Long-Term Care Survey Alert

A creative care plan can prevent spread of MRSA and other pathogens.

If a resident with dementia has an MRSA-infected or colonized wound he keeps touching, you don' t have to resort to restraints to keep the person's hands from spreading the microorganism to other parts of his body--or other residents.

Instead, consider these field-tested strategies:

• Dress the wound to get it out of the person's sight and mind--and then cover it with clothing, suggests Cheryl Field, MSN, RN, a consultant with LTCQ Inc. in Lexington, MA.

• Occupy the person with her favorite activities involving the hands during times when she might be bored and thus focus on the wound.

• Ask the ordering clinician to use a dressing that's changed every other day or every three days where the outcome won't be any different if the staff used a different wound dressing requiring multiple daily changes, advises Field.

Assess for Discomfort

If a person continues to touch a wound--and can't tell you why--look to see if the wound dressing may be causing an allergic reaction or irritation. Also use a standardized pain scale, such as the Pain Assessment In Advanced Dementia Scale, appropriate for people with impaired cognition, suggests Sheila Capitosti, RN,C, MHA, MHSA, with LTCQ.

Medicating the resident who has wound pain 30 to 45 minutes before a dressing change can be a good infection-control measure. "The dressing change can aggravate or cause pain that won't diminish for a time after the wound manipulation--and that's when the person may try to touch an infected wound," says Capitosti.

Tip: Provide a diversional activity during wound dressing changes, such as allowing the resident to hold a favorite doll or sing a song with you so he attends to something rather than the wound, suggests Field.