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CorrectCare
LA
Confidential: County Jail Solves MRSA Mystery
Recommendations for Battling MRSA
MRSA infections are an emerging problem in correctional
facilities, and while institutional settings sometimes can
benefit from a standard approach, its important to remember
that one size may not fit all. With that caveat, we present the
recommendations developed for the Los Angeles County jails based
on our experiences with MRSA.
Surveillance
Encourage inmates to report skin lesions
Culture all skin infections upon presentation
Maintain skin infection log in medical unit to capture data
Include culture results and antibiotic sensitivities in the
log
Review the log regularly
Evaluate cellmates and close contacts of MRSA-positive inmates
for skin lesions
Visually survey for skin lesions on admission to jail
Add a screening question to identify current or past skin
infections
Appropriate
Diagnosis and Treatment
Culture lesion and determine susceptibility to MRSA
Optimize wound care, utilizing dedicated wound-care nurses
Provide wound care each day
Ensure adequate drainage: I&Ds are done by clinicians, not by
other inmates
Dispose of bandages and other materials appropriately
Adequate wound care may avoid need for antibiotics
Prevention
Education is essential and should address staph infection,
access to medical care and good personal hygiene
Enable good hygiene, including access to showers
Ensure frequent exchanges of laundry (linens, clothing, etc.)
Ensure adequate environmental cleaning
About the author:
John H.
Clark, MD, CCHP-A, is chief medical officer for the County of
Los Angeles Sheriffs Department. This article is based on his
presentation at the Clinical Updates in Correctional Health Care
conference in Anaheim, CA, in April. Clark wishes to thank two
colleagues whose efforts were invaluable in identifying this
outbreak: Martha Tadesse, public health nurse in the
communicable disease unit of the Medical Services Bureau, and
Elizabeth Bancroft, MD, epidemiologist for the Los Angeles
County Department of Health Services.
[This article first appeared
in the Summer 2003 issue of CorrectCare.]
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