Management of Furuncles in Skilled Nursing Facilities

Initial Assessment and Treatment

The Infectious Diseases Society of America recommends applying warm, moist compresses several times daily to promote spontaneous drainage of small furuncles, then covering the area with a dry sterile dressing once drainage occurs 1, 2
For large furuncles, the Infectious Diseases Society of America recommends performing incision and drainage as the cornerstone of treatment, thoroughly evacuating pus and probing the cavity to break up any loculations 1, 3, 2
The conservative approach for small furuncles achieves cure rates of 85-90% without antibiotics 2

Systemic antibiotics are not routinely needed after adequate drainage unless specific complications are present, such as fever, extensive surrounding cellulitis, multiple lesions, or immunocompromising conditions 1, 2, 4
The Infectious Diseases Society of America recommends choosing agents active against Staphylococcus aureus with consideration for MRSA coverage, such as trimethoprim-sulfamethoxazole, doxycycline, or clindamycin 2, 4

Skilled nursing facilities require heightened infection control due to close living quarters and potential for outbreaks, including bathing with chlorhexidine antibacterial soap, thorough laundering of clothing and linens, and separate use of towels and washcloths 1, 3
The Centers for Disease Control and Prevention recommends screening and treating colonized residents to eradicate staphylococcal carriage 1, 3

For residents with repeated episodes, a comprehensive decolonization strategy should be implemented, including intranasal mupirocin 2% ointment, daily chlorhexidine body washes, and daily decontamination of personal items 2, 3, 1
Culture recurrent lesions early to identify the causative organism and evaluate household contacts and other residents for S. aureus colonization 2