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Can a Living Green Space Address the Growing Problem of Mrsa in Hospital Settings?

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Assignment #5

Can a living green space address the growing problem of MRSA in hospital settings?

An ever-increasing difficulty in today's healthcare industry is trying to prevent and control the spread of Methicillin Resistant Staphylococcus Aureus, or MRSA. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that does not react to certain antibiotics. It will normally cause skin infections, but MRSA can also cause other infections including fatal pneumonia.

Within hours of a hospital patient's admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract. Risk factors for contracting MRSA include; pathogens on the hands of medical personnel, invasive procedures like intubation, extended ventilation, vascular lines, and urine catheterization, as well as antibiotic use and prophylaxis. Organizational risk factors include contaminated air-conditioning systems, contaminated water systems, staffing, nurse-to-patient ratio, bed crowding. Patient risk factors include the severity of illness, underlying immunocompromised state, and length of stay.

"In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%. CDC estimated that 94,360 invasive MRSA infections occurred in the United States in 2005; 18,650 of these were associated with death. MRSA is resistant to antibiotics including methicillin, oxacillin, penicillin, and amoxicillin. Since these strong drugs are not effective with MRSA, these infections are sometimes called Multidrug-Resistant Organisms (MDROs). Staph infections, including MRSA, occur most often among people in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems." The concern about MRSA by both medical providers and the general public is the possibility of this infectious disease becoming widespread. There is already some evidence of MRSA making its way beyond the hospitals and into the community, referred to as "community-acquired" MRSA (CA-MRSA) and effecting otherwise healthy individuals.

The societal cost of MRSA is staggering, not to mention burdensome on the healthcare system and ultimately to each of us individually. Due to the unrestricted use of antibiotics in our agriculture and healthcare industries over the past few decades, staph bacteria strains are becoming more and more powerful enemies. The overuse has ironically, created more of a need for antibiotics. The Superbug we are breeding continues to be one-step ahead of our capacity to kill it, so it manages to morph into another strain.

This is causing an increasing frequency of antimicrobial resistance among infectious organisms. "Since the first reported episode of methicillin resistant Staphylococcus aureus (MRSA) infection in the United States in 1968, the proportion of S. aureus isolates resistant to methicillin causing infections in hospitalized patients has risen significantly from 2% in 1974 to about 40% 1997. More recent statistics show that invasive MRSA infections occur in approximately 94,000 persons each year and are associated with approximately 19,000 deaths. Of these infections, about 86% are healthcare-associated and 14% are community-associated. In most instances, 1

MDRO infections have clinical manifestations that are similar to infections caused by susceptible pathogens. However, options for treating patients with these infections are often extremely limited. For example, until recently, only vancomycin provided effective therapy for potentially life-threatening MRSA infections and during the 1990's there were virtually no antimicrobial agents to treat infections caused by VRE. Although antimicrobials are now available for treatment of MRSA and VRE infections, resistance to each new agent has already emerged."

In addressing the immediate problem of trying to contain and eradicate the spread of MRSA in the hospital environment, many additional cost issues have been identified. For instance; longer patient stays, resources used in treatment of MRSA cases for patients and staff, and increases in overall costs of preventative measures. Studies have reported the association between MRSA infections and increased length of stay and healthcare costs. In fact, the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention (CDC) performed a survey from October 1986 to April 1998. They ranked hospital wards according to their association with central-line bloodstream infections. The highest rates of infection occurred in the burn ICU, the neonatal ICU, and the pediatric ICU. Nosocomial infections are estimated to occur in 5% of all acute-care hospitalizations; the incidence rate is 5 infections per 1,000 patient-days. Based on the 35 million patients admitted to 7,000 acute-care institutions in the United States, the incidence of HAIs is more than 2 million cases per year. HAIs result in an additional 26,250 deaths (range 17,500-70,000) and an added expenditure in excess of $4.5 billion dollars.

So, can a living green space address this massive problem with MRSA? Well, research has shown that vegetative plants have an innate ability to cleanse the air of all types of toxins as well as absorb airborne bacteria and mold. The foremost expert in this area is Dr. B.C. "Bill" Wolverton whom I quote here as saying,

"Air-conditioned rooms, synthetic building materials and inadequate ventilation cause numerous respiratory and nervous disorders. The mere presence of plants has been proved to lessen environmental pollution, increase labor productivity and reduce the cost of healthcare."

"When plants transpire water vapor from their leaves, they pull air down around their roots. This supplies their root microbes with oxygen. The root microbes also use other substances in the room air, such as toxic chemicals, as a source of food and energy. Microbes, such as bacteria, can rapidly adapt to a chemical contaminant by producing new colonies that are resistant to the chemical. As a result, they become more effective the longer they are exposed to the chemical."

Any further technicalities of how this happens are beyond the scope of this paper so I will leave it at that.

In Japanese studies, researchers have found that creating a green living space in public places has improved the lives of its patrons. Mr. Takenaka is President of Takenaka Garden 2

Afforestation, Inc. of Tokyo. He and Dr. Bill Wolverton have worked in close association for more than ten years to develop the 'Ecology Garden' concept. Ecology



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