Transcript Skilled Nursing, Inc

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
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• 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
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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
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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)
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Treatment Failures
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Inadequate I&D
Differential Diagnosis
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Cellulitis
Prevention
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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
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Prevention
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
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Potential Vaccine
Nurses Role
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major player in education and enforcement of hand washing, teach about
the hazards of transferring.
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MRSA
Example: Alleghany Hospital/Pittsburg
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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%)
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MRSA Transmissions
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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.
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