VRE/MRSA

What will you expect a infected patient to look like?

-Clammy (diaphoretic) -Look at wound or lower extremity cellulitus, red, swollen, if so circle it or mark it. Check for drainage, if infected it will be purlent (pusy, white, brown, or green, may have odor), if draining it will have medium to large amount. You measure drainage by paying attention to gauze saturated and the hours it took to do it. That's the indication if its draining more or less.

What are some interventions for infection?

-Give medications that are prescribed. -You need to do culture insensitivity before we give antibiotics -Elevate the irritated extremity to decrease swelling -Look at I's and O's keep track of the draining. -You will need to get CBC so you can look for high WBC. (check daily) -You could do MRI or cat scan to see if there is a pocket they need to go into. -If the patient is diabetic we will worry about high blood glucose levels. So we need to monitor those. -You will need to increase insulin. Even if they arent diabetic. Sweet blood breeds bacteria.

Who are at risk for getting VRE?

-Individuals who have been treated in the past with vancomycin and combinations of other antibiotics. -People in hospitals, esp. on antibiotics for long durations. -People with weak immune systems or who have had surgical procedures. -People with indwelling percutaneous medical devices and catheters. -Steriods -Young and elderly -Immunocompromised

What kind of problems do patients with infection have?

-Nausea and vomiting or lack of appetite. -Nutrition intake is important because it helps the patient heal. -Hyperthermia -Decrease cardiac output for those who have severe sepsis -You will have pain. -Activity intolerance -Some will be at risk for injuries like falls.

Ways to get MRSA...

-Physical contact with someone carrying the disease -Touch an object that is contaminated -Abrasion or cut to the skin of someone infected can pass it on

S/S of MRSA...

-Small red bumps on the skin -Pus-filled hair follicles -Pus under skin -Pus filled blisters -Infection of eyelid gland -Infection of skin openings -Internal organs causing: Elevated temp, HR Chills Rash Joint pains Severe headaches SOB

Common things caught by contact transmission...

-Staph -Warts -STD

When you are assessing a patient for a suspected infection, what will the vitals look like?

-Temperature and pulse is elevated due to vasodilation -BP will drop in significant infection

Common things caught by indirect contact...

-Tetanus -Common cold -Enterovirus -Ringworm

What will you palpate in an infected patient?

-You can check if the edema is pitting or not pitting. -Tender to touch. -Lymph nodes. -Heat (warmth to touch) -Check border of swellings.

Things that effect wound healing.

-increased perfusion -steriods -malnutrition ( look at albumin ), decrease healing and swelling -smoking (changes vascular system and decreases blood flow)

How long can C-diff live on a surface?

5 months

How long can VRE live on a surface?

9 months

How long can MRSA live on a surface?

90 days

What are antibiotics that are broad that include penicillin derivatives, cephalosporin, and B-lactamase inhibitors?

B-lactam

What type of infection is staph?

Bacterial

Common things caught by droplet...

Common cold Influenza Measles Pneumonia Whooping cough

What type of isolation is used for staph?

Contact

What type of precaution is used for VRE?

Contact

Avoid MRSA By...

Cover any skin breaks with antiseptic cream and a Band-Aid Use excellent hygiene practices Wash clothes in contact with MRSA patients or carriers Use disposable items when treating MRSA patients Use antiseptic solutions and wipes to clean both hands and surfaces that may contact MRSA

How is VRE spread?

Direct contact with: stool urine blood hands contaminated surfaces

What happens to people with VRE that are colonized (bacteria is present but no symptoms of an infection)?

Do not need treatment

What should you tell the patient about curing MRSA?

Entire dosage needs to be taken.

Why is MRSA so commonly found in school aged children?

Found in grade school and sports because they don't wipe things down, heat moisture, sweat, they share things, lots of touching.

Where can you find enterococci?

Intestines and female genital tract

How is the treatment of VRE determined?

Labortory to determine which antibiotics would be the most effective

What is the type of staph infection that is resistant to antibiotics called betalactams?

MRSA

Does enterococci normally cause harm, when it does why?

No, when the bacteria seeds to other places it can cause infections like UTI's, blood, and wound infections.

What type of people commonly get MRSA?

People who get MRSA are frequently in hospitals and healthcare facilities, with weakened immune systems.

Where is staph carried in most healthy people?

Skin or in the nose

Which staph causes most infections such as Skin infections, Pneumonia, Food poisoning, and Toxic shock?

Staphylococcus aureus

What happens to nurses that are commonly surrounded by staph?

They become colonized with it.

How is VRE not spread?

Usually is not spread through casual contact such as touching or hugging. VRE is not spread through the air by coughing or sneezing.

What antibiotic is used to treat infections caused by enterococci?

Vancomycin

What type of antibiotics is MRSA usually treated with?

Vancomycin and linezolid

What is it called when bacteria become resistant to this drug?

Vancomycin resistant enterococci.

What should you do after removing gloves? Can you wear them in the hallway?

Wash hands, never

What should you watch for when administering Vancomycin?

Watch Vanc levels. Watch peak and trough. The peak is after. Typically an hour after. Trough is drawn before, typically 30 minutes before. Watch ototoxicity, red man syndrome (red from chest up) happens within 30 minutes of admin.

What is enterococci considered?

bacteria

How should Vancomycin be administered?

main central line because its hard on veins. Endocarditis (long term antibiotic through central line)