Mrsa

[marjoriemac, LPN]

Just an issue bugging me just now. We have a resident with MRSA in a wound, he keeps taking the dressing off due to mild dementia. Head of unit thinks he should be confined to his room however I have never known this to happen in any other home I have worked and we never had any spread of MRSA. I have told all staff to inform the nurse in charge if he takes the dressing off so a new one can be put on but the care staff seem so misinformed. They think if he touches the table, that table should be quarantined. I have tried to approach the head of unit with the fact that the carers need to be re-educated and the fact that current legislation (country-wide) states that there is no need to isolate residents in care homes with MRSA but she used to work in a big hospital and cannot grasp that we really are 'community setting'.

[nightmare, RN]

Strange isn't it,when MRSA first started making an appearance in the community we had full isolation measures in force for the affected resident.Now its just apron and gloves,yet it's still the same infection!

[jmgrn65, RN]

well is it a draining wound? and where is it? Abd binder might work it would be harder for him to get to it.

[jill48, ASN, RN]

We have a resident with MRSA in a wound, he keeps taking the dressing off due to mild dementia. Head of unit thinks he should be confined to his room however I have never known this to happen in any other home I have worked and we never had any spread of MRSA. .

Just because it hasn't spread yet doesn't necessarily mean it can't and won't. How would you like it if it was your mom sitting next to him in the dining room and he stuck his gooey nasty fingers in her potato salad? :barf01: I don't like isolating people either, but you have to think about the rest of the patients:nurse: .

[ginger58, ASN, RN]

I'm not an ID nurse, but I feel like if the wound is still active with MRSA and he's removing the dressing and most likely getting it on his hands and whatever else he touches, I wouldn't want him running loose. How do you know that other patients aren't with positive skin cultures and when they get a scratch or whatever it won't flare up? All it takes is a pin prick to have a costly, needless cellulitis. There has to be a dressing he can't undo or what about when he's alone try mitten restraints?

[CapeCodMermaid, RN]

If you read the latest studies, MRSA is on the rise in the general population...schools, camps, gyms (another good reason not to exercise:lol2: ) ..the bacteria can live on inert surfaces for days, so in theory if he touches his wound and then the table and some other immunocompromised resident (and aren't most of them) touches the table, they, too could get MRSA. I'm not for seclusion, but if you can't keep the bandage on, you have to do something to prevent the spread.

[Nascar nurse, ASN, RN]

I'm not for seclusion, but if you can't keep the bandage on, you have to do something to prevent the spread.

Exactly how we would handle it too. The dressing stays on or he is to his room

[marjoriemac, LPN]

The guy has dementia amd thus it is really hard to isolate him without severe distress! Also people live in the community without isolation and they could theoretically infect more people. I just don't get the ethics and policy. We are not allowed to use mittens etc as restraint in UK

[nightmare, RN]

Where abouts is his wound ,Marjorie?

[marjoriemac, LPN]

On the crown of his head, it is a wound that he has been told by dermatology that will never heal due to cancerous growths.

[nightmare, RN]

Oh difficult to keep the fingers off then!Have you tried one of the adhesive film dressings?they are quite difficult to remove it might deter him for a while!Or how about spray on dressing then a normal one,he could pull off the normal dressing but the wound would still be protected by the spray on dressing.Worth a try anyway.

[marjoriemac, LPN]

Thanks for the advice, adhesive dressings seemed to stick to his hair rather than his scalp! I have now finished working in the home but was curious as to the ethics and legislation surrounding isolation. New home here I come!