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MRSA outbreak

Posted

Specializes in LTC, Hospice, corrections, +.

I work at a small county jail and we are currently having an outbreak of caMRSA. Are other corrections nurses seeing an increase? What are some more creative ways that you have handled it? For instance we do hand sanitizing at shift count three times a day. How isolated to you keep the active cases? Do you do complete skin checks on intake...I usually just ask for any new piercings, tats, rashes, etc. Any input would be appreciated.

One thing to check would be to make sure the laundry is being washed at a hot enough temperature. I know that other prisons in my area, that this has been an issue with MRSA outbreaks.

Active cases should be on medical obs in my opinion but, does that always happen, no.

No, I don't do a full skin assessment. I just ask whether they have any open or broken skin on their body and go from there.

JailHouseTeer

Specializes in HIV Coordinator/Disease Intervention Spe. Has 26 years experience.

Its summer again and it will start all over

1. for those with draining boils shower daily

2. clean linens changed everday towels sheets clothes ect put in a disolving laundry bag

3. dressing changes need to be at least BID for draining wounds. Clean with betadine and water if MD will order. '

4. MD needs to order the nose ointment and I cant remember the name of it.

5. MD needs to order a culture

6. . MD needs to order antibiodics - (not telling MD what to do! LOL)

Those were our standard orders for MRSA (boils)

Notmywil

Has 23 years experience.

Personal hygiene in a crowded environment is always a problem. Same issues at my institution. If drainage is not well-contained, all the inmate does is spread the MRSA, so isolation from the general population becomes a measure to limit risk of transmission. Think about all the things they touch that are rarely (to never) disinfected (e.g. inside recreation facilities/weights, door knobs, railings). I am seeing MRSA wounds on abdomens, wrists, back, knees--you name it. I am also seeing it take more than one round of antibiotics to take care of the problem--so follow up after initial antibiotic therapy is essential. Many of the inmates come to me and tell me that they have a wound that looks like a spider bite. We have some really :banghead: tough strains of MRSA to deal with--some only susceptible to Vancomycin (& and we're praying the bugs don't get resistant to that!) In addition to antibiotic therapy, I often use sustained-release silver dressings--often irrigating the wound with non-cytotoxic dilution of sodium hypochlorite, then rinsing with sterile water (to avoid neutralizing the silver in the dressing). My disclaimer is, of course, that all the things I've mentioned need to be ordered by a physician. Summer is a tough time for outbreaks. Bottom line, I feel your pain!

psychonurse

Specializes in ER, ICU, Corrections.

I can remember when this MRSA stuff started and all the inmates were telling us that they got bitten by a spider and it went from there. Well that was many years ago and it is still running rampant in the facilites. We don't always put them on antibiotics unless they get really large and it is after the culture comes back and shows us what it is resistant to. Sometimes we have to use Rochepin but most of the time we are using Doxy.

A few years ago we contacted the Convetex company and they came in and did a great demonstration of their dressing supplies and we have been using them with good success.

At the beginning we sometimes dress the wounds twice a day when there is a lot of drainage. We have them shower with Hibiclens daily and when they are draining we restrict them from work and activities. We have had quite a bit of success with this although there are some people that you won't be able to get totally clear since their hygiene isn't the best. We have had some of those lesions in the worst places but I really feel sorry for the guys who have the cellmate that have one of these and doesn't do good washing and the other guy ends up with them.

Sonya

deyo321

Specializes in LTC, Hospice, corrections, +.

Thank you for your replies. We have not had a new case in two weeks. Fingers are crossed. We did all of the above ( except for special dressings) but what I feel really helped was educating the IM's, i.e. contact and clealiness, and the officers did head count with hand sanitizer once each shift. If IM refused he was lugged( tho no one refused). CO's have stopped now that we have none active but I wish they would continue through summer at least...I now have IMs come to window at med pass to ask for a squirt. Anyway you do it it takes us all more time.Thanks for the help.

Notmywil

Has 23 years experience.

We're never too old to learn, so I'll share something I just learned.

TWO SQUIRTS

When you use hand sanitizer, do one squirt in the palm of your hand, then dip your fingertips from the opposite hand in the sanitizer. Follow by rubbing all over your hands. Then rotate and place a second squirt in the opposite hand, dip the fingertips and rub all over your hands.

Apparently the infection control folks have tested competency and we keep missing the most critical parts of our hands----the fingertips and around the nails. (We won't even discuss what problems cracked nail polish and acrylic nails can be!)

I know old habits die hard, but this technique is worthy of making a new habit! :nurse:

Pam

~~RN~~

Specializes in Corrections, Emergency. Has 20 years experience.

A few years ago I worked in a large metro Jail and we had a HUGE problem with Staph infections/MRSA..64 - 65 new cases per month. Working with the Sheriff's staff, we implemented changes to the laundry temperature and the pod cleaning that the inmates did. We also developed a wound care protocol and inmate education handouts and posters. We did not use the bactroban (nose ointment) routinely, but only on individuals who continued to get new lesions. It worked! After three months, our numbers were down to 3-5 per month (and those were usually people off the street coming into the Jail). I was not a supporter of the gel hand sanitizers...but now I use them myself!

aknurs

Specializes in ER- Correctional. Has 25 years experience.

I work in a facility of 538 inmates.Percentage wise, the known MRSA,cases that we have had, is less , than that of, the free people in our town.

The P.A that is the IHCO, has instiuted a strict regime of treating, suspected( before the results of the culture, has been confirmed)MRSA cases. We clean & sanitize, our exam tables, after each client has left. Also Security has been helpful, by making sure all the Gym equipment, showers, anywhere that Inmates can congregate are disinfected after each use... It's really about, "Wash your hands, Wash your hands, you can't wash your hands enough, though...:wink2:

Notmywil

Has 23 years experience.

Go to Nursing Behind the Walls and there is excellent info posted there on MRSA prevention.

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