Contact precation and Isolation question

[MomRN0913]

When is it OK to DC contact precations? If a patient was cultured a few weeks positive in another facility and the cultures were positive, were treated with antibiotics for a length of time, then transferred to another facility, is OK after treatment to DC contact isolation and cohort patients? It's hard to place a patient int he LTACH I manage in a semi private room because at one point or another they almost all had an active organism. Some aren't actually ordered contact precations, we just see it from another facility and automatically isolate them. Is that necessary?

What if organisms are contained, like VRE in urine, but patient has a foley? I am going ot have a meeting with the head ID Dr, but I was just wondering what your facility might do. Thanks!

[SolaireSolstice, BSN, RN]

Our facility considers anyone w/ a previous positive to *be* positive until 3 seperate cultures come up negative, without a positive between.

[MomRN0913]

my next questions is, can a clean patient be roomed with a patient who is contact precation and actively being treated and organism is contained (i.e., foley for urine)? Contact precations should always be mantained and no sharing of bathrooms or supplies. Can it be done?

[rkitty198, BSN, RN]

Not in the facility that I work in.

[shhhh]

To be clear here on one issue you've mentioned twice already: Just because you have a foley placed in a VRE in urine or MRSA in urine patient, it doesn't mean that the foley is going to stop the possibility of cross-contamination in that shared room. Isolation precautions are just that: it's isolation of one patient from every other patient on the floor so those "clean" patients don't catch the bug.

[mpccrn, BSN, RN]

The Infectious disease nurse at our facility just informed us she is really no longer even trying to get patients previously flagged as positive for MRSA worked up to see if they are still positive. There is a ridiculous itinerary that must be met to finally declare a patient negative....3 negatives in a row, none of which can be obtained while on antibiotics etc etc etc. Since nursing homes do not isolate their MRSA patients, if a resident doesn't have it going in, they will eventually be exposed and will result in their now being positive so why bother......once positive, always positive and isolation is required.

[GM2RN]

Policies will vary from one facility to another. You need to check the policy where you work.

For instance, one hospital where I work no longer isolates for a r/o c-diff unless and until a stool sample comes back positive. The other hospital I work at goes to the opposite extreme and isolates every patient for a history of c-diff, MRSA, VRE, etc., even if they are not currently positive.