OASIS Alert

Published on Mon Jan 28, 2008 PDF

Your OASIS assessment may help you catch MRSA early.

When you're assessing a patient's wounds to answer M0440 through M0488, keep an eye out for a potentially deadly infection.

Nearly one in every five patients with the virulent, drug-resistant bacteria methicillin-resistant Staphylococcus aureus (MRSA) dies, according to a study published in the Oct. 17, 2007 edition of the Journal of the American Medical Association. This infection is now frequently showing up outside of medical facilities and may be twice as common as previously thought, says Dr. R. Monina Klevens, lead author of the study.

What to do: To prevent spreading the infection, and to improve outcomes, early detection and treatment are crucial. And these two clinical scenarios should raise your level of suspicion that MRSA may be involved:

1. Infected surgical wounds. M0488 asks you to assess the status of the most problematic surgical wound. If that wound is not healing, and appears infected, suspect staph. "Staph is the leading cause of surgical site infections -- and up to 60 percent will be MRSA," advises James Marx, a certified in-fection control expert with Broad Street Solutions in San Diego. So be sure to culture an infected surgical wound site, he says.

2. Necrotic wounds diagnosed as spider bites. When you're answering M0440 (Does this patient have a skin lesion or an open wound?), pay special attention to necrotic wounds the patient may dismiss as "just a spider bite." These can really be MRSA infections, warns Dr. Steven Warren, the medical director of several nursing homes in Texas. "Culture any wound believed to be a spider bite where you don't actually see a spider," he advises.

Tip: Check with your local public health department to see if brown recluse or other spiders known to cause serious lesions inhabit your area.

Resources: To learn more about MRSA, go to http://www.mayoclinic.com/health/mrsa/DS00735. For a map showing where brown recluse and related spiders live, go to http://spiders.ucr.edu/images/colorloxmap.gif. To see pictures and descriptions of brown re-cluse spider bites go to http://www.emedicine.com/EMERG/topic547.htm#target1.