Which client is most at risk for hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA)? A)15-year-old student athlete in the emergency department with a fractured femur B)46-year-old with a large abdominal incision and 2 peripheral IV lines C)72-year-old who received a permanent pacemaker 24 hours ago D)80-year-old with chronic obstructive pulmonary disease (COPD) who is on a ventilator

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Clients at highest risk for hospital-acquired MRSA are older adults and those with suppressed immunity, long history of antibiotic use, or invasive tubes or lines (hemodialysis clients). Clients in the intensive care unit (ICU) are especially at risk for MRSA. The 80-year-old client with COPD in the ICU on the ventilator has several of these risk factors. COPD is a chronic illness that can affect the immune system, and clients experience exacerbations that may require frequent antibiotic and corticosteroid use. This client is elderly and also has an invasive tube from the ventilator. (Option A) A student athlete could be colonized with MRSA from time spent in locker rooms and around athletic equipment. MRSA more often appears as skin infections in this age group. Unless this client has an open fracture, there is no break in skin integrity. (Option B) This client does have an incision (portal of entry) and invasive lines but is younger and has no evidence of suppressed immunity. (Option C) This client is older and does have a small surgical incision but is not as high risk as the client with COPD. All clients undergoing pacemaker placement will receive a prophylactic antibiotic to prevent surgical site infection just before surgery. Educational objective: Clients at highest risk for developing hospital-acquired MRSA are older adults and those with suppressed immunity, long history of antibiotic use, invasive tubes or lines, or in the ICU. Nurses should follow infection control procedures diligently with these clients.

Which Client Is most at Risk for Hospital-Acquired Methicillin-Resistant Staphylococcus