Contents

• This report is based on the following case study –
• Mrs Gibson, 85 years old, has been admitted to a medical ward at Royal Perth Hospital (RPH) from an aged care facility with an infected pressure ulcer wound on the sacral area.
• The transfer letter from the aged care facility stated that Mrs Gibson usually wears glasses for reading, used a walking frame for ambulation with assistance, requires assistance with feeding and showering and may become incontinent of urine at times. Her favourite hobby is playing weekly bingo with the friends and occasional outings with her son and granddaughter.
• You are admitting Mrs Gibson and place her under MRSA precautions. Swabs are taken and sent to the laboratory as ordered by the treating doctor. You want to plan her care and decide to assess the patient (vital signs) and her wound.
• The next day Mrs Gibson’s MRSA swab results have confirmed MRSA in her sacral wound.

Description

This report answers the following questions on the case study –
1. What is MRSA and why do microbes become resistant? What do the acronyms MRSA, EMRSA and CA-MRSA stand for? What is the difference between colonisation and infection? What are the implications for health care facilities?
2. From what body sites would MRSA swabs be collected in reference to this case-study? Once swabs are collected, what laboratory processes would follow when MRSA is suspected? Please consider: Gram stain, distinguishing MRSA from other organisms and tests to determine which antibiotics can be used.
3. In reference to the case-study, please discuss standard precautions and the transmission-based precautions that will need to be implemented when checking vital signs, assisting with a shower and attending to the wound dressing. Specifically refer to the RPH MRSA policy.
4. What strategies would you implement to prevent the spread of MRSA to other patients? What about visitors? How would you handle equipment (both the hospital’s and the patient’s, e.g. Dinamap, walking frame, etc.). Please link your answer to the chain of infection.
5. Briefly discuss psychosocial issues that a client with MRSA may experience, and some issues for nurses with regard to MRSA, e.g. antibiotic use, workload, etc.