Spreading erythema, fever, hypotension, or tachycardia may indicate bacteremia or sepsis and must be reported immediately.
Before you read
Test yourself first: 3 questions
Question 1 of 3
Which of the following clients should the charge nurse assign to a private negative-pressure airborne isolation room?
Answer: B. Measles (rubeola) is transmitted by the airborne route and requires a negative-pressure room. Pertussis and influenza are droplet, and MRSA wound infection is contact.
Question 2 of 3
A client with an open, draining wound infected with MRSA is admitted. Which precaution is appropriate?
Answer: C. MRSA in a wound is transmitted by contact, so contact precautions (gown and gloves) are used, along with proper containment of wound drainage.
Question 3 of 3
The nurse is caring for a client with a methicillin-resistant Staphylococcus aureus (MRSA) wound infection. Which precautions are required?
Answer: B. MRSA is spread by direct and indirect contact, so contact precautions (gown and gloves, dedicated equipment, private room or cohorting) are required. Airborne or droplet precautions address respiratory spread and are not indicated. Standard precautions alone are insufficient for a multidrug-resistant organism.
Keep the streak going with more questions like these, each with a full rationale.
What is mrsa?
It commonly causes skin and soft-tissue infections (abscesses, cellulitis) but can also cause pneumonia, bacteremia, and surgical-site infections. People may be colonized (carrying it without illness, often in the nares) or actively infected. Contact precautions and prudent antibiotic use limit its spread.
Key points to remember
- MRSA frequently appears as a red, swollen, painful, often purulent skin lesion that may look like a spider bite or boil.
- It is spread mainly by direct contact and contaminated hands, surfaces, and shared items.
- Colonization (especially nasal) means carriage without symptoms; infection means active disease.
- Vancomycin and linezolid are common treatment choices because the organism resists penicillins and cephalosporins.
- Healthcare-associated MRSA often causes bloodstream, wound, and ventilator-associated pneumonia infections.
- Contact precautions with gown and gloves are required to prevent transmission.
Nursing priorities
- Place the patient on contact precautions with gown and gloves and a private room or cohort.
- Perform meticulous hand hygiene and dedicate equipment to the patient.
- Administer vancomycin or other ordered antibiotics and monitor for therapeutic levels and adverse effects.
- Care for wounds with sterile technique and keep drainage contained and covered.
- Implement decolonization protocols (such as mupirocin nasal ointment and chlorhexidine baths) when ordered.
Labs & values
Patient teaching
- Keep wounds clean, dry, and covered, and do not share towels, razors, or personal items.
- Wash hands frequently and complete the entire antibiotic course even if you feel better.
- Report increasing redness, warmth, drainage, or fever around a wound to the provider.
Red flags: report now
- Spreading erythema, fever, hypotension, or tachycardia may indicate bacteremia or sepsis and must be reported immediately.
- Monitor vancomycin trough levels and renal function; report signs of nephrotoxicity or red man syndrome with rapid infusion.
- Never allow MRSA wound drainage to contact other patients or shared equipment.
- New respiratory distress in a MRSA-positive patient may signal MRSA pneumonia needing urgent attention.
References
Clinical references for this topic
