15TH CASE SCENARIO. (NURSING)MRSA.

WHAT IS MRSA?.

MRSA stands for methicillin resistant staphylococcus aureus. MRSA is the cause of the staphylococcus aureus infection that is resistant to some antibiotics.It is also known as a strain of Staph aureus that is differentiated from other strains due to its resistance to the antibiotics use to treat the organism.It was first discovered in 1960.MRAS is a world wild problem that is spread from person to person It can easily spread in hospitals if proper hand hygiene is not maintained such as good hand washing for 20seconds,use hand sanitizer frequently.Washing hands before seeing a patient and after seeing the patient. It should be a habit formed.Provide safe care. If there is possibility of blood and body fluids put on clean gloves.

MRSA can spread in Skilled Nursing facilities, other healthcare facilities, and in the community where you reside or work. Patient with MRSA should be on contact Isolation. VANCOMYCIN RESISTANT ENTEROCOCCUS(VRE)This is enterococcus resistant to Vancomycin. Spread from person to person. It developed due to miss use of Vancomycin and antibiotics. VRE can stay on the skin, table tops,doorknobs for at least or up to two weeks.

STEPS FOR CONTROL AND PREVENTION.

Good handwashing.

The use of antibiotics as prescribed. Antibiotics should not be misused.

Educate your patients and families.

Infected patients should be isolated.

Proper identification of MRSA and VRE is important by healthcare professionals, the laboratory and infection control department.

IS IT CONTAGIOUS?.

The main method of transmission is through the direct contact with mucous membranes, non-contact skin, blood and body fluids. It is contagious and can spread with direct contact from a person who has the infection. It is TREATABLE with intravenous antibiotics. In some cases it can go away after treatment and come back.It can cause bloodstream infection, pneumonia,and surgical sites infection. It can cause skin infection. If it gets into the bloodstream,it can lead to the infection of the heart known as endocarditis.

Who should be tested for MRSA in the hospitals?.

Everyone that comes through the Emergency room should be tested.Infact all patients should be tested within 24hours of arrival to the hospital. CDC has recommendation and guidelines on MRSA.Check it out.

HOW DO YOU DO THE TESTING.

Nasal Swabs within 24hour upon I arrival. There are active Surveillance Culture on MRSA.I don’t delay if I receive my patient from emergency room and there is no indication that patient was swab in Emergency room. Or there is no documentation to support that my patient was swabbed. I will swab my patient, label it with patient name,medical record number, date and my initial,put it in a small biohazard bag and send it to the laboratory.

It is also very important that some certain patients must be swab.

(1) Patient who was discharged from another acute care hospital within 30 days and is been admitted again or coming from any general acute care hospital.

(2)Admissions to ICU, Burn unit, NICU,MICU,SICU regardless on when admitted.

(3) Hemodialysis patients, or any form of dialysis treatment before hospitalization.

(4) Patients from SNF.(Skilled nursing facility)

(5) Patient with history of MRSA.

Patients with drainage wounds, history of IV drug abuse.

Patients with HIV or AIDS.

Forensic patients for inpatient Admissions.

Surgical patients with drainage wounds.

NICU patients.

Patients transferred from another acute care facility.

Patients admitted with doctor orders for ASC.

CASE STUDY 15TH.

Mrs Marian Goldsmith.

64years old female.

She is married with grown up children. Diabetes type 2.She had right leg surgery four months ago,but her wound refused to heal.She decided to self treat her wound with over the counter medications. She is a heavy smoker. Severe pain at wound site.Lots of odor from the wound. (+) MRSA of the wound. This has forced her to isolate herself,lethargy. She was admitted to the hospital, after 4 days of intravenous antibiotics treatment that failed ( Broad Spectrum antibiotics)The doctor changed her antibiotics IV to Vancomycin 1gm Iv Q12hours.

Zosyn 3.375gm IV Q8hrs.

Norco 10/325mg po 1tablet Q4hours prn pain.

Morphine 1mg IV Q4hours prn breakthrough pain.

Wound consult ordered by the doctor .

Physical therapy for evaluation and treatment ordered.

QUESTIONS:

Did mrs. Goldsmith need to have nasal Swabs upon arrival to emergency room?

Why should she be swab?.

What are the factors that led to her leg ucler?.

Do you need a picture of her wound?

What are the underlying pathophysiology?.

What is the etiology of the wound?.

How will you educate her about smoking?.

Where is her MRSA?.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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