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MRSA

MRSA. Methicillin Resistant Staph Aureus HA MRSA and CA MRSA Causes SSTI’s, sepsis, necrotizing fascitis and fatality Bacteria can mutate, Paton Valentine Leukocidin(PLV) gene thought to be the virulent factor. Pencillin resistance due to production of beta lactamase

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MRSA

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  1. MRSA Methicillin Resistant Staph Aureus • HA MRSA and CA MRSA • Causes SSTI’s, sepsis, necrotizing fascitis and fatality • Bacteria can mutate, Paton Valentine Leukocidin(PLV) gene thought to be the virulent factor. • Pencillin resistance due to production of beta lactamase • Unnecessary use of antibiotics, antibiotics in food and water • Staff is normally found in the skin and nares of healthy people. • At risk elderly, kids, and those in crowded and or poor conditions • Urban populations, prisons, and athletes sharing equipment and towels Skilled Nursing, Inc. Staffing & Search

  2. Presentation usually in the ED/Primary care office • C/O red tender bite like sore • spider bite, boil, pustules • 2nd stage –deep abscesses • can lead to sepsis • I&D, flush with saline, can use Iodoform gauze, cover wound. • Antibiotics • If no fever and general health is good oral antibiotics with follow-up in 8 to 12 hours • If fever comorbidities in patient treatment and IV antibiotics Skilled Nursing, Inc. Staffing & Search

  3. IV Antibiotics • Vancomycin-1gm q12 hrs • Clindamycin -loading dose(600-900mg) then 500 mg q 6 hrs • Keflex- 1gm loading dose then 500mg q 6 hrs. PO Antibiotics • Clindamycin -300 mg 4 times per day x 10 days • Doxycycline-100 mg twice a day x 10 days • Rifampin-300 mg twice a day x 10 days • Bactrim/Septra-one double strength tablet twice a day x 10 days (160 mg Trimethoprim-800 mg sulfamethoxazole) Skilled Nursing, Inc. Staffing & Search

  4. Treatment Failures • Inadequate I&D Differential Diagnosis • Cellulitis Prevention • Hand washing and Contact pre-cautions • Wound covered/respiratory etiquette • Clean environment • No contact sports if open wounds • No public whirlpools or spas until wounds are healed • No sharing of razors, towels, or soaps Skilled Nursing, Inc. Staffing & Search

  5. Inpatient -nasal swab and isolation until return cultures (rapid polymerans rx) -hand washing by all team members -identify patient prior to transfer/studies -nasal swab prior to discharge Future Potential Vaccine Nurses Role major player in education and enforcement of hand washing, teach about the hazards of transferring. Prevention Skilled Nursing, Inc. Staffing & Search

  6. MRSA Example: Alleghany Hospital/Pittsburg • 236 infections over 4 years • Average payment - $40,302.00 • Average expense - $54,065.00 • Average loan - $13,763.00 • Total Loss from operations- $1,234,343.00 • Average age – 63 years old • Average LOS-31 days • Most common DRG: CV(24%), GI (16%), ID (15%) Neuro (13%) and Put (11%) Skilled Nursing, Inc. Staffing & Search

  7. MRSA Transmissions • 69% previous hospital contact in last 6 months • 19% previous hospital contact in last 6 months • 12% from Nursing homes • Cost of surveillance $50,680.00/$2,141.00($24/pr) • 4 preventions recovered the cost of the surveillance-prevented 19 infections and 10 deaths. Skilled Nursing, Inc. Staffing & Search

  8. Skilled Nursing, Inc.®Staffing & Search Joint Commission Certified www.snistaffing.com

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