higher centers enabling voluntary control over respiration.
• Information from the peripheral circulation indicating the amounts of oxygen and Carbon Dioxide.
• Inputs from the chemoreceptor area situated near the respiratory centre which detects the amount of CO₂ present in the brain.

Out of above the inputs from the chemoreceptor area plays a major role. As the CO₂ in the brain increased the respiratory centre increases the respiratory rate to get rid of the excess CO₂. 

In chronic lung diseases they are persistently high amount of CO₂ in the brain making the respiratory centre insensitive to its presence. At this time the respiratory rate is maintained by the peripheral oxygen concentrations. If the peripheral oxygen content reduces the massage is sent to the respiratory centre to increase the respiratory rate.

So, if we give 100% oxygen for such person once the peripheral oxygen content raises the stimulation of the respiratory centre reduces. As a result the respiratory rate reduces. This ultimately leads to reduction of oxygen. Therefore, 100% oxygen is not given for patients with chronic lung diseases. 

Oxygen Therapies [VHS]