Doctors Lounge - Dermatology Answers
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Forum Name: Dermatology Topics
|nursie3205 - Fri Sep 09, 2005 3:50 am|
Hello, My name is Rachael. I am a geriatric nurse in a nursing home. In the last 3 months, several of our patients have shown up with MRSA, either active or colonized. We have used the appropriate isolation/contact precaution strategies. However several employees, have tested positive for MRSA, after getting what has been decribed as a spider bite. These employees have had to take a lot of time off from work.
About one and a half weeks ago, a combative patient sank her (what Im sure were unclean) fingernails into the palm side of my left lower arm. I immeadiately scubbed my arm from fingertips to elbow with antimicrobial soap, and then used alcohol preps scrub the nail "gashes" on my arm.
The very next day i started breaking out with small pimple like bumps on the top of my left forarm. The doctor told me just to watch the area and see what happened. Well, I did watch the area for about 20 minutes, the time it took me to drive to the emergency room. (LOL). The ER doc diagnosed me with folliculitis and prescribed Cipro. When I asked him to culture the area, he passed it off by saying "there is no need to do that". I took the medication exactly as prescribed and was very careful not to scratch or even rub the bumps, as not to affect them further. I came home and thoroughly disinfected all the surfaces, floors, doorknobs, toilets, showers, etc. I was afraid that my family might pick this up. I have always been an OCD handwasher, lol, and instructed all my family to do the same thing.
The next morning they got worse. They were now larger and very inflamed. Went back to ER, a different doctor diagnosed me with furunculosis, and prescribed Keflex. This dx, made more sense, since the surrounding skin was puckered, and there was a pinlike hole in each one, like a carbuncle. They were very painful and inflamed. Again I asked the doc for a culture and even explained the problem with outbreak of MRSA at the nursing home. I was denied again, this being the second time.
The pain was so bad that I could barely move my left arm. When I got home I drained the leisions myself with a sterile needle. They oozed a nasty greenish-yellow pus drainage. In a desperate attempt to dry up the leisions, I poured household bleach over them, which as a nurse, I would never advise anyone to do, but I was desperate.
IT WORKED, IT REALLY HURT, BUT IT WORKED. Less than an hour later, the swelling was basically gone and the pus filled boils were scabbed over. Since then, I even went to one other doctor and asked for a culture. Again denied, which was logical due to the leisions being basically healed, and the fact that I had been on antibiotics for a while.
I have researched and learned a lot about staph aureus and boils. However, the last doctor told me to simply cover them and go back to work, which I have done but I am scared, that I may have contracted MRSA, in which case, the cephalexin that I am currently taking will not treat it. I know that there is a chance that MRSA can cause or lead to very serious, even life-threatening health problems, such as bactremia. Even though I am almost healed, I still have a couple of small bumps, that have spread from the localized area they started in. How can I keep them from spreading further, I am very hygienic and never scratch them. Another question, i fear there will be signicant scarring on my arm. What can I do to keep this from recurring?
Any advise would be greatly appreciated. I have been to four doctors, done hours of research, but still have so many questions. In closing, " thank you " to anyone who takes the time to read this.
Rachael (nursie3205) Please feel free to email me at email@example.com.
|nursie3205 - Sun Sep 11, 2005 3:19 am|
I know that this is a very long post, but I had to tell my complete story in order to make my point and give accurate info.. This problem is seriously troubling me and I am desperate.
|Theresa Jones, RN - Wed Sep 14, 2005 7:08 am|
I'm sure you are already aware of all the possible exposures of known and unknown illnesses due to fact of being in healthcare alone. The most effective way to prevent the spread of MRSA is handwashing (which it sounds like you already do well), keep open or draining wounds covered, not sharing personal items, etc. Even though you are very conscientious about handwashing and isolation procedures at your workplace, it only takes one staff member not being conscientious to spread this infection to other patients or for that matter other patients coming in contact with other patients. My suggestion for you is contact an Infectious Disease Specialist for an evaluation. This physician would not have any question abount performing a culture. If you were to need any verification of your possible exposure to present to him/her I am quite sure that you nursing home coordinator would provide the information required. I hope this has been somewhat helpful.
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