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SNF Infection Control Guidelines for MRSA Cheat Sheet by

Nursing Home Infection Control Guidelines for MRSA
nursing     medical     control     guidelines     snf     infection     mrsa

Introd­uction

At least 25 percent of antibiotic prescr­iptions in nursing homes do not meet clinical guidelines for prescr­ibing. This use and overuse of antibi­otics results in side effects and drug-r­esi­stant bacteria. The Commun­ication and Decisi­onm­aking for Four Infections toolkit aims to reduce inappr­opriate prescr­ibing for the four infections for which antibi­otics are most frequently prescribed in nursing homes:
(1) Urinary tract infections (UTIs)
(2) Lower respir­atory tract infect­ions
(3) Skin and soft tissue infect­ions
(4) Gastro­int­estinal infect­ions

When To Culture:

Resident with abscess >5 cm (via needle aspirate).
Tracheostomy resident with evidence of pneumonia.
Expectorated sputum of resident with acute bacterial bronchitis or pneumo­nia..

When To Treat

Symptomatic infection, not coloni­zation.
Use anti-MRSA antibiotic empiri­cally for abscess or chronic ulcer meeting criteria for deep infection.

How To Isolate Cultur­e-p­ositive Residents

Do not use contact precau­tions in the absence of a draining wound, profuse respir­atory secret­ions, or evidence implic­ating the specific patient in ongoing transm­ission of the MDRO within the facility.
Use approp­riate hand hygiene before and after all resident contacts (soap and water, or waterless alcohol product).
Avoid placing resident in same room with person with indwelling medical device or open wound.
Use sterile bandages to contain secretions from MRSA-i­nfected wound.
Clean contam­inated surfaces with EPA-re­gis­tered hospital disinf­ectant.

When to Decolonize a Resident

Do not attempt; no proven successful regimen exist
 

MRSA Infrec­tions

Where Systemic Antibi­otics Generally Not Indicated

12 Common Nursing Home Situations in Which Systemic Antibi­otics are Generally Not Indica­ted
1. Positive urine culture in an asympt­omatic resident.
2. Urine culture ordered solely because of change in urine appear­ance.
3. Nonspe­cific symptoms or signs not referable to the urinary tract, such as falls or mental status change (with or without a positive urine culture).
4. Upper respir­atory infection (common cold).
5. Bronchitis or asthma in a resident who does not have COPD.
6. “Infil­trate” on chest x-ray in the absence of clinically signif­icant symptoms.
7. Suspected or proven influenza in the absence of a secondary infection (but DO treat influenza with antivi­rals).
8. Respir­atory symptoms in a resident with advanced dementia, on palliative care, or at the end of life.
9. Skin wound without cellul­itis, sepsis, or osteom­yelitis (regar­dless of culture result).
10. Small (<5cm) localized abscess without signif­icant surrou­nding cellulitis (drainage is required of all absces­ses).
11. Decubitus ulcer in a resident at the end of life.
12. Acute vomiting and/or diarrhea in the absence of a positive culture for shigella or salmon­ella, or a positive toxin assay for Clostr­idium difficile

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