Practice Doesn’t Always Make Perfect

  The hospital’s infection control committee (ICC) had determined that our wound center served as a “ground zero” for an outbreak of a relatively new problem — methicillin-resistant Staphylococcus aureus (MRSA). It was the mid-1990s and the ICC had just finished investigating a high percentage of wound center patients who had received the diagnosis. When we were visited by ICC members as part of their review, I was reminded of the story related to the 1854 cholera outbreak caused by contaminated public water in London’s once squalid Soho District. According to reports, physician John Snow disclosed the source of the outbreak, which killed hundreds of people, as a public water pump on Broad Street. (Remember that this was even before the “germ theory” was proven.) Snow stopped the deaths in London by removing the handle to the water pump so no one could use it.   I was a bit worried the ICC had a similar fix in mind for the wound center when it cultured every piece of equipment as well as the nares of every wound center employee and physician. In the meantime, I asserted that all the patients living with a MRSA infection had been discharged from our hospital with that diagnosis and were referred to the wound center for their outpatient follow up. After some weeks of head scratching (and negative cultures), the ICC came to the conclusion that the wound center was following a lot of patients who had become colonized with MRSA during their inpatient stay. (It wasn’t long before we began to see MRSA infections that were “community acquired.”) When we first began to treat MRSA patients, the hospital insisted we don gowns and masks and perform a “terminal clean” of the exam room. As the percentage of patients with this diagnosis grew, those practices were unsustainable. Eventually, we treated patients with MRSA using the same “universal precautions” we employed with every patient. Just what is the best practice for managing MRSA patients (or the possibility of them) in the outpatient wound clinic, and how much of a concern should MRSA be for wound care providers? There may not be one single answer to these questions, but authors Julia Ernst and Joe Darrah will share some thoughts that experts have shared with them in this issue.

Practice Doesn’t Always Make Perfect

  Many standards for “best practices” have changed over the years. A few years ago, one of my patients who had undergone a below-the-knee amputation crafted his own prosthetic out of poly(vinyl chloride), aka PVC pipe after he had been unable to obtain one from his insurer. Fellow TWC board member Harriet Jones, MD, BSN, FAPWCA, also provides in this issue of the journal considerations for best practices in prosthetics. With this month’s TWC we are also excited to introduce the new column, “Preparing for ICD-10-CM,” written by Donna J. Cartwright, MPA, RHIA, CCS, RAC, FAHIMA, another fellow board member. Implementation of ICD-10-CM is just a year away, and TWC is doing what it can to prepare readers with this exclusive content. When you think about it, TWC might be the most vital piece of equipment in your wound center