Advanced Practice Nursing in Community Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Infection: A Guide for Practice in Shelter Populations
Dubiel, Kalista H.
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Purpose: To analyze the state of the science for the recognition of CA-MRSA skin and soft tissue infections (SSTIs), optimal pharmacologic treatment, wound care management, effective environmental controls and disease education that may be utilized by health care providers in a shelter environment. Data Sources: Published research was limited to US studies from 2006 to February, 2012 in the CINAHL, Pubmed and Cochrane databases. CA-MRSA treatment and infection control guidelines were obtained from the Washington Department of Health, Centers for Disease Control and the Spokane Regional Health District. Antimicrobial susceptibility profiles of the Spokane, WA region were obtained from Providence Associates Medical Laboratories. Conclusions: Homeless clients in a shelter are a high risk group for CA-MRSA infection. Shelter health care providers need a comprehensive understanding of the resistance patterns in their locale as well as effective antibiotic, wound care and environmental control measures to ensure effective treatment of CA-MRSA. This knowledge will aid health care workers in their efforts to provide efficacious treatments, accurate health education to shelter clients and workers and decrease infection rates within a shelter environment. Implications for Practice: Nurse Practitioners should have a high degree suspicion of CA-MRSA in homeless clients with SSTIs. As an acknowledged group at risk for CA-MRSA and a population often lost to follow-up, Nurse Practitioners should consider empiric CA-MRSA antibiotic treatment for this transient population. NPs must also identify local resistance, prevalence and infection patterns for CA-MRSA, and should offer antibiotics, bandage supplies and perform incision and drainage (I&D) at clinic appointments for homeless clients whenever possible. Lastly, Nurse Practitioners can combat stigmatization of shelter clients with CA-MRSA by conveying that CA-MRSA is a manageable, treatable condition when managed by covering wounds, frequent cleansing, not sharing personal items and taking antibiotics as prescribed. The literature was divided into four sections: recognition of CA-MRSA SSTIs, pharmacologic treatment, wound care management, and effective environmental controls in a shelter environment. Key words used in Cochrane and PubMed were: CA-MRSA treatment, CA-MRSA infection, SSTI and CA-MRSA infection control. Articles which focused on HIV patients and pediatrics were eliminated, and research was limited to US studies from 2006 to February, 2012. In the CINAHL database, the search criterions of wound care and homeless care were added. Articles were included whose focus was outpatient or emergency patient care and the reference lists of selected research and journal articles were reviewed to identify additional sources of research studies. Other sources of information regarding CA-MRSA were obtained via the search engine Google Scholar from the Washington Department of Health, Centers for Disease Control and the Spokane Regional Health District. The most recent available (2010) antimicrobial susceptibility profile of the Spokane, WA region was supplied by Providence Associates Medical Laboratories. Latest edition pharmacological and primary care procedural texts were reviewed as well.