Monday, January 18, 2010

Nurse Practitioner Ahead Of The Game In Treatment Of MRSA

Nasal carriers of S aureus infection have a high risk for healthcare-associated infection 3 to 6 times that of noncarriers, and more than 80% of healthcare-associated S aureus infections are endogenous. Although intranasal application of mupirocin ointment has been shown to prevent invasive infection in patients receiving dialysis, the results with surgical patients have been controversial. The authors proposed that adding skin cleansing with chlorhexidine gluconate soap would improve outcomes of S aureus infection in hospitalized patients.

The above study was conducted recently and printed January 7, 2010, issue of the New England Journal of Medicine. Ask my patients what I've been doing for the last two years in my office. I learned that regimen from the hospital where I worked as a floor nurse from the surgical group. This is not something that most providers know by now.

The area that I work here in North Florida is a hotbed of MRSA and almost daily I get patients in with complaints of chronic boils and spider bites. I still have to shake my head over the continued misunderstanding of the process of bacterial resistance. This is the main reason that I stress to all of my patients the need to finish an antibiotic and to only take one if it's indicated. Too many want instant results and ask for an additional antibiotic before the first one has had time to take effect.

The regimen that I have used for the last two years is Hibaclens body wash daily x 10 days while on antibiotics and Mupricion ointment to nares twice daily x 7-10 days. Usually the MRSA is reactive to Septra DS or Cipro. In some rare cases, Rifampin or Tetracycline is used for resistant strains. Hand washing is so important and teaching patients to wipe off grocery carts. The first place people often go after discharge from a hospital is to Walmart. We all know that insurance companies are requiring much shorter stays and people are still contagious.

Protect yourself through education and proper use of antibiotics out there!

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