1. 1 Skilled Nursing, Inc. Staffing & Search MRSA Methicillin Resistant Staph Aureus HA MRSA and CA MRSA Causes SSTI’s, sepsis, necrotizing fascitis and fatality Bacteria can mutate, Paton Valentine Leukocidin(PLV) gene thought to be the virulent factor. Pencillin resistance due to production of beta lactamase Unnecessary use of antibiotics, antibiotics in food and water Staff is normally found in the skin and nares of healthy people. At risk elderly, kids, and those in crowded and or poor conditions Urban populations, prisons, and athletes sharing equipment and towels

2. 2 Skilled Nursing, Inc. Staffing & Search Presentation usually in the ED/Primary care office C/O red tender bite like sore –spider bite, boil, pustules –2 nd stage –deep abscesses –can lead to sepsis I&D, flush with saline, can use Iodoform gauze, cover wound. Antibiotics –If no fever and general health is good oral antibiotics with follow-up in 8 to 12 hours –If fever comorbidities in patient treatment and IV antibiotics

3. 3 Skilled Nursing, Inc. Staffing & Search IV Antibiotics Vancomycin-1gm q12 hrs Clindamycin -loading dose(600-900mg) then 500 mg q 6 hrs Keflex- 1gm loading dose then 500mg q 6 hrs. PO Antibiotics Clindamycin -300 mg 4 times per day x 10 days Doxycycline-100 mg twice a day x 10 days Rifampin-300 mg twice a day x 10 days Bactrim/Septra-one double strength tablet twice a day x 10 days (160 mg Trimethoprim-800 mg sulfamethoxazole)

4. 4 Skilled Nursing, Inc. Staffing & Search Treatment Failures Inadequate I&D Differential Diagnosis Cellulitis Prevention Hand washing and Contact pre-cautions Wound covered/respiratory etiquette Clean environment No contact sports if open wounds No public whirlpools or spas until wounds are healed No sharing of razors, towels, or soaps

5. 5 Skilled Nursing, Inc. Staffing & Search Prevention Inpatient -nasal swab and isolation until return cultures (rapid polymerans rx) -hand washing by all team members -identify patient prior to transfer/studies -nasal swab prior to discharge Future Potential Vaccine Nurses Role major player in education and enforcement of hand washing, teach about the hazards of transferring.

6. 6 Skilled Nursing, Inc. Staffing & Search MRSA Example: Alleghany Hospital/Pittsburg 236 infections over 4 years Average payment - $40,302.00 Average expense - $54,065.00 Average loan - $13,763.00 Total Loss from operations- $1,234,343.00 Average age – 63 years old Average LOS-31 days Most common DRG: CV(24%), GI (16%), ID (15%) Neuro (13%) and Put (11%)

7. 7 Skilled Nursing, Inc. Staffing & Search MRSA Transmissions 69% previous hospital contact in last 6 months 19% previous hospital contact in last 6 months 12% from Nursing homes Cost of surveillance $50,680.00/$2,141.00($24/pr) 4 preventions recovered the cost of the surveillance-prevented 19 infections and 10 deaths.

8. Skilled Nursing, Inc. ® Staffing & Search Joint Commission Certified www.snistaffing.com