What's your opinion: MRSA

fiestynurse · Aug 19, 2004

Yes, MRSA is a big problem in Correctional facilities, where you have a large population living in close quarters and less than ideal sanitary conditions.

Many jails (and ERs) are now doing cultures on ALL wounds. It is important to work closely with your local public health department and develop good policies and procedures. I suggest having a MRSA tracking log. It is helpful to know if the inmate came in with the infection or contracted it in the facility. Is it isolated to one housing unit or is it widespread throughout the jail. MRSA should be discussed at monthly infection control meetings.

Of course, if the inmate has a large abscess or multiple weeping lesions he should be placed in contact isolation until it dries and starts to show signs of healing. Other inmates with MRSA may be housed in the same location. These inmates should be given clean linen and clothing everyday and have access to daily showers. Staff should wear gloves and gowns when indicated for dressing changes.

There should be a regular cleansing of surfaces with a bactericidal agent (toilet seats, sinks, bathtubs, weight room equipment, etc) Assess the laundering procedures at your facility (type of detergent and water temperature) Don't overload the machines!

Education is key! You really have to be proactive! Some places are posting or handing out educational material to the inmates. Many are providing inservices to custody and medical staff.

oicu8bacilli · Aug 19, 2004

Funny you mention it. I see plenty of "spider bites". I have no idea why, but folks seem to get bitten by stuff in their sleep a lot. Some abscesses from these "bites" do come back as MRSA.

fiestynurse · Aug 19, 2004

In the Correctional setting, the proverbial spider bite is, in reality, most often an infection caused by Staph, which may be MRSA. I knew a facility that actually fumigated their jail "because of all the spider bites," only to have a MRSA outbreak reach epidemic proportions. Boy, did they feel stupid!

I think they found one dead spider!

nurseT · Aug 19, 2004

Tell me more about the "spider bite". I work at the county jail and every once in a while I see one little red bump that an inmate thinks is a spider bite. How do you culture it if there's nothing to culture? I have had two inmates in the past, not bunkies, who had cysts on their coccyx that drained. They never had any other symptoms and the Dr. didn't seem to think it was necessary to culture. I would be willing to bet that if the general public were to be tested, the amount of MRSA would be stunning.

fiestynurse · Aug 20, 2004

The fact is that spiders rarely bite people and usually it is inconsequential. Ironically, there is probably more potential harm to the inmate by the chemicals that are used to eradicate the spiders--which aren't really there --

as opposed to the potential danger from a brown recluse spider.

There has been increasing litigation regarding the misdiagnosis of minor skin infections as spider bites. It important to teach custody officers and inmates to report any skin lesions, no matter how minor, to medical. Obviously, the small non-draining and closed lesions can't be cultured, but monitor them closely. Be pro-active and treat early and appropriately. These infections can become quite serious, requiring hospitalization and treatment with expensive IV Vancamycin. It costs more money to ignore them!

Jast · Aug 20, 2004

Vancomycin is the last antibiobic of choice. We now have incidents of VRSA due to over usage: ie last antibiotic of choice.

When hospitals do pediatric open heart surgery the last thing they need is VRSA.

Yes we must be proactive, but there are usually other antibiotics that are appropriate and can be used first.

Yes we do isolate, track, discuss all cases of MRSA

Nurse_Peachie · Aug 20, 2004

"How big a problem is MRSA, specifically CA-MRSA (community-acquired methicillin-resistant staphylococcus aureus)? Is your facility dealing with a large number of what's thought to be spider-bites? If you are culturing these abcesses, are they coming back MRSA?"

We are seeing a large amount of "bites" at our facility and if the inmate has an open wound or drainage, we do put them in our medical cell for observation. There, they receive a shower twice a day with special soap and have their dressing changes. We are also doing cultures on all wounds.

I know that there are many more inmates out on the yard that have these symptoms, but they just refuse to come to medical due to the $2.00 charge. No matter how much education a nurse/provider does, they still do not come over. We even offer no charge just so we can get a handle on the outbreak, but then their excuse is, "I ain't goin over there for them to lock me up". UGH!!!

fiestynurse · Aug 20, 2004

Yes, I agree - Vancomycin is the last antibiotic of choice, when the infection has been allowed to fester and become critical. I didn't say that it was the first drug of choice. That's why it is important to be proactive, so that hospitalization and IV Vancomycin is not needed.

Any lesion typical of staph aureus should be cultured and the treatment based on sensitivity results.

MRSA is often sensitive to the following antibiotics: Bactrim or Septra, Clindamycin, and Rifampin. Rifampin should always be used in conjunction with another sensitive antibiotic, since resistance to rafamfin develops quickly, when used as a single antibiotic. Deep seated infections such as pneumonia, metastatic abscesses or endocarditis due to MRSA should be treated with IV Vancomycin or Vancomycin in combination with low dose gentamycin or Rafampin.

ddc101 · Aug 20, 2004

I am not in correctional nursing but I wanted to say that in our area there is a big outbreak of MRSA and its not from hospital exposure.Its going around bad right now.My friend works in ER at a major hospital and in ER a guy came in for a swollen knee.They withdrew fluid and it came back postive for MRSA.Also a friend broke out in boils and its MRSA.He is pastor and hasn't been near a hospital lately.A lady in his church family had it and thats where it came from.Somehow it passed around.I know of a whole city block where the residents were breaking out in boils.This stuff is nasty.People don't realize that it lies dormant once you have it and exacerbates with stress.

Megan-Cho · Dec 9, 2004

I am not a nurse. I am a mom of a 10 year old boy that has Community Acquired ORSA. This is one of 3 or more strains not found in healthcare settings. It's very aggressive. It attacks healthy skin. I have to nearly paint his body with bactroban and about 200 Qtips three times a day. I'm collecting information on CA-ORSA and posting it on a site.

I would like to see the CDC's elite guard the EIS, take a more proactive or public approach to tracking strains and getting the word out. To that end, I email people I find on the net that might have influence and I copy the EIS and CDC on each one!

Since I can't directly battle the bacteria, I can battle people not knowing about the newer strains. It's often misdiagnosed as spider bites. It's spreading like wild fire through school athletes, day cares and jails.

Here's my site. I just started it this past October and already it needs to be updated with new and more severe instances of the spread.

http://www.caercoork.com/orsa/orsa.html

fiestynurse · Dec 23, 2004

Great site Megan-Cho! I have also wondered why we don't have mandatory reporting of these resistant strains? Keep up the good work!