MRSA

What is MRSA Resistant to?

• Beta-lactam antibiotics

  • Penicillin

  • Cephalosporins

    • cephalexin, cefaclor, ceftriaxone

  • Carbapenems

    • penems

Risk Factors for MRSA

• Recent Hospitalization

  • Last 12 months

• Soft tissue infection

  • portal of entry

• ICU

• LTC facility

• Catheters, IV, Hemodialysis port

  • portal of entry

• Long-term broad spectrum antibiotic therapy

  • bacteria becomes resistant to specific antibiotic

• Weakened Immune system

  • HIV

  • DM
    Cancer

  • COPD

  • CHF

  • Immunosuppression

How is MRSA Spread?

• Lives on Surfaces and humans

• Transferred to skin and other body areas (INFECTION risk)

  • If a person is colonized with MRSA in the nose and he or she wipes the nose with the hand and then touches an open wound, the bacteria can then be transferred to the wound and cause an infection

• Contaminated Surfaces

  • Prevent Spread!

    • cover cuts and open wounds

    • good hygiene

• Unclean hands and equipment

  • HAND HYGIENE

  • Contamination from

    • side rails

    • beds

    • supply carts

    • nurses sleeves and uniforms

Major Clinical manifestation/Complication of MRSA

Infection

Clinical manifestations of MRSA

Minor Skin infection - “Spider-bite” - we need to culture this

• pimples

• abscesses

• sties

• impetigo

Serious infection

• PNEUMONIA

• skin and soft tissue infection

• surgical-site infection

• bloodstream infection

Complications of MRSA

• Wide spread INFECTION

• osteomyelitis

• toxic shock syndrome

• organ failure

Where to collect cultures for MRSA

• Most common is anterior nares

• also

  • areas of skin breakdown

  • draining wounds

Best way to prevent MRSA

HAND HYGIENE!!

MRSA Isolation type

Contact isolation

Isolation precautions with MRSA

• Contact Isolation

• hand hygiene before gown and gloves

• secure gowns at neck and waist

• Gown and gloves removed before you leave the room

• hand hygiene before you leave to room

• Private rooms ideal

• If unavailable, place in room with same organism

Most common med for MRSA

Vancomyocin

• Draw trough level after dose is given but immediately before next dose. Monitors therapeutic levels.

• Nephrotoxic and octotoxic (eyes)

Treatment for minor to moderate skin infections

incision and drainage of abscesses without antibiotic use

Tx for decolonizing patients

2% mupirocin ointment

• Don’t apply to open wounds, burns, and eyes

• may cause HA, pharyngitis, rhinitis

Wound Appearence in MRSA

red, warm, purulent

S/S of INFECTION

• Fever

  • immune response to infection

• Tachycardia/pnea

• increased WBC

• Pain

• Wounds

  • red, swollen, painful, warm, purulent drainage

Nursing Interventions

• Hand Hygiene

• Contact-isolation

• Administered antibiotics as ordered