MRSA infection control in long-term care facilities

The situation this topic covers

A nursing home resident is hospitalized, and shortly before she is to be discharged she develops a skin ulcer that proves to be infected with MRSA. The question is what is most important in terms of infection control when she returns to the nursing home, and the measures set beside each other are surveillance cultures of residents with rooms near the patient, aggressive housekeeping in the patient's room, masks, gowns and gloves for anyone entering the patient's room, strict handwashing practices by all staff, visitors and residents, and isolation of the patient in a room by herself.

Where MRSA sits among the precautions

MRSA is placed under contact precautions, and it is listed there twice over: once by name at the head of the contact list, and once by category, since resistant bacteria, meaning MRSA and VRE, are one of the four groups for which contact precautions are used. The four are any disease which is feco-orally transmitted, resistant bacteria, skin and wound infections, and parainfluenza and RSV. Skin or wound infections are always contact, gloves and gown. This resident meets two of the four at once: the bacterium is resistant and the site is a skin ulcer.

The contact list in full carries MRSA, VRE, adenovirus, diarrhea, C. difficile, rotavirus, E coli 0157, enterovirus, salmonella, shigella, hepatitis A, herpes zoster when localized, herpes simplex, parainfluenza with a mask if coughing, RSV with a mask if the cough is productive, lice, scabies, and chicken pox while symptomatic, until all lesions are crusted and dried.

The line that holds it is MRS. WEE: MRSA, RSV, skin infections, wound infections, enteric such as C. diff, and eye, meaning conjunctivitis.