Mrsa

[MadisonsMomRN, BSN, RN]

I know this is common in prison's but how common? We have about 4 cases in the infirmary right now. We are having repeat infections and vancomycin is not working. We have been using Zyvox with some success. It is getting BAD in population. We had a guy come up to us (repeated MRSA infections) and the doctor wanted to do an I&D and put him on vanc but the inmate refuse because of not having any success with vanc in the past. The MD had him sign AMA and sent him BACK to population!! This sore was draining horribly. Well the PA made him come back to the infirmary the day after and changed his meds.

It's hard to control because of close living conditions and its definitely the not cleanest... I guess there is nothing more to do to slow the spread of this?

[BSNinTX]

It is exceedingly common.

I&D as well as moist heat is a good choice for minor infection or early in the course.

We have good success with Bactrim DS twice daily + Rifampin 300mg twice daily. A two drug regimen is important.

There is literature to support the use of Bactroban intranasal to eradicate MRSA in patients who have recurrent infections. It is used after the active infection is resolved. The goal is to decolonize the patient.

The Federal Bureau of Prisons guidelines on MRSA are available at http://www.bop.gov and give some ideas on the matter.

FYI, I'm speaking from professional experience as well as my own. I had an MRSA infection on my neck. Most likely came from worl.

[MadisonsMomRN, BSN, RN]

We do the moist heat too. The two drug regimen is a great idea.

Our medical director is a quack... I am sorry but he is. He firmly believes vanc is the best drug of choice.

This is coming from a doctor that put coumadin as a prn order!:uhoh21:

[nursemomruns]

I agree - Bactrim and Rifampin are working well for us. Also, talk to operations about wiping everything down on the dorms, weights, weight room, etc. Also, see about educating the prisoners and the non-medical staff about the disease. It seemed to help us.

It is exceedingly common.

I&D as well as moist heat is a good choice for minor infection or early in the course.

We have good success with Bactrim DS twice daily + Rifampin 300mg twice daily. A two drug regimen is important.

There is literature to support the use of Bactroban intranasal to eradicate MRSA in patients who have recurrent infections. It is used after the active infection is resolved. The goal is to decolonize the patient.

The Federal Bureau of Prisons guidelines on MRSA are available at http://www.bop.gov and give some ideas on the matter.

FYI, I'm speaking from professional experience as well as my own. I had an MRSA infection on my neck. Most likely came from worl.

[Sunshine22]

Madison, You sound like you have my medical director!! He likes to use just the Bactrim. It doesn't kick it all the way. We did have another doc that used the Bactrim and Rifampin, and it was OK. Then, we had another doc that used Bactrim and Doxy....worked like a charm. There wasn't alot of repeat break outs either. But...you know how it is when you try to tell a doc what worked with another doc.

[MadisonsMomRN, BSN, RN]

Madison, You sound like you have my medical director!! He likes to use just the Bactrim. It doesn't kick it all the way. We did have another doc that used the Bactrim and Rifampin, and it was OK. Then, we had another doc that used Bactrim and Doxy....worked like a charm. There wasn't alot of repeat break outs either. But...you know how it is when you try to tell a doc what worked with another doc.

Yea, we need a new medical director. I could tell you some orders that would make your mouth drop!

[shell911rn]

BSNinTx,

We have seen success with Bactrim and Rifampin just as you prescribed in California prisons as well. I've also seen Bactroban intranasally ordered by one physician to eradicate those inmates who have recurrent MRSA infections. I keep trying to tell the inmates to stop squeezing/touching their wounds, to shower and change their linens every chance they get, and to wash their hands frequently. That seems to work some of the time, but prisons are an infection control nightmare for inmates and staff alike. I can't even say that we are having an MRSA outbreak because it is so common. I do know that a year or two ago, they had an outbreak amongst custody staff with several officers coming down with Cellulitis of various extremities. Inmates demand antibiotics for what looks like a pimple now, they are so paranoid. The overuse of antibiotics is what helped lead us to MRSA and other antibiotic resistant-bacteria in the first place. Our continued overuse of antibiotics will continue to fuel the resistance of Staph to most antibiotics. This is scary for the public at large. When I was working in the ER, we started seeing more and more community-acquired MRSA, and that was a year ago. Patient education and more control over the sanitation of our facilities would do wonders for helping to curb MRSA.