Consider the following scenario: Patient is finally discharged from the hospital status post open partial ray amputation of the foot managed with a Wound Vac. Culture-specific antibiotic therapy has been instituted. MRSA Screen is negative. The wound dressing is either changed by our clinic staff, wound care clinic, or home health nursing staff. Several weeks later there is stagnant wound contracture, increased clear drainage, and wound margin masceration. A wound culture reveals MRSA. I often questioned methods of substerile technique observing staff and even physicians' gloved hands in the wound then touching the handle of the supply cabinet or using dressings that are resting on a countertop. Patients have also reported home healthcare nurses placing Wound Vac foam and dressing components on the barefloor prior to application to the wound. We have periodic skill assessments of our staff monitoring sterile and substerile technique which has seemed to reduce incidence of secondary infections. I would be interested to hear everyones thoughts and experiences.