Evidence-Based Practice: Combatting MRSA

For many years, methicillin-resistant Staphylococcus aureus (MRSA) has been a source of infection for hospitals patients. Lately, MRSA infections have been on the rise among people who were not hospitalized. This community-associated MRSA (CA-MRSA) is microbiologically different from hospital-associated MRSA and requires different treatment.

Recent research has suggested the need to be proactive in identifying and managing CA-MRSA. Based on the research, the selected nursing implications below can help you and your colleagues combat MRSA infections:

• Know the prevalence of CA-MRSA in your hospital and your geographical area.
• Suspect CA-MRSA for every patient with a skin or soft-tissue infection.
• Assess patients for risk factors for MRSA, such as antibiotic use in the prior month and an abscess or lesion attributed to a spider bite, recurrent skin infections, and close contacts with similar infections.
• Examine the skin for warmth, redness, swelling, or purulent drainage.
• Note the type and amount of wound drainage.
• Obtain vital signs, including temperature.
• Examine the patient for complications, unreported infections, or developing abscesses.
• Obtain a medication history, including allergies, particularly to antibiotics.
• Obtain specimens for wound and blood cultures, as prescribed.

Planning and Implementation
• Follow Standard Precautions for all patients, and Contact Precautions for those with known infection.
• Administer wound care and apply dressings, as prescribed. Prepare for incision and drainage of the wound, as appropriate.
• Administer antibiotics, as prescribed.
• Know your health department regulations about reporting CA-MRSA.
• Follow your facility’s cleaning procedures after patient discharge.

Discharge Planning
• Provide instructions on wound care, prescribed medications, and follow-up care.
• Instruct the patient to complete the prescribed antibiotic.
• Emphasize that the patient should return immediately if systemic symptoms develop, local symptoms worsen, or improvement does not occur in 48 hours.
• Teach the patient and close contacts how to prevent disease transmission:
– Cover draining wounds with a bandage.
– Wash hands regularly and always after wound contact.
– Practice proper hygiene.
– Avoid sharing razors, towels, and other personal equipment.
– Launder and thoroughly dry contaminated clothing.
– Avoid sports or other activities if the wound can’t be covered.
– Clean equipment and surfaces with which other people will have contact.

For more on MRSA, check out our Practice Guidelines.

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