The Ugly Face of MRSA Lesson #2

Please watch this youtube video Staph and MRSA by Krumhead which gives a great summary of MRSA.

Symptoms of a MRSA infection

MRSA infection presents like any infection. The diagnosis of a MRSA infection is determined by culture results. Cultures can be from the blood, wounds, sputum, urine, or nasal or rectal swabs. If the culture grows S. aureus in the presence of the antibiotic, methicillin, it is diagnosed as a MRSA infection. Any signs or symptoms of infection observed need to be reported immediately to the patient’s nurse or your immediate supervisor.

Here are some general signs and symptoms of infection:

• Blood stream infection: fever, chills, low blood pressure
• Open wounds: increased or purulent drainage, odor, fever, increasing redness around the wound, pain
• Closed surgical wounds: increased or purulent drainage, redness, warmth, pain, fever, raised or increased swelling around the incision
• Pneumonia: fever, shortness of breath, productive cough, wheezing
• Tissue (cellulitis): redness, swelling, warmth, weeping drainage
• Abscess: raised red, warm, painful, pus-filled
• Urine: odor, painful urination, fever, back pain, sediment in urine
• Generalized symptoms of infectious process: fever, chills, change in mental status, rash, low blood pressure, joint pains, headaches, shortness of breath, fatigue

Risk facts for HA-MRSA include:

• prolonged hospital stay or residence in a long-term care facility
• stay in an intensive care or burn unit
• major underlying chronic illness
• invasive procedures or devices like indwelling foley catheters
• recent or intensive antibiotic therapy
• age extreme (very young or very old)
• Anyone who is immunocompromised

How is MRSA infection treated?

Treatment of a MRSA infection will depend on the site of the infection. For a closed surgical wound or abscess, the first treatment may be the opening and draining of the wound. Antibiotics are the main treatment for a serious MRSA infection. For MRSA, the treatment if choice is Vancomycin. Antibiotics used to treat serious MRSA infections are powerful and come with their own risks to the patient. The elderly are at an increased risk to side effects from powerful antibiotics. Here are some of the side effects that can occur with antibiotic therapy:

• Hypersensitivity reaction. This is a reaction to the medication that can range from mild to severe. A mild reaction can be itchy skin or rash. A severe reaction can include chills, shortness of breath, swelling, or full anaphylactic reaction.
• Gastrointestinal side effects. The most common is nausea and vomiting, also abdominal pain, loss of appetite, and diarrhea.
• Superinfection. This can result from antibiotics suppressing the normal bacteria in the body, allowing overgrowth of other bacteria, fungi, or yeasts that are normally suppressed. Clostridium difficile (often referred to as C. diff ) overgrows in the GI tract, causing severe watery diarrhea, abdominal cramping, foul-smelling stool, and fever. Oral candidiasis (referred to as thrush) is the overgrowth of Candida. Vaginal and skin infections can also occur.
• Loss of hearing and kidney damage can also result from the use of powerful antibiotics.

MRSA/VRE precautions

Because MRSA is mainly spread by person-to-person contact or by contact with contaminated equipment, it should make sense that the best prevention of spreading would be by appropriate hand hygiene and proper use and disposal of protective personal equipment (PPE). It is very important to know and follow your hospital’s policies/protocols on hand hygiene and isolation procedures. If you do not know your agency’s policy or protocol, meet with your immediate supervisor and ask him or her for a copy, or contact the person in your agency responsible for staff education, or your infection control department.

Standard and contact precautions are used with MRSA precautions. Correct hand hygiene and glove use before, during, and after care is of critical importance. Depending on your agency’s or hospital’s policy/protocol, gowns may be required if physical contact is made with the infected area or they may be required regardless of the type of contact that will be made with the patient. Disposable patient equipment should be used as much as possible, such as disposable stethoscopes and blood pressure cuffs. Equipment that cannot be disposed of must be disinfected with agency-approved cleanser before removing it from the patient’s room. Contact precautions need to remain in place for the patient until cultures have been repeated and return back negative for MRSA.

Patient care techniques should be followed to prevent the development of an infection that could become an MRSA infection. Appropriate care for patients with urinary catheters helps prevent the development of urinary tract infections. Cleanse the perineal area with soap and or water or per your hospital’s policy/protocol for the patient with a urinary catheter. Drainage bags should be kept off the floor and below the level of the bladder. Use a designated container for emptying the drainage bag and cleanse after each use. Report to the nurse or your immediate supervisor if you observe dressings that are not intact or soiled on wounds or IV lines. If you notice a patient or caregiver performing care without using proper hand hygiene, notify your supervisor so that further education can be provided.

For the patient with an MRSA respiratory infection, direct him or her to cough into a tissue and then dispose of promptly. Wear gloves, a gown, and a mask with close contact, such as during suctioning or mouth care. For the patient with a MRSA skin infection, make sure the wounds are covered. Wear gloves and a gown when providing personal care. Be familiar with the signs and symptoms of an infection. If the patient displays any signs or symptoms of an infection, immediately report this to the nurse or your immediate supervisor. Prompt diagnosis and treatment for infections is extremely important in the outcome of the patient.

In summary, the most single important thing that a nurse assistant and other caregivers can do to prevent the spread of MRSA and other superbugs like VRE is diligent and proper handwashing. When it comes to MRSA and other drug-resistant infections, the best defense is basic hygiene. Several studies have provided evidence that the improvements in hand hygiene compliance translated into a real decrease in the number of hospital-acquired MRSA infections.

References:

Banning M. Transmission and epidemiology of MRSA: current perspectives. Br J Nurs. 2005;14(10):548-554.

Department, Stark County Health. Understanding the Facts About MRSA(n.d.): n. pag. Web.

“MRSA: Contagious, Symptoms, Casues, Prevention, Treatments.” WebMD. WebMD, n.d. Web. 23 Sept. 2014. <http://www.webmd.com/skin-problems-and-treatments/understanding-mrsa-methicillin-resistant-staphylococcus-aureus>.

“MRSA Infection.” MRSA: Understand Your Risk and How to Prevent Infection. N.p., n.d. Web. 25 Sept. 2014. <http://www.mayoclinic.org/diseases-conditions/mrsa/in-depth/mrsa/art-20047876?pg=2>.

“Protect Yourself from MRSA.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 6 Oct. 2009. Web. 24 Sept. 2014.

“Staph Infection: Symptoms and Staphylococcus Aureus Facts.” MedicineNet. N.p., n.d. Web. 23 Sept. 2014. http://www.medicinenet.com/staph_infection/article.htm