MRSA Strain on the Rise in US Hospitals: Root Cause Analysis Presentation

Definition of MRSA

The Acronym MRSA stands for meticillin resistant staphylococcus aureus. This is a kind of micro organism that’s delicate to antibiotic remedies that often colonizes the nostril, throat and the pores and skin of a affected person. This sort of an infection is immune to antibiotics akin to methicillin, amoxicillin and penicillin (Lonnen , 2010).

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MRSA infections have been identified to happen in hospitals amongst sufferers who’ve undergone surgical procedure or are experiencing suppressed immunity. It additionally happens in sufferers who’ve stayed within the hospital for an prolonged time frame.

MRSA hospitalization statistics

According to healthcare price and utilization undertaking (HCUP) statistics, MRSA hospitalizations have been greater than more likely to happen within the ICU (57%), between hospital transfers (5.9%), or between transfers from long run care settings to regular hospital settings (4.4%).

The quantity of people that have been discharged with MRSA infections in 2004 have been 0.7% with individuals who have been 65 years and over recording the best prevalence charges of 44%.

The high two procedures that led to MRSA infections included surgical remedy of pores and skin infections and pores and skin grafting (Elixhauser & Steiner, 2007).

The diagram under exhibits the variety of hospital stays because of MRSA infections, 1993-2005.

Identification of the Problem

Overcrowding and understaffing in hospitals has elevated the extent of MRSA infections. These have been recognized to be the basis causes of HA-MRSA (Hospital related MRSA).

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Overcrowding and understaffing elevated the degrees of HA-MRSA due to poor hand hygiene, isolation packages and poor affected person screening.

Community related MRSA (CA-MRSA) can be a serious downside within the US the place people are uncovered to the predisposing elements of the illness outdoors the hospital setting (Li et al, 2009)

MRSA infections principally happen in hospitals and well being care amenities akin to dialysis facilities and nursing properties (Science Daily, 2008).

Flow chart of MRSA Process

Root Cause Analysis: What led to the rise in MRSA infections

The causes for the rise in MRSA infections in hospitals has been attributed to overcrowding and understaffing in hospitals.

This has led to prolonged inpatient hospital stays, overcrowding in hospital wards and mattress blocking which will increase MRSA infections.

Overstaffing and overcrowding led to MRSA infections because of poor hand hygiene, variety of contacts between healthcare employees and sufferers and employees burnouts (Science Daily, 2008).

Flow Chart of MRSA infections in hospitals

Root Cause Analysis: What led to the rise in MRSA infections

Overcrowding and understaffing in hospitals has been recognized by most medical practitioners to be the basis explanation for MRSA infections.

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These causes have principally been associated to insurance policies that promote excessive affected person throughput and a fewer mattress capacities.

The improve of MRSA infections has additionally been attributed to a diminishing healthcare workforce in each hospital and healthcare amenities (Science Daily, 2008).

Overcrowding and understaffing cycle that results in MRSA infections

Proximate Factors in MRSA infections

The proximate elements that result in MRSA infections in hospitals embody excessive mattress occupancy charges which stop MRSA management practices, speedy affected person turnover in hospital wards or ward transfers

Periods of understaffing in hospitals have additionally contributed to the transmission of MRSA. The elevated employees workloads improve the dangers of transmitting the illness to different sufferers the place one employees employee is allotted to a excessive variety of sufferers. According to research, the well being care employee to affected person ratio has a direct relationship to MRSA an infection charges.

High nurse and affected person interactions additionally contribute to MRSA an infection charges in hospitals. Nurses who fail to apply secure hand washing are greater than more likely to improve the prevalence charge of MRSA in hospitals (Dailey et al, 2005).

The threat, human, exterior and gear elements related in buying MRSA infections

The elements which might be most certainly to extend threat of sufferers buying both HA-MRSA OR CA-MRSA embody hospitalization previously one 12 months, a current surgical procedure or trauma, diabetes, kidney dialysis, frequent antibiotic use, incomplete antibiotic dosages, persistent wounds, pores and skin illnesses akin to Dermatitis and Eczema and ulcers (Lonnen, 2010).

Equipment elements that improve the speed of MRSA in sufferers embody percutaneous endoscopic gastrostomy (PEG) tubes that are used for gastric feeding, and long run urinary catheters, traction tubes and different physique invasive gadgets which have been used for prolonged durations of time. These gadgets improve MRSA colonization within the affected person rising the speed of MRSA infections (Lonnen, 2010).

The human elements that led to MRSA infections embody excessive hospital or ward transfers, poor hand washing practices within the hospital, poor well being practices locally, low HCW: Patient ratios, excessive well being care employee to affected person contact charges and cohorting with contaminated sufferers (Clements, 2008)

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The exterior elements that improve MRSA infections in hospitals embody the altering healthcare techniques around the globe, fluctuations in affected person admission, low mattress capacities in public hospitals, rising healthcare prices, lower in high quality companies and healthcare supply because of MRSA root causes.

Systems and processes that underlie the proximate elements

The restructuring of the well being system within the US has led to a lower within the variety of sufferers which might be handled in in the future. The altering construction of the US healthcare system has modified because of financial rationalization and elevated effectivity (Klevens et al, 2007).

Such a scenario has created a excessive throughput system that has resulted in excessive affected person admission charges which have in flip led to periodic overcrowding and low well being care employee to affected person ratios. The throughput system has a restricted capability to cope with fluctuations in affected person admissions and employees numbers (Clements et al, 2008).

The ageing traits within the US have additionally contributed to nursing shortages in nursing properties and different well being care amenities across the nation. The US and different excessive earnings nations face staffing shortages within the healthcare sector which impacts the standard of healthcare and affected person security in hospitals (Klevens et al, 2007).

The variety of similar day separations have additionally gone down the place the variety of sufferers who depart the hospital the identical day they’ve been admitted has gone down.

Controllable environmental elements

The controllable elements that straight result in excessive incidences of MRSA in hospitals embody, low healthcare employee to affected person ratios, poor hand washing practices by well being care employees, poor well being care companies because of understaffing and elevated affected person workloads, frequent employees rotations in hospital wards, poor nursing abilities, and poor hand hygiene compliance by healthcare employees (Clements, 2008).

Areas which have been affected by MRSA infections

The areas which have been most affected by MRSA infections embody hospitals, group amenities akin to leisure amenities, gyms and sports activities facilities, prisons, faculties and faculties, animal shelters, cattle ranches, livestock farms and hospital nurseries.

Human Resource Issues which have led to MRSA prevalence charges

The composition of the nursing employees and their work abilities has been related to MRSA infections. Health care employees who don’t often work in a specific unit inside the hospital are greater than more likely to improve MRSA prevalence charges amongst sufferers since they aren’t accustomed to the workings of the hospital ward (Clements et al, 2008).

Healthcare employees who’re steadily moved between items or hospitals additionally improve MRSA infections.

Human useful resource points which have emerged because of understaffing have resulted in nursing assistants changing nurses in most hospitals. This has been performed to lower the rising healthcare prices within the US. This technique has additionally decreased the proportion of full time employees in most public hospitals.

Poor hand washing practices by most nurses and healthcare employees in hospitals has additionally had an influence on the MRSA an infection charges in hospitals and healthcare amenities (Clements et al, 2008).

How did genuine staffing measure as much as with final ranges?

The understaffing in hospitals and healthcare amenities differed from the perfect ranges of staffing the place the healthcare employee to affected person ratio was under 2:2.

Hugonnet et al (2007) observe {that a} quarter of HA-MRSA infections may be prevented if the nurse to affected person ratio is greater than 2:2 particularly within the intensive care items.

Such variations within the ideally suited staffing ranges result in will increase in well being care acquired infections (HAI) akin to MRSA infections.

They additional famous that there was rising proof that low nurse staffing in hospitals and healthcare amenities led to poor high quality in healthcare supply and affected person care (Hugonnet et al, 2007).

Plans for coping with employees contingencies in hospitals

Nurses and different healthcare employees are in excessive demand within the US and so they have grow to be more and more necessary within the provision of major healthcare in hospitals and healthcare amenities.

Estimates have proven that there shall be greater than 110,000 clinically lively nursing practitioners and physicians within the US within the subsequent 5 years. This quantity will symbolize one-sixth of the full variety of medical suppliers within the nation.

The plans which have been developed to reply to the low staffing ranges in hospitals embody a discount of tuition charges for folks coaching in any healthcare occupation, the usage of international skilled nurses in most public hospitals in order to scale back the understaffing stress, and the event of computerized remedy protocols (Sultz & Young, 2010).

Level of research of the basis causes of MRSA

Orientation and in-service coaching may be improved in hospitals and healthcare settings by coaching healthcare employees on MRSA transmission, an infection charges and the way they will stop the transmission of the illness between sufferers. Every healthcare employee must be supplied with primary info on MRSA and its causes within the hospital setting

There has been poor communication on MRSA and an infection charges amongst healthcare employees in hospitals and healthcare amenities. The quantity of data that’s obtainable on MRSA can be restricted which results in poor hand hygiene and healthcare practices.

There can be poor communication of MRSA points to sufferers who’ve been hospitalized or in healthcare amenities akin to nursing properties. This creates a scenario the place sufferers who’ve MRSA work together with sufferers that don’t have MRSA rising the prevalence charges of the illness.

The bodily or exterior setting has additionally affected the an infection charges of MRSA particularly locally setting the place there are lots of drug customers and there are lots of individuals who have pores and skin infections in a sure location (Lonnen, 2010).

The an infection charges locally have additionally been elevated amongst individuals who share clothes or private gear, individuals who have poor requirements of hygiene and individuals who have been in shut contact with an contaminated individual.

There are techniques which have been put in place to establish and reply to the environmental dangers of MRSA. One system that has been recognized is the intense untoward incident (SUI) that’s utilized in reporting circumstances of MRSA locally. Other techniques which might be in use in detecting environmental dangers of MRSA embody affected person and employees screening, MRSA surveillance, threat evaluation and root trigger evaluation of MRSA (Lonnen, 2010).

Leadership points: Corporate tradition and communication priorities

The company tradition that exists in most hospitals within the US doesn’t present a conducive setting for the detection of MRSA or different HAI infections inside the hospital. Management solely turns into concerned as soon as the an infection charges grow to be too excessive and can’t be contained.

Healthcare suppliers akin to docs and physicians don’t really feel snug approaching hospital managers on well being associated issues due to their lack of information. This has created a barrier in communication particularly in the case of the potential threat elements of MRSA.

To cope with uncontrollable elements akin to altering healthcare techniques and improve in healthcare prices, hospitals and healthcare amenities ought to develop insurance policies that may be capable of adapt to those modifications in each the current and future setting.

Action plan threat discount methods measures of effectiveness

Action merchandise 1: To scale back the prevalence charges of MRSA in hospital, the next actions should be taken:

  • Rigorous screening of recent admissions with specific give attention to contaminated pores and skin, nostril and open sore wounds.
  • Isolation of excessive threat sufferers or sufferers contaminated with MRSA
  • Hand hygiene practices and coaching amongst healthcare suppliers.
  • Creating consciousness of MRSA and rising info on private hygiene
  • Hand decontamination the place employees and sufferers decontaminate their fingers earlier than they enter and depart a medical space
  • Proper waste and laundry disposal the place contaminated hospital gear and affected person clothes is correctly disposed off.
  • The use of non-public protecting gear.

The related measure of effectiveness would be the variety of people who find themselves contaminated with MRSA earlier than and after being admitted to any hospital or healthcare facility.

Action merchandise 2: A call to develop methods for overcrowding and understaffing in hospitals shall be inconceivable to make given the unpredictable nature of the healthcare system in America:

  • The rising insurance coverage and healthcare prices will make it troublesome for public hospitals to accumulate extra employees to cope with the rising variety of sufferers who can not afford non-public well being care and medical cowl.
  • The poor wages and advantages which might be given to healthcare employees who’re based mostly in public hospitals could be very low when in comparison with well being care employees who work in non-public healthcare establishments and amenities.

Action merchandise 3: The chosen measure of effectiveness shall be acceptable in measuring the prevalence charges of MSRA infections in hospitals and healthcare amenities as it should present the suitable statistics and quantity of people that have been contaminated with MRSA in each the hospital and group setting.

Action merchandise 4: Pilot testing of deliberate enhancements and discount methods must be carried out within the type of growing MRSA insurance policies that shall be communicated to healthcare employees and sufferers. Training packages can even be carried out with specific give attention to hand hygiene practices. These packages and insurance policies shall be utilized in monitoring the MRSA prevalence charges inside the hospital setting.

Action merchandise 5: Improvements shall be applied in all non-public and public hospitals, well being care amenities akin to nursing properties, particular care amenities and kids’s properties, faculties, prisons, athlete facilities, livestock farms, group leisure facilities and animal shelters.


It is necessary for all hospitals and healthcare suppliers to apply secure medical procedures to scale back the incidences of MRSA in hospitals.

Public healthcare hospitals have to work at the side of the federal government to cope with the difficulty of overcrowding and understaffing in these hospitals.

The root causes of overcrowding and understaffing in these hospitals should be handled in order to develop methods that shall be utilized in managing MRSA an infection charges.

The proponents which might be utilized in altering healthcare techniques want to contemplate high quality healthcare and the burden of their actions to the healthcare employees.


Clements, A., Halton, Ok., Graves, N., Pettitt, A., Morton, A., Looke, D., & Whitby, M., (2008). Overcrowding and understaffing in trendy health-care techniques: key determinants in meticillin-resistant staphylococcus aureus transmission. Lancet Infectious Diseases, Vol., pp 427- 434

Dailey, L., Coombs, G.W., & O’Brien, F.G., (2005). Methicillin-resistant Staphylococcus aureus, western Australia. Emergency Infection Diseases, Vol.11, pp 1584-1590.

Elixhauser, A., & Steiner, C., (2007). Infections with methicillin-resistant staphylococcus aureus (MRSA) in U.S. hospitals, 1993-2005, Web.

Hugonnet, S., Chevrolet, J.C.,& Pittet, D., (2007). The impact of workload on an infection threat in critically in poor health sufferers. Critical Care Med, Vol.35, No.1, pp76–81.

Klevens, R.M., Morrison, M.A., & Nadle, J.,(2007). Invasive methicillin-resistant Staphylococcus aureus infections within the United States. Journal of American Medical Association, Vol. 298, pp1763–71.

Li, M., Diep, B.A., Villaruz, A.E., Braughton, Ok.R., Jiang, X., DeLeo, F.R., Chambers, H.F., Lu, Y, & Otto M., (2009).Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus. PNAS, Vol.106, No.14, pp 5883-5888.

Lonnen, S., (2010). Policy for the prevention and management of meticillin resistant staphylococcus aureus (MRSA), Gloucestershire NHS Primary Care belief.

Science Daily (2008). Overcrowding And Understaffing In Hospitals Increases Levels Of MRSA Infections. Web.

Sultz, H.A. & Young, Ok.M., (2010). Healthcare USA: understanding its group and supply. Massachusetts, US: Jones & Bartlett Learning.

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