Preventing The Spread Of Infection
Dr. Lipsky: I’m interested in your thoughts on what we do when we know that a patient is colonized with MRSA, either in a wound or in the anterior nares. Dr. Lavery, if that patient is making a visit to your clinic, how do you handle this person who is chronically colonized with MRSA? Do you have some kind of isolation procedures? Do you take special precautions?
Dr. Lavery: I think this is really a new thought process. In my institution, it’s a relatively new disease process or disease focus. Down the road, it seems that empirically, enhanced precautions such as isolation may be a logical approach, especially with such a high incidence of infection in this group. However, I think it’s something that probably needs to be discussed institution by institution with infectious disease colleagues before deciding on an appropriate systematic approach.
Dr. Armstrong: I just don’t think widespread isolation procedures are happening right now in the United States. I certainly don’t think there are that many patients who are being swabbed for potential colonization for epidemiologically significant organisms. When we have a patient who has a previous history of diabetic foot infection with MRSA, it might raise some interesting questions, but I’m not certain that this is going on in any widespread sense in the U.S. at present.
Dr. Lipsky: Dr. Armstrong, you have traveled all over the world and visited diabetic foot clinics in most of the cities that you travel to. Don’t you see in Europe, for example, that they are isolating or at least separating these patients?
Dr. Armstrong: Yes, indeed. In fact, at the clinic that I attend very frequently in Manchester, England, there have been what I would consider to be heroic measures taken to identify and isolate outpatients being treated for wounds with histories of MRSA.
Dr. Lipsky: I can tell you that from my time in the U.K. in Oxford no patient can be admitted to the bone infection unit without first having had screening cultures for MRSA. The patients are kept in a holding area, either off-site or in a nursing home, until the cultures come back negative. Then the patients can be admitted into the hospital.