Management of Skin and Soft Tissue Infections in a County Correctional Center: A Quality Improvement Project

Mullen, Lisa A.

Saturday, 16 November 2013

Lisa A. Mullen, MSN, APRN, FNP-BC
Correct Care Solutions Medical Department, Douglas County Correctional Center, Omaha, NE

Learning Objective 1: The learner will be able to identify best practices for screening and preventing MRSA SSTIs in clinical and community settings.

Learning Objective 2: The learner will be able to define measures that will promote sustainability of a newly implemented policy based on best practices.

Nearly 11,406 people died from methicillin-resistant Staphylococcus aureus (MRSA) infection in the U.S. in 2005. The number of antibiotic resistant infections has continued to grow since the onset of antibiotic resistance dating back to the 1950’s. Additionally, since 1980 the rate of incarceration in the U.S. has increased by 300%. Individuals who enter prison have an increased risk for MRSA infection and colonization and the risk for MRSA infection is proportional to the length of stay. The increased incidence of Skin and Soft Tissue Infections (SSTIs) due to MRSA in correctional facilities in the past several years has caused concern for correctional staff and the communities the inmates return to upon release. Correctional institutions have a vested interest in improving the screening and treatment of MRSA SSTIs as it is a costly and potentially preventable problem.

The purpose of this Quality Improvement project was to examine the current incidence rate of MRSA SSTIs among inmates of the Douglas County Department of Corrections (DCDC) and develop a formal, facility-specific policy for the screening and treatment of MRSA SSTIs based on current best clinical practices and existing guidelines. The sample for the project included current and former inmates of the DCDC who were prescribed Clindamycin and/or Trimethoprim-Sulfamethoxazole on the same date between March and December 2012. Ninety days after the institution of the policy an outcome study was conducted to determine the effectiveness of the newly implemented measures including the rates of resolution of suspected MRSA SSTIs and infection recurrence. A continuous process outcome monitoring program was also instituted to promote sustainability as well as ensure that the most recent guidelines were being implemented. Future research is needed to examine the effectiveness of uniform guidelines and sustainable policies in all correctional facilities.

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