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Hamilton RA, Lond B, Wilde L, Williamson I. Understanding the lived-experience and support-needs of people living with antimicrobial resistance in the UK through interpretative phenomenological analysis. Sci Rep 2024; 14:3403. [PMID: 38337017 PMCID: PMC10858033 DOI: 10.1038/s41598-024-53814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
In the UK nearly 54,000 infections were caused by serious resistant bacteria in 2022 but there is a lack of evidence regarding the long-term impact on patients' lives nor what support they need. This research aimed to answer the question: "What are the key elements of experience and support needs of people living with AMR in the UK?". In-depth semi-structured interviews were undertaken with nine people who had been living with resistant infections or colonisation for 12-months or longer. Interpretive Phenomenological Analysis was used to study the accounts and illustrate individuals' experiences and support-needs. Participants experienced marginalisation and isolation but also empowerment; described across three major themes: (1) I live in fear and stigma: The long-term impact of AMR; (2) I am battling on my own: A journey toward self-advocacy; and (3) I like to share my story: The role of AMR communities. All participants perceived a lack of knowledge, information, and support from clinicians; difficulties accessing reliable and understandable information; and lack of understanding from family and friends. Charities and online groups provided support with coping with their situation and improving mental health and wellbeing. Understandable and relatable information regarding the science of AMR, transmission, prevention, and living with AMR needs to be provided by clinicians and healthcare services around the time of diagnosis to readily available after diagnosis.
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Affiliation(s)
| | - Benjamin Lond
- Department of Psychology, De Montfort University, Leicester, UK
| | - Lucina Wilde
- School of Pharmacy, De Montfort University, Leicester, UK
| | - Iain Williamson
- Department of Psychology, De Montfort University, Leicester, UK
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2
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Qiao B, Wang J, Qiao L, Maleki A, Liang Y, Guo B. ROS-responsive hydrogels with spatiotemporally sequential delivery of antibacterial and anti-inflammatory drugs for the repair of MRSA-infected wounds. Regen Biomater 2023; 11:rbad110. [PMID: 38173767 PMCID: PMC10761208 DOI: 10.1093/rb/rbad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
For the treatment of MRSA-infected wounds, the spatiotemporally sequential delivery of antibacterial and anti-inflammatory drugs is a promising strategy. In this study, ROS-responsive HA-PBA/PVA (HPA) hydrogel was prepared by phenylborate ester bond cross-linking between hyaluronic acid-grafted 3-amino phenylboronic acid (HA-PBA) and polyvinyl alcohol (PVA) to achieve spatiotemporally controlled release of two kinds of drug to treat MRSA-infected wound. The hydrophilic antibiotic moxifloxacin (M) was directly loaded in the hydrogel. And hydrophobic curcumin (Cur) with anti-inflammatory function was first mixed with Pluronic F127 (PF) to form Cur-encapsulated PF micelles (Cur-PF), and then loaded into the HPA hydrogel. Due to the different hydrophilic and hydrophobic nature of moxifloxacin and Cur and their different existing forms in the HPA hydrogel, the final HPA/M&Cur-PF hydrogel can achieve different spatiotemporally sequential delivery of the two drugs. In addition, the swelling, degradation, self-healing, antibacterial, anti-inflammatory, antioxidant property, and biocompatibility of hydrogels were tested. Finally, in the MRSA-infected mouse skin wound, the hydrogel-treated group showed faster wound closure, less inflammation and more collagen deposition. Immunofluorescence experiments further confirmed that the hydrogel promoted better repair by reducing inflammation (TNF-α) and promoting vascular (VEGF) regeneration. In conclusion, this HPA/M&Cur-PF hydrogel that can spatiotemporally sequential deliver antibacterial and anti-inflammatory drugs showed great potential for the repair of MRSA-infected skin wounds.
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Affiliation(s)
- Bowen Qiao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710049, China
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Jiaxin Wang
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Lipeng Qiao
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Aziz Maleki
- Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan 45139-56184, Iran
| | - Yongping Liang
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Baolin Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710049, China
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
- Department of Orthopaedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of China
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A qualitative study examining the impact of multidrug-resistant organism (MDRO) carriage on the daily lives of carriers and parents of carriers with experiences of hospital precautionary measures. Antimicrob Resist Infect Control 2022; 11:103. [PMID: 35964059 PMCID: PMC9375065 DOI: 10.1186/s13756-022-01141-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022] Open
Abstract
Background Multidrug-resistant organism (MDRO) carriage may have an adverse impact on the quality of life of carriers, in particular those who have experienced hospital precautionary measures. This study aims to gain a deeper understanding of how MDRO carriage has affected the daily lives of carriers with these experiences. Methods This was a qualitative study based on 15 semi-structured interviews with MDRO carriers or parents of carriers, which were analysed by thematic analysis. Results Three main themes were identified: (1) Feeling dirty and unworthy portrays the feelings that MDRO carriers often expressed and how these were related to the language usage describing the MDRO, the perceived avoidance by staff and those in their personal networks, and the effects of the precautionary measures implemented in the hospital. (2) MDROs are invisible, but impact is visible covers how the microbe, despite its apparent invisibility, still impacted carriers in their physical and psychological health. MDRO carriage disrupted their lives, by affecting their other unrelated medical conditions at times and by causing varying levels of fear for their own and others’ health. (3) Carrying the burden on one’s own shoulders describes the lingering questions, uncertainties and confusion that carriers continued to live with and the perceived burden and responsibility that lay on their own shoulders with respect to carrying and preventing the transmission of the MDRO. Conclusions MDRO carriage can negatively influence the quality of people’s lives in various ways. Improved support and sensitivity from health care providers (HCPs) are needed to address feelings of unworthiness among MDRO carriers and the fears that many experience. Clearer information and guidelines are also needed from HCPs to address the many questions and uncertainties that MDRO carriers face outside of the hospital in their daily lives.
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Meagher KM, Watson S, Suh GA, Virk A. The New Precision Stewards? J Pers Med 2022; 12:jpm12081308. [PMID: 36013256 PMCID: PMC9409858 DOI: 10.3390/jpm12081308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.
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Affiliation(s)
- Karen M. Meagher
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9528
| | - Sara Watson
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Gina A. Suh
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Abinash Virk
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Voo TC, Lederman Z. Justice in control of methicillin-resistant Staphylococcus aureus transmission: a fair question to ask? Monash Bioeth Rev 2021; 38:56-71. [PMID: 32285336 DOI: 10.1007/s40592-020-00109-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Active surveillance cultures and contact precautions is a strategy to control the transmission of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities. Whether to implement this strategy to routinely screen and isolate inpatients with MRSA in non-outbreak (endemic) settings, or to remove it and use standard infection control precautions only is scientifically and ethically controversial, in view of the potential adverse effects of contact precautions on patients. To support the use of standard precautions only, it has been argued that active surveillance to identify patients who are asymptomatically colonised with MRSA to place them in contact precautions is unjust or unfair to these patients in various ways. This paper will unpack and examine four distinct arguments, which are advanced from a medical ethics or quality improvement ethical framework, for why this is so. Our analysis shows that while these arguments highlight the injustice of current practices, they do not provide strong ethical reasons for justifying the removal of active surveillance and contact precautions to control MRSA transmission and infection. An implication of our arguments is that the ethical frame for evaluating prevention and control strategies for MRSA, a multi-drug resistant bacteria, should shift from healthcare to primarily public health. From a public health ethics perspective, whether a strategy is unjust, or how ethically significant its lack of fairness is, depends on assessing the evidence for its public health effectiveness and necessity in a given setting, and the extent of the harms and burdens patients with MRSA bear when they are on contact precautions, which remain matters of scientific debate or uncertainty. As an ethical consideration in the debate, the chief normative implication of justice is to provide us further reasons to revise current active surveillance-contact precautions practices, and for the need for research and interventions to minimise their potential adverse effects on patients.
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Affiliation(s)
- Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, #02-03, 10 Medical Drive, Singapore, 117597, Singapore.
| | - Zohar Lederman
- Emergency Medicine Department, Shamir Medical Center, Ashdod, Israel
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6
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Wolters M, Frickmann H, Christner M, Both A, Rohde H, Oppong K, Akenten CW, May J, Dekker D. Molecular Characterization of Staphylococcus aureus Isolated from Chronic Infected Wounds in Rural Ghana. Microorganisms 2020; 8:microorganisms8122052. [PMID: 33371449 PMCID: PMC7767444 DOI: 10.3390/microorganisms8122052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Globally, Staphylococcus aureus is an important bacterial pathogen causing a wide range of community and hospital acquired infections. In Ghana, resistance of S. aureus to locally available antibiotics is increasing but the molecular basis of resistance and the population structure of S. aureus in particular in chronic wounds are poorly described. However, this information is essential to understand the underlying mechanisms of resistance and spread of resistant clones. We therefore subjected 28 S. aureus isolates from chronic infected wounds in a rural area of Ghana to whole genome sequencing. RESULTS Overall, resistance of S. aureus to locally available antibiotics was high and 29% were Methicillin resistant Staphylococcus aureus (MRSA). The most abundant sequence type was ST88 (29%, 8/28) followed by ST152 (18%, 5/28). All ST88 carried the mecA gene, which was associated with this sequence type only. Chloramphenicol resistance gene fexB was exclusively associated with the methicillin-resistant ST88 strains. Panton-Valentine leukocidin (PVL) carriage was associated with ST121 and ST152. Other detected mechanisms of resistance included dfrG, conferring resistance to trimethoprim. CONCLUSIONS This study provides valuable information for understanding the population structure and resistance mechanisms of S. aureus isolated from chronic wound infections in rural Ghana.
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Affiliation(s)
- Manuel Wolters
- Institute of Medical Microbiology, Virology and Hygiene, Universitiy Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (M.W.); (M.C.); (A.B.); (H.R.)
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology and Hygiene, Universitiy Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (M.W.); (M.C.); (A.B.); (H.R.)
| | - Anna Both
- Institute of Medical Microbiology, Virology and Hygiene, Universitiy Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (M.W.); (M.C.); (A.B.); (H.R.)
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, Universitiy Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (M.W.); (M.C.); (A.B.); (H.R.)
| | - Kwabena Oppong
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana; (K.O.); (C.W.A.)
| | - Charity Wiafe Akenten
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana; (K.O.); (C.W.A.)
| | - Jürgen May
- Tropical Medicine II, Universitiy Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany;
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), 20359 Hamburg, Germany;
| | - Denise Dekker
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), 20359 Hamburg, Germany;
- German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, 38124 Braunschweig, Germany
- Correspondence:
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Design and Synthesis of Small Molecules as Potent Staphylococcus aureus Sortase A Inhibitors. Antibiotics (Basel) 2020; 9:antibiotics9100706. [PMID: 33081148 PMCID: PMC7602840 DOI: 10.3390/antibiotics9100706] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 01/25/2023] Open
Abstract
The widespread and uncontrollable emergence of antibiotic-resistant bacteria, especially methicillin-resistant Staphylococcus aureus, has promoted a wave of efforts to discover a new generation of antibiotics that prevent or treat bacterial infections neither as bactericides nor bacteriostats. Due to its crucial role in virulence and its nonessentiality in bacterial survival, sortase A has been considered as a great target for new antibiotics. Sortase A inhibitors have emerged as promising alternative antivirulence agents against bacteria. Herein, the structural and preparative aspects of some small synthetic organic compounds that block the pathogenic action of sortase A have been described.
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8
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Gillett JL, Duff J, Eaton R, Finlay K. Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation. Spinal Cord Ser Cases 2020; 6:63. [PMID: 32665604 PMCID: PMC7358562 DOI: 10.1038/s41394-020-0313-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin-Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission. OBJECTIVES Determine the implications of MRSA-related infection isolation on spinal cord injury patients' anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls. SETTING National Spinal Injuries Centre, England, UK. METHODS Secondary analyses were conducted on pre-existing data based on patients' first admission for primary rehabilitation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge. RESULTS Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups. CONCLUSIONS Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation.
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Affiliation(s)
- Jenna L Gillett
- The University of Buckingham, Buckingham, Buckinghamshire, UK.
| | - Jane Duff
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Rebecca Eaton
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Wijnakker R, Lambregts MMC, Rump B, Veldkamp KE, Reis R, Visser LG, de Boer MGJ. Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study. J Hosp Infect 2020; 106:126-133. [PMID: 32628981 DOI: 10.1016/j.jhin.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Isolation precautions are applied to control the risk of transmission of multi-drug resistant organisms (MDROs). These precautions have been associated with adverse effects, such as anxiety and depression. This study aimed to quantify stigma among MDRO carriers and its association with perceived mental health and experienced quality of care. METHODS A quantitative questionnaire study was performed in MDRO carriers exposed to ≥3 days of isolation precautions during hospitalization. Items derived from the Consumer Quality Index questionnaire (CQI) were used to assess perception of care. Stigma scores were calculated using the recently modified Berger Stigma Scale for meticillin-resistant Staphylococcus aureus (MRSA). Mental health was measured with the RAND Mental Health Inventory. The Spearman rank correlation test was used to assess the association between stigma score and RAND mental health score. FINDINGS Of the 41 included carriers, 31 (75.6%) completed both questionnaires. The experienced quality of care was 'good' according to CQI score. Twenty-four percent reported not to have received proper explanation about MDRO carriership from healthcare workers (HCWs). MDRO-associated stigma was reported in 1/31 (3.2%). Poor mental health was self-reported in 3/31 (9.7%). There was no correlation between stigma score and RAND mental health score (Spearman correlation coefficient: 0.347). CONCLUSIONS In this study, MDRO carriers exposed to ≥3 days of isolation precautions did not report stigma. This contrasts with a recent study that investigated MRSA-associated stigma and may be explained by contact plus airborne isolation protocols in MRSA compared with contact isolation alone in most other MDROs. Also, the psychological impact may be of a different magnitude due to as yet unknown reasons.
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Affiliation(s)
- R Wijnakker
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.
| | - M M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - B Rump
- National Institute of Public Health and the Environment - National Coordination Centre for Communicable Disease Control (RIVM-LCI), Bilthoven, the Netherlands
| | - K E Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - R Reis
- Department of Medical Anthropology, Leiden University Medical Center, Leiden, the Netherlands
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
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10
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van Heuvel L, Eilers R, Feenstra SG, Haverkate MR, Timen A. Perceptions of Dutch nurses carrying methicillin-resistant Staphylococcus aureus: a qualitative study. BMC Nurs 2020; 19:50. [PMID: 32536812 PMCID: PMC7288426 DOI: 10.1186/s12912-020-00441-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background Carriers of methicillin-resistant Staphylococcus aureus (MRSA) experience a variety of personal and social consequences, despite the asymptomatic nature of carriage. Some of these consequences are inherent to the application in practice of strict infection prevention guidelines. However, the experiences of nurses carrying MRSA have not been documented. This study aimed to describe the experiences of nurses carrying MRSA to get insight into the impact of MRSA carriage on nurses in a country with a “search-and-destroy” policy for MRSA. Methods A qualitative study was conducted among eighteen nurses who experienced MRSA carriage and were working in healthcare organizations in the Netherlands (e.g. hospitals, nursing homes and home care). Semi-structured interviews were conducted using an interview guide. The interviews were audio tape recorded, transcribed and analyzed using thematic analysis. Results MRSA carriage has an impact on the life of nurses during four distinct phases: becoming aware of carrying MRSA, processing information and guidance, experiencing consequences of carriage and, when applicable, a life after eradication of MRSA. Each phase was found to be associated with negative consequences. The impact of MRSA carriage on the daily life of nurses is mostly influenced by the experience of consequences of MRSA carriage – including a ban to work with patients, eradication treatment with antibiotics, and social isolation from others – despite the asymptomatic nature of MRSA carriage itself. In addition, lack of information and guidance increased the impact of carriage. Conclusions This study shows nurses experience various consequences of MRSA carriage, despite the asymptomatic nature of carriage. The work ban, eradication treatment and social isolation influenced the nurses’ work-related future, personal health and social environment. The impact of carriage may be reduced by clear information and guidance, and support from others. Therefore, sufficient information and guidance needs to be given to MRSA carriers by healthcare organizations.
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Affiliation(s)
| | - Renske Eilers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabiena G Feenstra
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Manon R Haverkate
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Aura Timen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Athena Institute, VU University, Amsterdam, Netherlands
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11
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Heckel M, Sturm A, Stiel S, Ostgathe C, Herbst FA, Tiedtke J, Adelhardt T, Reichert K, Sieber C. '. . . and then no more kisses!' Exploring patients' experiences on multidrug-resistant bacterial microorganisms and hygiene measures in end-of-life care A mixed-methods study. Palliat Med 2020; 34:219-230. [PMID: 31659935 DOI: 10.1177/0269216319881603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In end-of-life care hygiene, measures concerning multidrug-resistant bacterial microorganisms may contradict the palliative care approach of social inclusion and be burdensome for patients. OBJECTIVES To integrate patients' perspectives on handling multidrug-resistant bacterial microorganisms at their end of life, their quality of life, the impact of positive multidrug-resistant bacterial microorganisms' diagnosis, protection and isolation measures on their well-being and patients' wishes and needs regarding their care. DESIGN A mixed-methods convergent parallel design embedded quantitative data on the patients' multidrug-resistant bacterial microorganisms' trajectory and quality of life assessed by the Schedule for the Evaluation of Individual Quality of Life in qualitative data collection via interviews and focus groups. Data analysis was performed according to Grounded Theory and qualitative and quantitative results were interrelated. SETTING/PARTICIPANTS Between March 2014 and September 2015 at two hospitals adult patients diagnosed with multidrug-resistant bacterial microorganisms and treated in a palliative care department or a geriatric ward were included in the sample group. RESULTS Patients in end-of-life and geriatric care reported emotional and social impact through multidrug-resistant bacterial microorganisms' diagnosis itself, hygiene measures and lack of information. This impact affects aspects relevant to the patients' quality of life. Patients' wishes for comprehensive communication/information and reduction of social strain were identified from the focus group discussion. CONCLUSION Patients would benefit from comprehensible information on multidrug-resistant bacterial microorganisms. Strategies minimizing social exclusion and emotional impact of multidrug-resistant bacterial microorganisms' diagnosis in end-of-life care are needed as well as adaption or supplementation of standard multidrug-resistant bacterial microorganisms' policies of hospitals.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Sturm
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Franziska A Herbst
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Johanna Tiedtke
- Institute of Psychogerontology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nürnberg, Germany
| | - Thomas Adelhardt
- Division of Health Management, School of Business and Economics, Institute of Management (IFM), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nürnberg, Germany
| | - Karen Reichert
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Cornel Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany
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Abstract
Multi-resistant bacteria pose an increasing and significant challenge to public health. Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Although few would dispute the need for such practices in preventing the spread of transmissible infections, patients' perspectives of isolation suggest that the imposed environment creates barriers to their physical, social and emotional needs. This article reviews the literature to uncover any reliable evidence supporting the assertion that the experience of isolation in healthcare settings impacts adversely on patient wellbeing. Database searches identified 25 relevant papers published between 1990 and 2017. A number of studies claimed to have uncovered an association between negative patient experiences and isolation.
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Affiliation(s)
- John Gammon
- Deputy Head, College of Human and Health Sciences, Swansea University, Swansea
| | - Julian Hunt
- Research Officer, College of Human and Health Sciences, Swansea University, Swansea
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Gammon J, Hunt J, Musselwhite C. The stigmatisation of source isolation: a literature review. J Res Nurs 2019; 24:677-693. [PMID: 34394593 DOI: 10.1177/1744987119845031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Patients' perspectives of isolation suggest that the imposed environment and procedures create barriers to their physical, social and emotional needs. Aims The purpose of this paper is to review the literature to uncover any reliable evidence supporting the assertion that stigma is a significant characteristic of the experience of source isolation in healthcare settings. Methods The methodological framework of Arksey and O'Malley was applied to this review. A total of 14 papers identified from 189 abstracts screened were included in the review. Results The research reviewed suggests a clear association between stigmatisation and isolation in which stigma does have a direct negative effect on patients placed in hospital isolation. None of the studies found evidence to the contrary. Conclusions The implications of this literature review for policy-makers and healthcare professionals suggest that when isolation or other forms of constraint are implemented and in use, patients must be provided with strengthened forms of support, including social and emotional support, and given access to healthcare of optimal quality to prevent the associated adverse effects of isolation as much as possible.
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Affiliation(s)
- John Gammon
- Deputy Head of College, Innovation, Engagement and Organisational Development, Swansea University, UK
| | - Julian Hunt
- Research Officer, College of Human and Health Sciences, Swansea University, UK
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King C, Grandison T, Cawthorne J, Currie K. Patient experience of hospital screening for carbapenemase-producing Enterobacteriaceae: A qualitative study. J Clin Nurs 2019; 28:3890-3900. [PMID: 31240778 DOI: 10.1111/jocn.14982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
Abstract
AIM To explore patients' accounts of screening and being managed for colonisation with the antimicrobial resistant organism, carbapenemase-producing Enterobacteriaceae (CPE), when in hospital. BACKGROUND Antimicrobial resistance (AMR) has been identified as one of the biggest global health challenges of the 21st Century. As the threat from AMR grows, screening to identify patients who are colonised with resistant organisms such as CPE is becoming an increasingly important aspect of nursing practice, in order to reduce risk of transmission of infection within hospitals. There is currently little research evidence on the patient experience of hospital management of CPE colonisation. METHODS Qualitative semi-structured telephone interviews were undertaken, using a topic guide. Nine patients participated in the study. The data were analysed thematically, and rigour was maintained through peer review. The COREQ checklist was used. RESULTS Two main themes were identified: "I can't make sense of CPE," illustrating limitations in patients' understandings of CPE; and, "I feel as if they are saying it is my fault," indicating the feelings of responsibility and blame which patients experienced. CONCLUSIONS This paper contributes original evidence to the limited literature on patients' experiences of being colonised with CPE. The findings suggest that support and information provided for patients by healthcare professionals needs to be based on current evidence-based guidance on the nature of CPE and its implications for patient care, as well as being responsive to patients' emotional needs. RELEVANCE TO CLINICAL PRACTICE This study has international relevance for nursing practice. As the global threat of AMR grows, the demands on healthcare providers to manage resistant organisms and their implications for patient care within healthcare settings are increasing. Enabling healthcare professionals to engage sensitively with patients being managed for colonisation with CPE is paramount to providing patient-centred care.
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Affiliation(s)
- Caroline King
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Tracyanne Grandison
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Julie Cawthorne
- Infection Prevention and Control, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kay Currie
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Mattingly TJ, Slejko JF, Perfetto EM, Kottilil S, Mullins CD. What Matters Most for Treatment Decisions in Hepatitis C: Effectiveness, Costs, and Altruism. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:631-638. [DOI: 10.1007/s40271-019-00378-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hasan N, Cao J, Lee J, Hlaing SP, Oshi MA, Naeem M, Ki MH, Lee BL, Jung Y, Yoo JW. Bacteria-Targeted Clindamycin Loaded Polymeric Nanoparticles: Effect of Surface Charge on Nanoparticle Adhesion to MRSA, Antibacterial Activity, and Wound Healing. Pharmaceutics 2019; 11:E236. [PMID: 31096709 PMCID: PMC6571677 DOI: 10.3390/pharmaceutics11050236] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 12/30/2022] Open
Abstract
Adhesion of nanoparticles (NPs) to the bacterial cell wall by modifying their physicochemical properties can improve the antibacterial activity of antibiotic. In this study, we prepared positively charged clindamycin-loaded poly (lactic-co-glycolic acid)-polyethylenimine (PLGA-PEI) nanoparticles (Cly/PPNPs) and negatively charged clindamycin-loaded PLGA NPs (Cly/PNPs) and investigated the effect of NP adhesion to bacteria on the treatment of methicillin-resistant Staphylococcus aureus (MRSA)-infected wounds. The Cly/PPNPs and Cly/PNPs were characterized according to particle size, polydispersity index, surface charge, and drug loading. Both Cly/PPNPs and Cly/PNPs exhibited sustained drug release over 2 days. The Cly/PPNPs bind to the MRSA surface, thereby enhancing bactericidal efficacy against MRSA compared with the Cly/PNPs. Furthermore, compared with other groups, Cly/PPNPs significantly accelerated the healing and re-epithelialization of wounds in a mouse model of a MRSA-infected wounds. We also found that both NPs are harmless to healthy fibroblast cells. Therefore, our results suggest that the Cly/PPNPs developed in this study improve the efficacy of clindamycin for the treatment of MRSA-infected wounds.
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Affiliation(s)
- Nurhasni Hasan
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Jiafu Cao
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Juho Lee
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Shwe Phyu Hlaing
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Murtada A Oshi
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Muhammad Naeem
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Min-Hyo Ki
- Samjin Pharm. Co., LTD., Seongnam 13488, Korea.
| | - Bok Luel Lee
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Yunjin Jung
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
| | - Jin-Wook Yoo
- College of Pharmacy, Pusan National University, Busan 46241, Korea.
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Wiklund S, Örtqvist Å, Berlin A, Stamm C, Broliden K. Experiences and consequences of living with extended-spectrum β-lactamase-producing bacteria: A qualitative study. Am J Infect Control 2018; 46:1394-1399. [PMID: 29934204 DOI: 10.1016/j.ajic.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/20/2018] [Accepted: 05/21/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The number of people who become carriers of antibiotic-resistant extended-spectrum β-lactamase (ESBL)-producing bacteria is steadily increasing. A carrier of ESBL can potentially be stressful for individuals, affecting their daily lives. METHODS The purpose of this study was to increase the understanding of experiences and consequences of being an ESBL carrier. A modified version of the grounded theory was used to analyze 16 open interviews. RESULTS The analysis resulted in the core category "to handle the new life situation." The results showed a lack of information being passed by attending doctors to study participants about ESBL and the consequences for their daily lives. This insufficient information initially caused fear and anxiety, leading to participants instead searching for information themselves using the Internet. Armed with this information, they developed strategies to continue with their lives as before. As patients they experienced staff that were respectful, showed no stigmatization toward ESBL carriership, and used correct hygiene routines. CONCLUSIONS When the information from the attending doctor about ESBL carriers is insufficient, patients often use the Internet to obtain additional information. With the use of this information, patients develop strategies to cope with their lives.
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Rump B, Timen A, Verweij M, Hulscher M. Experiences of carriers of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect 2018; 25:274-279. [PMID: 30832898 DOI: 10.1016/j.cmi.2018.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES A comprehensive overview of the ways control measures directed at carriers of multidrug-resistant organisms (MDRO) affect daily life of carriers is lacking. In this systematic literature review, we sought to explore how carriers experience being a carrier and how they experience being subjected to control measures by looking at the impact on basic capabilities. METHODS We searched Medline, Embase and PsychINFO until 26 May 2016 for studies addressing experiences of MDRO carriers. Twenty-seven studies were included, addressing experiences with methicillin-resistant Staphylococcus aureus (n = 21), ESBL (n = 1), multiple MDRO (n = 4) and other (n = 1, not specified). We categorized reported experiences according to Nussbaum's capability approach. RESULTS Carriage and control measures were found to interfere with quality of care, cause negative emotions, limit interactions with loved ones, cause stigmatization, limit recreational activities and create financial and professional insecurity. Further, carriers have difficulties with full comprehension of the problem of antimicrobial resistance, thus affecting six out of ten basic capabilities. CONCLUSIONS Applying Nussbaum's capability approach visualizes an array of unintended consequences of control measures. Carriers experience stigmatization, especially in healthcare settings, and have limited understanding of their situation and the complexities of antimicrobial resistance.
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Affiliation(s)
- B Rump
- National Coordination Centre for Communicable Disease Control, RIVM-Centre for Communicable Diseases, Bilthoven, the Netherlands.
| | - A Timen
- National Coordination Centre for Communicable Disease Control, RIVM-Centre for Communicable Diseases, Bilthoven, the Netherlands; Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, De Boelelaan 1081, 1081 HV Amsterdam, the Netherlands
| | - M Verweij
- Section Communication, Philosophy and Technology, Wageningen University, Wageningen, the Netherlands
| | - M Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Currie K, Melone L, Stewart S, King C, Holopainen A, Clark AM, Reilly J. Understanding the patient experience of health care-associated infection: A qualitative systematic review. Am J Infect Control 2018; 46:936-942. [PMID: 29395507 DOI: 10.1016/j.ajic.2017.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The global burden of health care-associated infection (HAI) is well recognized; what is less well known is the impact HAI has on patients. To develop acceptable, effective interventions, greater understanding of patients' experience of HAI is needed. This qualitative systematic review sought to explore adult patients' experiences of common HAIs. METHODS Five databases were searched. Search terms were combined for qualitative research, HAI terms, and patient experience. Study selection was conducted by 2 researchers using prespecified criteria. Critical Appraisal Skills Programme quality appraisal tools were used. Internationally recognized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied. The Noblit and Hare (1988) approach to meta-synthesis was adopted. RESULTS Seventeen studies (2001-2017) from 5 countries addressing 5 common types of HAI met the inclusion criteria. Four interrelated themes emerged: the continuum of physical and emotional responses, experiencing the response of health care professionals, adapting to life with an HAI, and the complex cultural context of HAI. CONCLUSIONS The impact of different HAIs may vary; however, there are many similarities in the experience recounted by patients. The biosociocultural context of contagion was graphically expressed, with potential impact on social relationships and professional interactions highlighted. Further research to investigate contemporary patient experience in an era of antimicrobial resistance is warranted.
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Heckel M, Sturm A, Herbst FA, Ostgathe C, Stiel S. Effects of Methicillin-Resistant Staphylococcus aureus/Multiresistant Gram-Negative Bacteria Colonization or Infection and Isolation Measures in End of Life on Family Caregivers: Results of a Qualitative Study. J Palliat Med 2016; 20:273-281. [PMID: 27858579 DOI: 10.1089/jpm.2016.0301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about the experiences of family caregivers of hospitalized patients with confirmed methicillin-resistant Staphylococcus aureus/multiresistant gram-negative bacteria (MRSA/MRGN) diagnosis at the end of life. The study at hand is a subproject of an interdisciplinary cooperation project that aims at developing a patient-, family-, and team-centered approach in dealing with MRSA/MRGN-positive hospitalized patients in palliative and geriatric care. OBJECTIVES The present study aimed to assess the individual effects of the patient's MRSA/MRGN colonization or infection and isolation measures on family caregivers. DESIGN Between April 2014 and September 2015, all known family caregivers associated with an MRSA/MRGN-positive patient from a palliative care unit, a hospital palliative care support team, and a geriatric ward were considered for study participation. A qualitative interview study with family caregivers and an additional focus group was conducted. Data were analyzed using the principles of Grounded Theory. RESULTS Family caregivers (N = 62) raised suggestions regarding the provision of information and communication on the MRSA/MRGN diagnosis and hygiene measures from staff members and the consistency of hygiene procedures. Family caregivers requested not to be stigmatized or being disadvantaged due to the MRSA/MRGN diagnosis of the patient, and they wished to receive psychosocial and emotional support. CONCLUSIONS Staff members and institutional stakeholders should be aware that family caregivers might be burdened and upset by positive MRSA/MRGN diagnosis and the required hygiene measures. The need for detailed and understandable information on MRSA/MRGN, adequate communication between staff members and family caregivers, and support for family caregivers should be of special attention in particular in end-of-life care.
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Affiliation(s)
- Maria Heckel
- 1 Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen , Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Sturm
- 2 Institute for Biomedicine of Aging, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg , Erlangen, Germany .,3 Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of Lord , Regensburg, Germany
| | - Franziska A Herbst
- 1 Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen , Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Ostgathe
- 1 Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen , Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Stiel
- 1 Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen , Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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21
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Rump B, De Boer M, Reis R, Wassenberg M, Van Steenbergen J. Signs of stigma and poor mental health among carriers of MRSA. J Hosp Infect 2016; 95:268-274. [PMID: 27789041 DOI: 10.1016/j.jhin.2016.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many countries have implemented guidelines to prevent transmission of meticillin-resistant Staphylococcus aureus (MRSA). Important contextual factors of stigma can be identified in the context of MRSA. Over the past decade, concerns have been raised over a possible stigmatizing effect of these actions. AIM To identify and quantify the occurrence of MRSA-associated stigma, and to explore its association with mental health in a country with an MRSA 'search and destroy' policy. METHODS In 2014, a questionnaire study among 57 Dutch MRSA carriers (people that carry MRSA without signs of MRSA infection) was performed. Stigma was measured with an adjusted version of the Berger HIV Stigma Scale. Mental health was measured with the five-item RAND Mental Health Inquiry. FINDINGS Thirty-two (56%) MRSA carriers reported stigma; of these, eight (14%) reported 'clear stigma' (Berger score >110) and 24 (42%) reported 'suggestive for stigma' (Berger score 76-110). Educational level, female sex and intensive MRSA eradication therapy were associated with higher stigma scores. Poor mental health (RAND score <60) was reported by 33% of MRSA carriers. Stigma and mental health scores were inversely correlated. Stigma was experienced most frequently in healthcare settings, and was seldom experienced in the religious community or at sport facilities. CONCLUSION A substantial proportion of MRSA carriers reported stigma due to MRSA, and stigma was associated with poor mental health. Anticipation of MRSA-associated stigma is warranted, both in the way that care is delivered by hospital staff and in the way that care is organized within the hospital.
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Affiliation(s)
- B Rump
- Department of Infectious Disease Control, Regional Health Service Utrecht Region, Zeist, The Netherlands; Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
| | - M De Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - R Reis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands; University of Cape Town, Cape Town, South Africa
| | - M Wassenberg
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Van Steenbergen
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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Herd H. The Benefits of a Preoperative MRSA Swabbing Protocol. J Perianesth Nurs 2016; 32:134-139. [PMID: 28343639 DOI: 10.1016/j.jopan.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/20/2022]
Abstract
Infection control practices pose a challenge to nursing care in general, but can have a huge negative impact on the perioperative process. Prior to July of 2012, our institution did not perform routine methacillin resistant staphylococcus aureus (MRSA) screening on preoperative patients with a prior history of MRSA. This resulted in patients remaining in isolation throughout their entire perioperative course. Screening for MRSA was delayed until the patient arrived in the medical surgical unit. Many of these patients were later found to have negative nasal swabs. The delay in screening often resulted in the unnecessary use of supplies (increased cost), delayed post anesthesia care unit (PACU) bay turnover and decreased staff satisfaction. Meetings with Hospital Infection Control, lab personnel and PACU staff resulted in the development of a preoperative MRSA swabbing protocol. In July of 2012 a preoperative MRSA swabbing protocol was implemented. Since implementation, the PACU has experienced a cost savings between $7,200- $11,800, a minimum of 40 minutes on PACU bay turnover and an increase in staff satisfaction.
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Raupach-Rosin H, Rübsamen N, Szkopek S, Schmalz O, Karch A, Mikolajczyk R, Castell S. Care for MRSA carriers in the outpatient sector: a survey among MRSA carriers and physicians in two regions in Germany. BMC Infect Dis 2016; 16:184. [PMID: 27112442 PMCID: PMC4845324 DOI: 10.1186/s12879-016-1503-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/09/2016] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the management of methicillin-resistant Staphylococcus aureus (MRSA) carriers in the German outpatient sector and about the impact of MRSA on their daily life. Reimbursement for MRSA related costs in the German outpatient sector is available since 2012, but its impact has not been studied yet. The aim of the study was to analyze the outpatient management of MRSA carriers from both, physicians’ and MRSA carriers’ perspective. Methods Paper-based questionnaires were mailed to physicians providing outpatient care and to MRSA carriers in 2013. MRSA carriers were recruited among patients tested positive for MRSA during a hospital stay in 2012. General practitioners, specialists for internal medicine, urologists, and dermatologists working in the outpatient catchment areas of the hospitals were contacted. Results Out of 910 MRSA carriers 16.5 % completed the questionnaires; among 851 physicians 9.5 % participated. 27.3 % of the responding MRSA carriers stated that no healthcare professional had ever talked to them about MRSA. 17.4 % reported self-stigmatization in terms of restricting social contacts; 47.3 % remembered decolonization and 33.3 % reported that their MRSA status was checked after discharge. Physicians displayed heterogeneous attitude and activity towards MRSA (number of applied decolonization and MRSA screenings). A minority (15.2 %) were satisfied with the reimbursement of costs, 35.9 % reported full agreement with the general recommendations for the handling of MRSA carriers. Conclusions MRSA carriers appear not well informed; (self-) stigmatization is occurring and should be tackled. Greater awareness of MRSA as a problem in the outpatient sector could lead to a better handling of MRSA carriers. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1503-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heike Raupach-Rosin
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Nicole Rübsamen
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Sebastian Szkopek
- Städtisches Klinikum Braunschweig, Institut für Mikrobiologie, Immunologie und Krankenhaushygiene, Braunschweig, Germany
| | - Oliver Schmalz
- Helios Klinikum Wuppertal, Abteilung für Onkologie und Palliativmedizin, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - André Karch
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.,German Centre for Infection Research, Hannover-Braunschweig, Germany
| | - Rafael Mikolajczyk
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,German Centre for Infection Research, Hannover-Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany.
| | - Stefanie Castell
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
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Petlin A, Schallom M, Prentice D, Sona C, Mantia P, McMullen K, Landholt C. Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Crit Care Nurse 2016; 34:17-25; quiz 26. [PMID: 25274761 DOI: 10.4037/ccn2014943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. Objectives To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidine-impregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units.
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Affiliation(s)
- Ann Petlin
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.
| | - Marilyn Schallom
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Donna Prentice
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Carrie Sona
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Paula Mantia
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Kathleen McMullen
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Cassandra Landholt
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
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Andersson H, Andreassen Gleissman S, Lindholm C, Fossum B. Experiences of nursing staff caring for patients with methicillin-resistant Staphylococcus aureus. Int Nurs Rev 2016; 63:233-41. [PMID: 26850089 DOI: 10.1111/inr.12245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus is a resistant variant of S. aureus and can cause pneumonia, septicaemia and, in some cases, death. Caring for patients with antibiotic resistant bacteria is a challenge for healthcare personnel. There is a risk of spreading the bacteria among patients and of healthcare personnel being infected themselves. AIM To describe nursing staffs' experiences of caring for patients with methicillin-resistant S. aureus in Sweden. METHOD A descriptive qualitative approach was used and 15 nurses from different hospitals and care units, including emergency and geriatric wards and nursing homes in Stockholm, were interviewed. All nurses had been involved in the care of patients with methicillin-resistant S. aureus, but not on a regular basis. The interviews were analysed using qualitative content analysis. FINDINGS Three themes emerged from the data: feeling ignorant, afraid and insecure, feeling competent and secure and feeling stressed and overworked. The more knowledge the nurses acquired about methicillin-resistant S. aureus, the more positive was their attitude to caring for these patients. DISCUSSION AND CONCLUSION Caring for patients with methicillin-resistant S. aureus without adequate knowledge of how to protect oneself and other patients against transmission may provoke anxiety among personnel. Guidelines, memos and adequate information at the right time are of central importance. Healthcare personnel must feel safe in their role as caregivers. All patients have the right to have the same quality of care regardless of the diagnosis and a lack of knowledge influences the level of care given. IMPLICATIONS FOR NURSING AND HEALTH POLICY This study demonstrates the importance of education when caring for patients with infectious diseases. Hopefully, knowledge gained from our study can provide guidance for future health care when new diseases and infections occur.
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Affiliation(s)
- H Andersson
- Sophiahemmet University and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
| | - S Andreassen Gleissman
- Sophiahemmet University and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
| | - C Lindholm
- Sophiahemmet University, Stockholm, Sweden
| | - B Fossum
- Sophiahemmet University and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
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Skyman E, Lindahl B, Bergbom I, Sjöström HT, Åhrén C. Being Met as marked - patients' experiences of being infected with community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Scand J Caring Sci 2016; 30:813-820. [PMID: 26773522 DOI: 10.1111/scs.12309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is known that patients who acquired methicillin-resistant Staphylococcus aureus (MRSA) in hospitals suffer and feel as plague. Moreover, the patient interaction with nurses and physicians is described as frightening. Little is known about patient experiences after having acquired CA-MRSA concerning care and everyday life. AIM To reveal and interpret otherwise healthy patients' lived experiences of receiving care and their everyday life after having acquired community MRSA (CA-MRSA). METHODS A phenomenological hermeneutic approach guided by Ricouer was conducted. Interviews with twelve patients were transcribed verbatim into a text. The text was analysed in three phases: naive understanding, structural analysis and comprehensive understanding to reveal a possible being in the world. In this study, this referred to what it means to be infected with CA-MRSA. RESULTS The findings indicate that patients who acquired MRSA experience a changed body image. They suffer from ignorant and frightened behavior from healthcare workers, social contacts, and also of being bullied by colleagues. Despite this, patients assume great responsibility for protecting others. However, knowledgeable staff alleviate suffering and bring peace of mind to the patients. CONCLUSIONS Preventing patient's feelings of being a pest, an outsider living with fear, requires urgent education and understanding about resistant bacteria and how to meet an infected patient. The results describing patients, affected with MRSA, may contribute and touch the readers to better understanding of patient's changed body image and suffering and how to mitigate these feelings.
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Affiliation(s)
- Eva Skyman
- Infection Control Unit, Institution of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Berit Lindahl
- Faculty of Caring Sciences, Work Life & Social Welfare, Borås University, Borås, Sweden
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Christina Åhrén
- Infection Control Unit, Institution of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden.,Strama, The Swedish Strategic Programme against Antibiotic Resistance, Region Västra Götaland, Gothenburg, Sweden
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Staff experiences of caring for patients with extended-spectrum β-lactamase-producing bacteria: A qualitative study. Am J Infect Control 2015; 43:1302-9. [PMID: 26293998 DOI: 10.1016/j.ajic.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients who become carriers of antibiotic-resistant bacteria are sometimes stigmatized by health professionals. Staff members' fears of becoming infected could affect their willingness to care for these patients. METHODS The purpose of this study was to increase the knowledge of what it means for staff in acute care settings and nursing homes to care for patients with extended-spectrum β-lactamase (ESBL)-producing bacteria. Assistant nurses, registered nurses, and physicians from acute care settings and nursing homes were interviewed. A modified version of Grounded Theory was used for the analysis. RESULTS The analysis resulted in the core category "to operate as an expert in a chaotic environment" in acute care settings. Despite a lack of resources, hospital staff try to provide the best possible care for patients with ESBL. The analysis of the interviews in the nursing homes resulted in the core category "the employee who, despite uncertainty, provides good care." Despite some fear, and a lack of knowledge, the study participants tried to provide the residents with good care. CONCLUSION Staff in acute care settings and nursing homes must have adequate knowledge and reasonable working conditions to be able to provide high-quality care for patients and residents who are ESBL carriers.
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Brown B, Tanner J, Padley W. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:1171-87. [PMID: 25470322 PMCID: PMC4437055 DOI: 10.1111/1467-9566.12160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system.
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Affiliation(s)
- Brian Brown
- School of Applied Social Sciences, De Montfort UniversityLeicester, UK
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MRSA-colonized persons' and healthcare personnel's experiences of patient-professional interactions in and responsibilities for infection prevention in Sweden. J Infect Public Health 2014; 7:427-35. [PMID: 24888790 DOI: 10.1016/j.jiph.2014.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient-professional interactions and adherence to infection control measures are central to the quality of care and patient safety in healthcare. Persons colonized with methicillin-resistant Staphylococcus aureus (MRSA) describe insufficient support and unprofessional behavior among healthcare personnel. METHODS A descriptive qualitative study was conducted to investigate managers', physicians', registered nurses' and MRSA-colonized persons' experiences of patient-professional interactions in relation to and responsibilities for infection prevention in the care of colonized patients. Five persons with MRSA colonization and 20 healthcare personnel employed within infection, hematology, nephrology or primary healthcare settings participated. The data were collected using open-ended semi-structured individual interviews with the MRSA-colonized persons and semi-structured focus group interviews with the healthcare personnel. RESULTS The participants perceived MRSA as an indefinable threat and described that the responsibility for infection prevention is important, but such adherence was a neglected and negotiable issue. The described actions that were acknowledged as unprofessional and inappropriate adherence to infection prevention resulted in stigmatized patients. CONCLUSION Colonized persons' and healthcare personnel's understanding of MRSA determines whether the personnel's behavior is perceived as proper or improper. Individual responsibility for patient-professional interactions in relation to MRSA colonization and adherence to infection control measures should be more stringent.
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Santiano N, Caldwell J, Ryan E, Smuts A, Schmidt HM. Knowledge and understanding of patients and health care workers about multi-resistant organisms. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi13027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Skyman E, Bergbom I, Lindahl B, Larsson L, Lindqvist A, Thunberg Sjöström H, Åhrén C. Notification card to alert for methicillin-resistant Staphylococcus aureus is stigmatizing from the patient's point of view. ACTA ACUST UNITED AC 2014; 46:440-6. [DOI: 10.3109/00365548.2014.896029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bükki J, Klein J, But L, Montag T, Wenchel HM, Voltz R, Ostgathe C. Methicillin-resistant Staphylococcus aureus (MRSA) management in palliative care units and hospices in Germany: a nationwide survey on patient isolation policies and quality of life. Palliat Med 2013; 27:84-90. [PMID: 22045727 DOI: 10.1177/0269216311425709] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND For palliative care settings, little is known about the benefits of specific methicillin-resistant Staphylococcus aureus containment regimens and the burdens patient isolation imposes on affected patients, their families, and professional caregivers. AIM To explore the current practice of MRSA management and its impact on inpatients' quality of life as perceived by professional caregivers. DESIGN Survey of inpatient palliative care institutions using 23-item questionnaires (infrastructural data: six items, management process: 14, clinical significance: three). SETTING/PARTICIPANTS All palliative care units (179) and hospices (181) listed in Germany's directory of palliative care services. The χ(2) test was used to test for differences; significance level: p ≤ 0.05. RESULTS 229 of 360 questionnaires were returned. More than 90% of the responding institutions employed specific MRSA protocols. Lack of resources was a more important issue for palliative care units than for hospices regarding availability of single rooms (p = 0.002) and staffing (p = 0.004). Compared to hospices, palliative care units more frequently isolated MRSA patients (p = 0.000), actively treated colonization (p = 0.026), assessed the efficacy of eradication (p = 0.000), provided information on MRSA management to patients (p = 0.014) and relatives (p = 0.001), more often restricted patients' activities (p = 0.000), and reported a negative impact on quality of life (p = 0.000). CONCLUSIONS Rigorously applied MRSA protocols impose significant burdens at the end of life. Research on clinical outcomes including quality of life may identify interventions of questionable benefit. The issue of handling MRSA should be studied as a model for the management of other highly complex conditions and special needs such as patient isolation.
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Affiliation(s)
- Johannes Bükki
- Division of Palliative Medicine, University of Erlangen, Erlangen, Germany.
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Risk factors for anti-MRSA drug resistance. Int J Antimicrob Agents 2012; 40:423-6. [DOI: 10.1016/j.ijantimicag.2012.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 11/18/2022]
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