MRSA in wound

[Second]

Hello! I am a home care nurse wanting advice from all you wound care pros. I have a patient who has HIV and Hep c. He is almost 80 and has lived long in spite of these long term infections. He now has a wound to the dorsal foot that started as a trauma injury but has become infected with MRSA. the caregive says this wound has slowly grown in size over the last 6 months. It is is now 4x3 centimeters approximately and has a red beefy appearance, no foul odor and moderate serosanguinous drainage. Our orders are to cleanse with wound cleanser, apply a debriding agent cover with gauze moistened with 1/4 strength Dakins solutions and cover with kerlix. What do you think? The order is different from what I am used to and I am not an expert. I want to make sure we are doing the best for this very sweet gentleman. Previously the caregiver was soaking the foot in water and epsom salts per physican order and this only made things worse.

This doctor likes to give orders but admits to a knowledge deficit in the wound care department and would be open to suggestions. Any one have ideas?

[annaedRN, RN]

In general a clean wound would not need a debriding agent. Ask the MD about using a wound care product with silver (ex. Aquacel AG) -usually helps clean out the infection in a wound. Most of my patient's docs are pretty receptive to ideas too - they often admit I know more about what to put on the wounds than they do.

[lsyorke, RN]

Dakins wet to dry on a clean, granulating wound is not a good idea. If there are no signs of active infection(a + MRSA on culture does not "have" to be treated) then you support the wound healing with a moisture providing dressing with silver.

No slough, no need for a debriding agent.