[michelle126]

So the first answer would be to check your facility manuals. I would if I could find it, but that is an other issue.

Question: MRSA of the nares in the LTC setting.
Private room, treat with bacroban in the nares, reculture and if neg then they may get out of isolation? What about entering the room...should staff be masked at all times? Do you let your pts leave with a mask on? What about equiptment?

Question: HIV, Hep everything +, seeping leg wounds and frequent picker with the occasional nose bleed, pt in LTC setting
Private room? What do you do for blood spills/ nose bleeds...protective equiptment...gloves and gown if you expect fluids to touch you? What about equiptment...should be kept in the room and prob shouldn't use the roving cell phone?

Any links you can point me to, the CDC site is overwhelming! I posted here instead of LTC so you all can give me some input.
Thanks!!!

[chadash]

Originally Posted by michelle126

So the first answer would be to check your facility manuals. I would if I could find it, but that is an other issue.

Question: MRSA of the nares in the LTC setting.
Private room, treat with bacroban in the nares, reculture and if neg then they may get out of isolation? What about entering the room...should staff be masked at all times? Do you let your pts leave with a mask on? What about equiptment?

Question: HIV, Hep everything +, seeping leg wounds and frequent picker with the occasional nose bleed, pt in LTC setting
Private room? What do you do for blood spills/ nose bleeds...protective equiptment...gloves and gown if you expect fluids to touch you? What about equiptment...should be kept in the room and prob shouldn't use the roving cell phone?

Any links you can point me to, the CDC site is overwhelming! I posted here instead of LTC so you all can give me some input.
Thanks!!!

Your first question: When MRSA is found in the nares of a pt.
Standard precautions are adequate for pts with a positive swab for MRSA in the nares, unless they also have active infection, or have been indicated as a source for infection of others. Colonized patients are less likely to be a source of spread than those actively infected with MRSA. With an actual infection, contact precautions are necessary. Wear a gown, gloves, and have separate equipment for the patient. I don't know if there is respiratory MRSA if the precautions are droplet or airborne. Possibly that is where the masking comes in.
DO go to the CDC web site and review standard, contact, airborne and droplet precautions.

[chadash]

http://edcp.org/guidelines/mrsa.html
Maybe this will help sort things out. It seems to imply that colonization in other than the nares also requires contact precautions.
The CDC information is worth a good "think through".

[suzanne4]

MRSA of the sputum is not transmitted by droplets or in the air, but by contact. If the patient has the bug in their sputum, then you need to be wearing a ,mask when suctioning the patient, etc.

This patient should be in contact precautions and that requires a gown and gloves when having contact with the patient or their bed.

Patient does not need to wear a mask at any time. And private room is not needed but their roommate needs to have MRSA as well, and have a documented case of it. They do not require private rooms in the hospital provided that the roommate also has the same infection.

Anytime that you can get secretions in your eyes or mouth require you to wear protective coverings of same.

[michelle126]

Thanks for the replies. No coughing or need to suction, just the hospital did a swab and came up postive in the nares..boom, they put in a private room (very rare that we even have one open) It just seems like it is all over the place with what is being done. That is why I'd love to be able to find the facility manual. So...we should be wearing a mask if pt is coughing with or without sputum? If that is the case, then shouldn't they be somewhat isolated to the room?

What is you alls thought on the second senario? Equiptment should be kept in the room since it does have the potential to come into contact with fluids or other items that came into contact with fluids?

[CapeCodMermaid]

MRSA in the nares....yikes. If I or half my staff let someone stick a culturette up our noses, at least 1/2 of us would come back positive. We do bactroban for 10 days...no private room, no mask, no gown. MRSA in the sputum-droplet precautions. MRSA in the wound, contact precautions.
HIV...you probably have people in the building who are positive for HIV but no one knows it. Hence...universal precautions. One of the largest growing populations of HIV positive people is the over 65 set.

[michelle126]

Thanks Capecod....I was lookink for some LTC people to respond!
I've been colonized for years with the MRSA in my nares (swabbed years ago while in micro class in school) And I soooo agree that even more than half of our residents would be too. The hospitals are swabbing the pts now and starting treatment. That is why I was wondering the private room. ( We have soo few private rooms that they are rare to come about)
As far as the 2nd pt. She is mid stage AIDS and like I said..seeping body fluids and drops of blood is common so see when walking in the room. What bothers me is that housekeeping stinks (that is putting it nicely) and they are taking equiptment in and out of that room and reusing it. We really havent seen a increase in HIV in our area...now hep...that is a diferent story!