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Mupirocin: A Preventative Study Joyelle Francke College of the Ozarks
fentanyl patch 100mg (for pain). and tramodol 50mg (for pain management).MUPIROCIN: A PREVENTATIVE STUDY The purpose of this study was to determine if there is evidence-based research that validates the use of mupirocin in the nares of an individual to prevent infection or spread of MRSA. retired female. mupirocin ointment (antibacterial). morphine every eight hours at 8mg (for pain). and anxiety. paroxysmal atrial fibrillation. The physicians’ orders were veterbral plasty. who came onto the unit with an acute vertebral fracture and recent L2 kyphoplasty. limited range of motion and pain in the lower back of 7-10. and respirations were 16. The individual this research emphasized is a 73-year-old. gastro esophageal reflux disease and deep vein thrombosis. Her vitals were oxygen saturation 97. The magnetic resonance imaging impression was an acute. citalopram 400mg (anxiety). weakness in her right leg. contact precautions. magnesium oxide 400mg (antacid). Labs showed the patient to be positive for methicillin resistant stapylococcus aureus. cerebrovascular accident. likely osteoporotic. prednisone 20mg (inflammation). hiatal hernia with esophageal spasms. pregabalin 50mg (neuropathic pain).1 on room air. temperature 97. Her present symptoms were ipsilateral weakness. Hypertension. pulse 58. turn patient every two hours. 2 dyslipidemia. 150 pound. methocarbamol 500mg (muscle relaxant). . blood pressure 132/76. mild lumbar 1 compression fracture. sotalol 120mg (antidysrhythmic). physical therapy. chronic back pain. Her head to toe was unremarkable except for fine crackles throughout both lungs. She has a history of osteoporosis. weakness in the right leg.
When the patient’s nurse was asked she could not identify where or how much of the ointment should be given. aureus in patients’ nasal passages. and Verbrugh published a study on the presence of S. intermittent carriers reverted to sometimes testing positive for S. without any explanation as to why. Boelens. she saw that the 3 medication was to be applied to both nares every eight hours. intermittent carriers and non-carriers. While this was understood to the physician it was not understood by the nursing staff. After the nurse reviewed the physicians’ orders. When the medication was applied.MUPIROCIN: A PREVENTATIVE STUDY The problem arose when the mupirocin ointment was to be given at 0900. They inoculated patients from each of these groups in their nasal passages with a cultured strain of S. aureus carriers: persistent carriers. with a negative result for S. From these results. with another important goal being to see if the use of mupirocin in preventative instances is worth noting by the nursing portion of the health care team. and they discovered that the patients reverted to their original states. The persistent carriers reverted to their original habitation of bacterial flora. aureus. it was explained by a student nurse that it was a precaution to prevent the further spread of MRSA. van Belkum. Nouwen. What was gathered from this scenario was that the physician understood the preventative benefits of the use of mupirocin in the patient’s nares to prevent infection or spread of MRSA. This lack of understanding by the nurse is what influenced this evidence-based project. and non-carriers reverted to their original healthy floral state. aureus. The . In 2004. the researchers hypothesized that people have environments in their nasal passages that are uniquely suited for a precise bacterial make-up. The patient was interested in why she had never had this preventative measure before. aureus. The researchers experimented with three different categories of S.
and Kluytmans (2008) also saw a potential argument against mupirocin use is the development of resistance. aureus infection is high (Van Rijen. aureus infections originate from the patients’ own flora. Bonten. where the risk of S. with nasal carriage of S. The researchers. In total. or who suffer from cirrhosis of the liver. aureus in their noses. especially for those on dialysis or with intravascular devices. 2008). According to the researchers. The researchers found that the majority of nosocomial S. aureus before surgical procedures being a risk factor for subsequent infection. In 2008. when patients are treated peri-operatively with nasal ointment. & Kluytmans. Wenzel. aureus infections among 686 mupirocintreated carriers. Van Rijen. Van Rijen. high-risk surgical procedures.MUPIROCIN: A PREVENTATIVE STUDY 4 researchers also found a link between harmful bacteria and the presence of pets and other animals. Bonten. & Verbrugh. The researchers do not recommend use of mupirocin on all surgical patients. These results indicate mupirocin is effective in clean. Wenzel. 2004). resistance has not been a significant problem. aureus. Wenzel. An analysis on four studies that evaluated mupirocin for the prevention of S. mupirocin nasal ointment is often used to eradicate nasal carriage because of effectiveness. if used for only a short period of time. Boelens. However. as there is no . while 46 were infected among 686 in a control group. van Belkum. It also has minimal side effects. Approximately 30% of the population carries S. low cost and safety. which will be discussed in greater detail later (Nouwen. Bonten. aureus at any given moment in time. aureus in carriers after surgery showed significant effect on those that did carry S. especially as a skin ointment. and Kluytmans published a study on the effects of mupirocin on S. This has been observed repeatedly when mupirocin was used for prolonged periods. there were only 25 S.
Wenzel. aureus. This reinforces the physician’s use of mupirocin in our patient. no resistance by the bacteria should develop (Epstein. aureus. She was a carrier of MRSA and had a vertebral plasty that day. If she follows the prescribed regimen for mupirocin. so she met the study’s criteria for the use of mupirocin peri-operatively. Those who tested positive for S. cat. 2008). aureus. Bonten. a rapid screen and treat approach is important for high-risk patients such as our patient. aureus carriers. aureus. Epstein studied the effects of mupirocin on S. It is also interesting to note that the prevention of these postoperative infections saved two small hospitals $240. Rather. A study by Epstein (2011) examined measures that can be taken to reduce spinal infections before and after surgery. or other animal. accompanied by a 2% application of CHG to the skin. who had undergone surgery (Van Rijen. The preventative use of mupirocin in positive carriers of S. Epstein found that having a pet. Like the previously discussed researchers. Furthermore. like a fish. What was concluded from these evidence-based articles is that the use of mupirocin on patients who tested positive for S. infections due to MRSA were diminished by 78%. Epstein found this decreased the overall number of surgical infections by 63%.MUPIROCIN: A PREVENTATIVE STUDY effect in patients that do not carry S. especially patients who fall into the high-risk category such as those undergoing surgical procedures. increased the likelihood of a patient testing positive for S. 2011). it should only be used on patients 5 that have tested positive for S.000 (Epstein. & Kluytmans. twice a day for seven days prior to surgery. dialysis or with intravascular devices. aureus were treated with mupirocin. 2011). if treated preoperatively. aureus or MRSA did reduce the infection rate. or who suffer from cirrhosis of the . For efficiency.
This enables the nurse to correctly teach the patient about their care and allows them to be an active participant in their healing journey. . have a decreased infection rate.MUPIROCIN: A PREVENTATIVE STUDY liver. It is important for the nursing team to understand 6 the benefit of mupirocin and its proper regimen.
. van Belkum. Boelens. doi:10. R. P. 61. 2(1). 66856688. & Verbrugh.. E. N. H.2004 Van Rijen. Wenzel. M.4103/2152-7806.. doi:10.MUPIROCIN: A PREVENTATIVE STUDY 7 References Nouwen. (2011). 254-61. A. Surgical Neurology International. 72(11). Intanasal mupirocin for reduction of Staphyolococcus aureus infections in surgical patients with nasal carriage: a systematic review. Bonten. Human Factor in Staphylococcus aureus Nasal Carriage.. Journal of Antimicrobial Chemotherapy.72. Preoperative.1128/IAI. L.1093/jac/dkm480 Epstein.. M. 17. J. A. H. doi:10.76938 . J. (2008).11. J.6685-6688. M. and postoperative measures to further reduce spinal infections. (2004). Infection and Immunity.. & Kluytmans. intraoperative.