Wound Management and Care for MRSA

Management of Methicillin resistant Staphylococcus aureus (MRSA)

1. Treatment

Patients infected with MRSA should be treated with relevant antibiotics guided by an antibiotic sensitivity test.

2. Screening Patients for colonization a. Nose – both nostrils swabbed with one swab b. Perineum or groin – both sides swabbed with one swab c. Axilla – both axillae swabbed with one swab d. Throat e. Skin lesions – swabbed as wounds, ulcers, rash, IV or drain site f. Catheter Specimen of Urine – if indwelling catheter present g. Sputum – if productive

3. Swabs are moistened with sterile saline before obtaining specimens.

4. Eradication

5. The Microbiologist should be consulted before instituting eradication protocol.

6. Colonized patients should undergo a 5 Day MRSA Eradication Protocol:-

7. Daily baths with 4% chlorhexidine in detergent solution or 4% povidone iodine applied neat to the skin with a washcloth.

8. On days 1, 3, 5 wash hair with 4% chlorhexidine or 4% povidone iodine followed by normal shampoo.

9. Apply 2% mupirocin nasal ointment to anterior nares three times per day. A match-head size portion of ointment/cream to be applied to each nostril using a disposable cotton swab. Alternatively, chlorhexidine cream, neomycin / chlorhexidine cream or povidone iodine cream can be used.

10. Apply 2% mupirocin on colonized or infected skin lesions (avoid use on deep/extensive wounds)

11. Change personal clothing and bed linen daily.

12. After 5 days stop eradication treatment.

13. 48 hours after completing the eradication protocol, repeat the screening. If a patient has had antibiotics for MRSA do not re-screen till 48 hours after IV treatment has ceased.

14. Continue isolation until 3 complete sets of negative swabs are obtained. There should be at least 3 days between each set of swabs.

15. Refer Hospital Infection Control Manual © SLCM / 2005