Case 03 - Owen 8 Years Old Answers | PIAC Series
UnityPoint Health - Des Moines

PIAC Case Series

Case 03 - Owen, 8 Years Old - Answers

Owen is a 8 y/o who underwent ORIF L tibia and fibula following a severe fracture. He is readmitted 6 days post-op with wound dehiscence, drainage and surrounding cellulitis.

Blood cultures are negative but wound cultures show PMN and gm + cocci on gm stain and grow MRSA.


1) What isolation precautions should be taken to prevent spread of MRSA in the hospital?

  • Should staff wear masks to enter?
  • Should staff or other patients be cultured?


  • Measures to be taken = Contact Precautions
  • Masks do not need to be worn; MRSA is spread by contact by hands (less likely objects or clothing) but not by airborne/droplet route
  • The most likely source of MRSA is patient colonization (found in 6 - 8% of general population). No culturing of staff is indicated unless this is part of a cluster of infections epidemiologically associated with a staff member


The patient undergoes debridement with removal of hardware and placement of external fixator; he is responding to iv vancomycin. The patient, his family and doctors have several questions.

  • Does MRSA pose a risk to his family/friends?
  • What are the criteria for discontinuation of contact precautions?
  • What measures can be undertaken to decrease risk of MRSA infection for future surgery?


Generally MRSA does not pose a risk to family/friends
- Low risk of transmission to healthy individuals with intact skin; even if were transmitted, generally would result in colonization rather than infection; so patients can socialize normally with a reminder for good hand hygiene

  • Criteria for discontinuation of contact precautions (can be found on intranet site)

- Negative nares culture x 2 and negative culture of previous positive site with patient off antibiotics
- If re-admitted, should re-institute contact precautions and obtain nares culture x 1; if negative, can stop contact precautions; 
- IF OPEN WOUNDS PRESENT, contact precautions should be continued as risk of persistent colonization is high and screening cultures not fully sensitive

  • For surgery in the near future

- Use vancomycin as peri-operative antibiotic in place of or in addition too standard (cefazolin)
- Some centers use de-colonization regimen pre-operatively:
 - chlorhexidine skin cleansing + mupirocin nasal cream x 5 days

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