| Abstract | Meticilin-rezistentni Staphylococcus aureus (MRSA) opisan je prvi put 1961. godine, no bakterija se počela širiti osamdesetih godina prošlog stoljeća. MRSA sojevi otporni su na sve β-laktamske antibiotike, osim na najnovije cefalosporine, te je kod njih očuvana osjetljivost još samo na glikopeptide, daptomicin, linezolid i rimfapicin. Neke od najčešćih infekcija koje uzrokuje meticilin-rezistentni Staphylococcus aureus su infekcije kože i mekih tkiva, endokarditis, osteomijelitis te stafilokokna sepsa. Staphylococcus aureus nosi otprilike 30% zdravih ljudi u nosu i drugim vlažnim i dlakavim područjima tijela, npr. prepone i pazusi. Infekcije uzrokovane Staphylococcus aureus se prenose zrakom, hranom, predmetima i dodirom, a izvor može biti sam bolesnik za sebe i druge bolesnike, zdrave osobe kolonizirane stafilokokom (primjerice, zdravstveni radnici). U Hrvatskoj se kontrola meticilin-rezistentog zlatnog stafilokoka temelji na smjernicama usmjerene prevenciji, kontroli i liječenju infekcija. Glavni cilj smjernica je smanjiti širenje MRSA u intrahospitalnom i izvanbolničkom okruženju, dok su specifični ciljevi standardizirati postupke prevencije i kontrole MRSA u bolnicama, domovima za starije i nemoćne osobe, ambulantama opće medicine te u kućnoj njezi. Smjernice su namijenjene svim profilima zdravstvenih djelatnika u bolnici i izvanbolničkoj zdravstvenoj zaštiti, članovima uprava zdravstvenih ustanova i domova za starije i nemoćne osobe. U svakom trenutku u svakoj bolnici moraju se provoditi standardne mjere zaštite od širenja bolničkih infekcija. Na odjelima visokog rizika potrebno je uzimati nadzorne obriske i aktivno tražiti kliconoše MRSA-e, pogotovo kod prijema rizičnih pacijenata – često konzumiranje antibiotika, boravak u domu za starije, bolesnici s teškom osnovnom bolešću ili kronični bolesnici, te imunokompromitirani bolesnici. Medicinske sestre su te koje po prijemu moraju prepoznati rizične pacijente, te prema tome dalje izraditi plan. Osnovne sestrinske intervencije u prevenciji širenja infekcija uzrokovanih MRSA su održavanje higijene ruku prema standardima i smjernicama, korištenje zaštitne odjeće, primjena mjera izolacije prema standardu, prikupljanje uzroka za analizu, edukacija pacijenata i osoblja te provođenje dekolonizacije kliconoša i same okoline i opreme. |
| Abstract (english) | Methicillin-resistant Staphylococcus aureus (MRSA) was initially described in 1961, but the largest dispersion of such strains was noted in the 1980s of the last century. MRSA strains are resistant to all β-lactam antibiotics, except to the most novel cephalosporins, and preserved sensitivity only to glycopeptides, daptomycin, linezolid and rifampicin. Some of the most common infections caused by methicillin-resistant Staphylococcus aureus are infections of the skin and soft tissue, endocarditis, osteomyelitis, and staphylococcal sepsis. Basically as much as 30% of healthy people are colonized with Staphylococcus aureus in their nose and other moist and hairy areas of the body, e.g. groin and armpits. Staphylococcus aureus infections are spread through the air, food, objects, and by touch. The source of the infection can be the patient himself (either as autoinfection or for other patients), but also healthy people colonized with Staphylococcus aureus, e.g. health care workers. In Croatia, the control of MRSA is based on guidelines aimed at the prevention, control and treatment of infections caused by MRSA. The main objective of the guidelines is to reduce the spread of MRSA in hospitals and in people who are healthy and who have not been in the hospital or a nursing home. The specific objective is to standardize procedures for prevention and control of MRSA in hospitals, nursing homes, general medical facilities and home care. The guidelines are intended for all profiles of health professionals in hospital and ambulatory health care, but also for members of management in health facilities and nursing homes. Standard protective measures against the spread of hospital infections should be implemented in every hospital. High-risk departments need to take control swabs and actively look for individuals infected with MRSA, especially when considering high-risk patients, who are often consuming antibiotics, staying in a nursing home, as well as patients with serious underlying medical conditions or chronic/immunocompromised patients. Nurses are the ones who are at the forefront and who must identify all patients at risk, and therefore are responsible ones to develop a plan. Basic nursing interventions to prevent the spread of infections caused by MRSA are maintaining hand hygiene (according to standards and guidelines), the use of protective clothing, isolation according to prescribed standards, collecting samples for analysis, patient and staff education, decolonization of infected patients and their environment and equipment. |
