MRSA – Management of Recurrent Skin and Soft Tissue
Infection
Highlights
Policy Statement
Strategies for the management of recurrent skin and soft tissue infections (SSTI) with
methicillin-resistant Staphylococcus aureus are consistent with current practice guidelines.
Policy Interpretation and Implementation
Contact Precautions
1.
CDC recommends contact precautions when the facility (based on national or local
regulations) deems MRSA to be of special clinical and epidemiologic significance.
The components of contact precautions may be adapted for use, especially if the
resident has draining wounds or difficulty controlling body fluids.
Standard Precautions
2.
Utilize standard precautions at all times for all resident care.
Staff/Resident Education
3.
Educate staff and residents about the need for personal hygiene and appropriate
wound care, including:
a.
b.
c.
d.
Environmental Cleaning
Procedures
4.
Enforce strict environmental cleaning procedures, including:
a.
b.
Possible Decolonization
Situations
5.
b.
6.
Focusing cleaning efforts on high-touch surfaces (e.g., door knobs, counters,
bath tubs and showers, toilet seats, etc.); and
Using CDC recommended cleaners appropriate for the surface being cleaned.
Decolonization may be considered in the following situations:
a.
Strategies for
Decolonization
Keeping draining wounds covered with clean, dry bandages;
Performing hand hygiene after touching infected area or any item that has been
in contact with the wound;
Encouraging/assisting resident with regular bathing; and
Not allowing residents to share or reuse items that have come in contact with
infected skin.
A resident develops a recurrent SSTI despite optimizing wound care and
hygiene measures; or
Ongoing transmission is occurring among residents or other close contacts
despite optimizing wound care and hygiene measures.
Decolonization requires a physician order. Strategies may include:
a.
b.
Nasal decolonization with mupirocin twice daily for 5–10 days; or
Nasal decolonization with mupirocin twice daily for 5–10 days and topical body
decolonization regimens with a skin antiseptic solution (eg, chlorhexidine) for
5–14 days or dilute bleach baths.
(1) For dilute bleach baths, 1 teaspoon per gallon of water (or ¼ cup per ¼
tub or 13 gallons of water) given for 15 minutes twice weekly for 3
months.
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© 2001 MED-PASS, Inc. (Revised August 2011)
Interpersonal Transmission
7.
In cases where interpersonal transmission is suspected:
a.
b.
Reinforce personal and environmental hygiene strategies; and
Evaluate contacts for evidence of S. aureus infection.
(1) Recommend evaluation and treatment of symptomatic contacts; and
(2) Recommend the possible decolonization for asymptomatic contacts.
Screening Cultures
8.
Screening cultures prior to decolonization are not recommended if at least one of the
previous infections was due to MRSA.
Surveillance Cultures
9.
Surveillance cultures following decolonization are not recommended in the absence
of active infection.
References
OBRA Regulatory
Reference Numbers
Survey Tag Numbers
Related Documents
Policy
Revised
483.65(a); 483.65(b)(1); 483.65(b)(3); 483.65(c)
F441
See also:
Management of Multidrug-resistant Organisms in Healthcare Settings, 2006
CDC Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
(Appendix D)
Clinical Practice Guidelines by the Infectious Disease Society of America for the
Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and
Children (2011) (Appendix D)
Isolation – Categories of Transmission-Based Precautions
Date:________________
By:__________________
Date:________________
By:__________________
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© 2001 MED-PASS, Inc. (Revised August 2011)