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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tosas Auguet O, Betley JR, Stabler RA, Patel A, Ioannou A, Marbach H, Hearn P, Aryee A, Goldenberg SD, Otter JA, Desai N, Karadag T, Grundy C, Gaunt MW, Cooper BS, Edgeworth JD, Kypraios T. Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data. PLoS Med 2016; 13:e1001944. [PMID: 26812054 PMCID: PMC4727805 DOI: 10.1371/journal.pmed.1001944] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation. METHODS AND FINDINGS This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level. CONCLUSIONS There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes.
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Affiliation(s)
- Olga Tosas Auguet
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Jason R. Betley
- Illumina, Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, United Kingdom
| | - Richard A. Stabler
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amita Patel
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Avgousta Ioannou
- Illumina, Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, United Kingdom
| | - Helene Marbach
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Pasco Hearn
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anna Aryee
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon D. Goldenberg
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jonathan A. Otter
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nergish Desai
- Department of Medical Microbiology, King's Hospital NHS Foundation Trust, London, United Kingdom
| | - Tacim Karadag
- Department of Microbiology, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Chris Grundy
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael W. Gaunt
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ben S. Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Jonathan D. Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Theodore Kypraios
- School of Mathematical Sciences, University Park, University of Nottingham, Nottingham, United Kingdom
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Abstract
BACKGROUND Although breast pain remains a common cause of weaning, controversy exists regarding the etiology of chronic pain. Prospective studies are needed to define optimal treatment regimens. We evaluated patient history, exam, and bacterial cultures in breastfeeding women with chronic breast pain. We compared pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX) (n=38) versus those in patients failing CTX and receiving oral antibiotic treatment (OTX) (n=48). SUBJECTS AND METHODS We prospectively enrolled 86 breastfeeding women with breast pain lasting greater than 1 week and followed up patients through 12 weeks. RESULTS Higher initial breast (p=0.012) and nipple pain severity (p=0.004), less response to latch correction (p=0.015) at baseline visit, and breastmilk Staphylococcus aureus growth (p=0.001) were associated with failing CTX. Pain type was not associated with failure of CTX. When culture results were available at 5 days, breast pain remained higher (p<0.001) in patients failing CTX and starting antibiotics. OTX patients then had more rapid breast pain reduction between 5 and 14 days (score of 3.1 vs. 1.3; p<0.001). By 4 weeks there was no difference (1.8/10 vs. 1.4/10; p=0.088) in breast pain level between groups. Median length of OTX was 14 days. At 12 weeks, weaning frequency (17% vs. 8%; p=0.331) was not statistically different. CONCLUSIONS Initial pain severity and limited improvement to latch correction predicts failure of CTX. S. aureus growth is more common in women failing CTX. For those women not responding to CTX, OTX matched to breastmilk culture may significantly decrease their pain and is not associated with increased complications.
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Affiliation(s)
- Ann M. Witt
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
- Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio
- Senders Pediatrics, Cleveland, Ohio
| | - Kelly Burgess
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Thomas R. Hawn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Steven Zyzanski
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio
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Abstract
BACKGROUND Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage. SUBJECTS AND METHODS A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study. RESULTS After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage. CONCLUSIONS Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.
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Affiliation(s)
- Miranda L Buck
- 1 Mother and Child Health Research, La Trobe University , Melbourne, Victoria, Australia
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Jones D. How to reduce the negative psychological impact of MRSA isolation on patients. Nurs Times 2010; 106:14-16. [PMID: 21086832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
MRSA is contagious and difficult to treat, and the isolation of infected patients is recommended by the Department of Health. However, isolation can have a negative psychological impact on patients and is controversial. This literature review explores the effects of isolation based on three themes: isolation environment and psychological impact; stigma of MRSA; and nursing care.
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Affiliation(s)
- Donna Jones
- Surgical Assessment Unit, Royal Shrewsbury Hospital
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6
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Mozzillo KL, Ortiz N, Miller LG. Patients with methicillin-resistant Staphylococcus aureus infection: twenty-first century lepers. J Hosp Infect 2010; 75:132-4. [PMID: 20236730 DOI: 10.1016/j.jhin.2009.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/16/2009] [Indexed: 11/18/2022]
Abstract
In the recent past, there has been a rapid increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, especially community-associated (CA)-MRSA. Many media descriptions of MRSA are sensational and focus on its potential for severe disease and contagiousness. Our objective is to describe psychological and social morbidity associated with MRSA infection via a case series of five patients with CA-MRSA infection. We also analyse the resulting stigmatization associated with being diagnosed with MRSA infection. We learned that patients describe a variety of stigmatization related to their diagnosis of MRSA, including being shunned at home and in the workplace. Patients describe being asked by family, colleagues, and clients to take extraordinary measures to prevent MRSA transmission. Consequences of MRSA diagnoses have included erosion or termination of key personal and business relationships. In conclusion, stigmatization resulting from the diagnosis of MRSA can have profound personal and social morbidity. Media and public health awareness of MRSA infection needs to be balanced with information about how MRSA transmission is usually preventable with simple hygienic measures.
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Affiliation(s)
- K L Mozzillo
- Kaiser Permanente South Bay Medical Center, Harbor City, California, USA
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7
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Luszczynska A, Gunson KSE. Predictors of asking medical personnel about handwashing: the moderating role of patients' age and MRSA infection status. Patient Educ Couns 2007; 68:79-85. [PMID: 17582725 DOI: 10.1016/j.pec.2007.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 05/10/2007] [Accepted: 05/10/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The study investigates patients' behaviours protective of methicillin-resistant Staphylococcus aureus (MRSA), asking doctors and nurses about handwashing before examination, and its relations with the Theory of Planned Behaviour (TPB) variables and knowledge. We expected that MRSA infection status and age might moderate relations between the behaviour and its predictors. METHODS A total of 171 individuals (59% with MRSA; 54% of 65 years or older) who had contact with the Patients Association and MRSA Support groups filled out questionnaires. RESULTS Across the groups beliefs about ability to control own behaviour were the best predictors of intention and behaviour, except for non-MRSA patients older than 65 years, for whom knowledge about MRSA infection remained the sole predictor of behaviour. The amount of explained variance of behaviour was twice as high among younger patients compared to older ones. CONCLUSIONS The study indicates limitations of the predictive value of the TPB among older patients. The results support the importance of beliefs about ability to control own behaviour in predicting an error-preventive action. PRACTICE IMPLICATIONS Enhancing control beliefs may promote asking medical personnel about handwashing. Interventions aiming MRSA prevention should target different cognitions or knowledge depending on patients' age and MRSA infection status.
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Affiliation(s)
- Aleksandra Luszczynska
- University of Sussex, Brighton, United Kingdom; Warsaw School of Social Psychology, Wroclaw, Poland.
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Sani G, Manfredi G, Pacchiarotti I, Caltagirone SS, Mancinelli I, Koukopoulos AE, Tatarelli C, Kotzalidis GD, Tatarelli R, Girardi P. A case of resolution of an acute psychotic episode after high fever. CNS Spectr 2007; 12:447-50. [PMID: 17545955 DOI: 10.1017/s1092852900015327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Fever (pyretotherapy) was used for psychosis during the turn of the 19th century, but pyretotherapy (ie, the treatment of a disorder by inducing fever) fell out of use after the introduction of convulsive methods. Here, we report on a case of schizoaffective disorder and review classical and recent literature on fever and psychosis. The patient developed auditory hallucinations, persecutory delusional ideas, and was terrified soon upon his arrival in a foreign country. After being treated for 12 days with olanzapine and haloperidol, he developed a fever due to urinary infection; his creatine phosphokinase levels were high, prompting the suspension of antipsychotics. Psychotic symptom resolution followed immediately fever abatement. Antipsychotics were reintroduced at lower dosages. He was discharged asymptomatic with a prescription of olanzapine 15 mg/day and haloperidol 3 mg/day. The time course of symptom resolution in this patient suggests that fever had a beneficial role in this case. The associations between body temperature changes and psychotic symptoms need to be further studied.
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Affiliation(s)
- Gabriele Sani
- Medical School II, Department of Psychiatry, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
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Affiliation(s)
- C H Meyer
- Zentrum für Augenheilkunde, Philipps-Universität Marburg, 35037, Marburg
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10
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Donaldson AD, Jalaludin BB, Chan RC. Patient perceptions of osteomyelitis, septic arthritis and prosthetic joint infection: the psychological influence of methicillin-resistant Staphylococcus aureus. Intern Med J 2007; 37:536-42. [PMID: 17445009 DOI: 10.1111/j.1445-5994.2007.01359.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Patients form their own representations of their illness, which can be important determinants of their coping and influence outcome. Our aims were to (i) assess patient perceptions of osteomyelitis, septic arthritis and prosthetic joint infection, (ii) compare perceptions of methicillin-resistant Staphylococcus aureus (MRSA) with non-MRSA infection and (iii) investigate the emotional aspects of these infections. METHODS A questionnaire was developed from the 'Illness Perception Questionnaire' of Weinman et al.with additional questions assessing emotional response. This was offered to all patients with osteomyelitis, septic arthritis and prosthetic joint infection attending the Liverpool Hospital Infectious Diseases Outpatient Clinic during a 3-month period. RESULTS There were 91 respondents--25 with MRSA infection, 14 with MRSA colonization and 52 without MRSA. Seventy-nine per cent of all respondents felt that their infection was very serious and 76% felt their infection had had major consequences on their life. On multivariate analysis MRSA was associated with a greater emotional effect; the consequences and emotional effects of infection were greater in younger people and prosthetic joint infection was associated with less sense of control or cure. CONCLUSION Osteomyelitis, septic arthritis and prosthetic joint infection have a significant effect on an individual. Ongoing support and education are important, particularly for the young, those with prosthetic joint infection and patients with MRSA.
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Affiliation(s)
- A D Donaldson
- Liverpool Health Service, Sydney, New South Wales, Australia
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Abstract
The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their hands before a clinical procedure and to explore if methicillin-resistant Staphylococcus aureus (MRSA) status and access to patient information about infection control would influence the patients' anxiety about asking. A descriptive survey was undertaken using a semi-structured questionnaire. The questionnaire was distributed to a randomized convenience sample of 185 inpatients across all departments of an acute NHS Trust hospital (response rate 58.9%). Spearman's rank order and Kendall Tau-b tests were used to analyse specific correlations. Respondents were more confident than anxious about being involved in a campaign that empowered patients to ask staff to wash their hands. Patients were more anxious to ask if their previous admission episodes were fewer, if their knowledge of MRSA was high and if there was less information about infection control available. Patients who had contracted MRSA in the past were less anxious, as they had a better understanding of the disease. In addition, more patients felt less anxious about asking staff to wash their hands if staff wore a badge saying 'It's OK to ask'.
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12
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Hartmann C. [How do patients experience isolation due to an infection or colonisation with MRSA?]. Pflege Z 2006; 59:suppl 2-8. [PMID: 17069418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The development of antimicrobial-resistant bacteria confronts hospitals and nursing homes with new problems which affect patients, their relatives and friends as well as staff. In order to gain insights into the experience of patients suffering from prolonged isolationas a result of MRSA, a qualitative study was conducted using narrative interviews. The results indicate that for patients isolation due to MRSA is for various reasons an enormous stress factor. They experience fear and anger while their future perspective remains unclear. The infections cause a lack of control of their own situation. To cope with isolation for an unforeseen duration the patients withdraw into themselves, although they try to rationalise their situation. They feel imprisoned. To build or maintain confidence contact to doctors is important. Single room accommodation is not always a strain for patients, because co-patients can cause even higher stress factors. Protective clothing often encumbers visitors which conclusively do not come at all or stay for a shorter period. Due to protective clothing patients do not easily recognise who enters the room. Nevertheless, the strict sanitary standards are not consequently fulfilled by staff members. For various reasons patients experience anger. The results of this study should be taken into account at the nursing of patients suffering from MRSA or similar infections.
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Mphahlele NR, Fuller A, Roth J, Kamerman PR. Body temperature, behavior, and plasma cortisol changes induced by chronic infusion of Staphylococcus aureus in goats. Am J Physiol Regul Integr Comp Physiol 2004; 287:R863-9. [PMID: 15217786 DOI: 10.1152/ajpregu.00064.2004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most experimentally induced fevers are acute, usually lasting ∼6–12 h, and thus do not mimic chronic natural fevers, which can extend over several days or more. To produce a model of chronic natural fever, we infused eight goats ( Capra hircus) intravenously with 2 ml of 2 × 1011 cell walls of Staphylococcus aureus ( S. aureus) for 6 days using osmotic infusion pumps (10 μl/h) while measuring changes in body temperature, behavior, and plasma cortisol concentration. Seven control animals were infused with sterile saline. Abdominal temperature-sensitive data loggers and osmotic infusion pumps were implanted under halothane anesthesia. To compare our new model with existing models of experimental fever, we also administered 2-ml bolus intravenous injections of 2 × 1011 S. aureus cell walls, 0.1 μg/kg lipopolysaccharide ( Escherichia coli, serotype 0111:B4), and sterile saline in random order to six other goats. Bolus injection of lipopolysaccharide and S. aureus induced typical acute phase responses, characterized by fevers lasting ∼6 h, sickness behavior, and increased plasma cortisol concentration. Infusion of S. aureus evoked prolonged fevers, which lasted for ∼3 days, starting on day 4 of infusion (ANOVA, P < 0.05), and did not disrupt the normal circadian rhythm of body temperature. However, pyrogen infusion did not cause plasma cortisol concentration to rise (ANOVA, P > 0.05) or the expression of sickness behavior. In conclusion, infusion of S. aureus produced a fever response resembling that of sustained natural fevers but did not elicit the cortisol and behavioral responses that often are described clinically and during short-term experimental fevers.
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Affiliation(s)
- Noko R Mphahlele
- School of Physiology, Univ. of the Witwatersrand, 7 York Road, Parktown 2193, South Africa.
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14
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Weber C. The spirit of sacred community. Altern Ther Health Med 2003; 9:16-7. [PMID: 14526706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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15
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Lessard JE. Mortality from methicillin resistant Staphylococcus aureus. Is death by disease or treatment? BMJ 2003; 326:501. [PMID: 12617075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Abstract
Drug-resistant nosocomial infections are an increasing problem. This issue has received considerable media coverage. To our knowledge there have been no studies investigating patient awareness and perceptions of nosocomial infections. A total of 113 surgical out-patients completed a questionnaire stating whether they had heard of either superbugs or MRSA. A series of questions were asked about the source of any information; methods of transmission and prevention; the consequences of infection and their emotional response if they were to acquire MRSA. Fifty patients (44%) had heard of superbugs or MRSA mainly via the media (58%) or from hospital staff (44%). The majority would feel either angry or afraid if they acquired MRSA in hospital, but there was good awareness of both methods of infection control and the consequences of infection. From our study, we conclude that the media is at least as important as health professionals in providing information. Concerns regarding nosocomial infection may need to be addressed prior to admission.
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Affiliation(s)
- Sally M A Hamour
- Department of Surgery, Northwick Park Hospital, Harrow, Middlesex, UK.
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17
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Catalano G, Houston SH, Catalano MC, Butera AS, Jennings SM, Hakala SM, Burrows SL, Hickey MG, Duss CV, Skelton DN, Laliotis GJ. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003; 96:141-5. [PMID: 12630637 DOI: 10.1097/01.smj.0000050683.36014.2e] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have reported an increase in psychiatric symptoms in seriously ill patients who were placed in resistant organism isolation. We conducted this study to assess whether there is an increase in symptoms of anxiety and depression in patients who are not critically ill and are placed in isolation. METHODS Patients hospitalized with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus species infections were evaluated with the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale at baseline and again during hospitalization. The results were then compared with the results of patients who were hospitalized for infectious diseases that did not require isolation. RESULTS Patients in isolation had significantly higher scores on both the anxiety and depression scales at the time of follow-up than did patients who were not isolated. There was no significant difference between the scores of the two groups before isolation. CONCLUSION The results of this preliminary study suggest that placement in resistant organism isolation may increase hospitalized patients' levels of anxiety and depression.
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Affiliation(s)
- Glenn Catalano
- Department of Psychiatry and Behavioral Medicine, and College of Medicine, University of South Florida, Tampa, FL, USA.
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Bush D. A lesson in poor care. RN 2002; 65:48-50. [PMID: 12087599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Delores Bush
- St. Peter Community Hospital in St. Peter, Minn., USA
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Klemke CD, Goerdt S, Orfanos CE, Blume-Peytavi U. [Persistent hemorrhagic crusts on the lips of a 13-year-old patient. Cheilitis crustosa factitia]. Hautarzt 2002; 53:265-7. [PMID: 12053696 DOI: 10.1007/s00105-001-0324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C D Klemke
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
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Newton JT, Constable D, Senior V. Patients' perceptions of methicillin-resistant Staphylococcus aureus and source isolation: a qualitative analysis of source-isolated patients. J Hosp Infect 2001; 48:275-80. [PMID: 11461128 DOI: 10.1053/jhin.2001.1019] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A group of 19 individuals who had been infected with methicillin-resistant Staphylococcus aureus (MRSA) and placed in source isolation were interviewed about their views of MRSA infection and the experience of source isolation. Participants were unclear about the nature of MRSA, and generally did not perceive the infection to have a significant impact upon their life (either in terms of the presence of symptoms or in restriction of activities). Despite this, roughly half the sample thought that an MRSA infection was 'serious'. Only one participant clearly viewed their MRSA as hospital-acquired, most being uncertain about the mode of transmission or viewing it as unrelated to the behaviour of care staff. Few respondents displayed an accurate knowledge of the reasons for source isolation and barrier nursing. Isolation was viewed as having advantages and disadvantages. There was little evidence of a detrimental psychological effect of isolation. Patients infected with MRSA appear to understand little about their condition or the necessity for barrier nursing and source isolation. This has implications for understanding patients' adherence with infection control procedures.
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Affiliation(s)
- J T Newton
- Department of Dental Public Health and Oral Health Services Research, Guy's King's & St Thomas' Dental Institute, Guy's Hospital, London, SE1 9RT, UK.
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Madeo M. Understanding the MRSA experience. Nurs Times 2001; 97:36-7. [PMID: 11957949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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Leach E. Resistance fighters. Nurs Times 1999; 95:18. [PMID: 10734889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Kennedy P, Hamilton LR. Psychological impact of the management of methicillin-resistant Staphylococcus aureus (MRSA) in patients with spinal cord injury. Spinal Cord 1997; 35:617-9. [PMID: 9300970 DOI: 10.1038/sj.sc.3100469] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Management of MRSA infection includes immediate isolation of the patient. Long periods of isolation are considered to be psychologically detrimental, though little information is available about the impact of isolation as an infection control procedure. The purpose of this study is to examine the psychological well-being of spinal cord injured patients who are isolated as a result of being MRSA positive. METHODS A cross-sectional matched-control study of MRSA positive patients with MRSA negative patients was carried out at the National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England. Sixteen MRSA positive patients, aged 18 to 65, and their matched controls completed a series of questionnaires to measure aspects of psychological impact. The measures used were functional independence, depression, anxiety, and the affective states of anger, vigour, fatigue and confusion. FINDINGS The MRSA positive spinal cord injured patients were only significantly more angry than the control group, although these isolated patients scored higher in all measures. INTERPRETATIONS In this spinal cord injured group the difference between the psychological well-being of isolated MRSA positive patients and non-isolated MRSA negative patients is not as great as might have been expected. Patients feel that rehabilitation is affected, but the situation may be improved by providing more space and a better view onto the ward.
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Affiliation(s)
- P Kennedy
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK
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