Is it really MRSA?

[nurseprnRN]

I lifted this quote from a closed thread to clarify a point made (which was not related to the reason it was closed).

" First, you don't find "MRSA" in the stomach, well you sort of do in that all enterococci are resistant to the methicillin family, but it's not the same as "MRSA". Everyone is colonized with bacteria, and if some of that bacteria is resistant to methicillin antibiotics then we call it MRSA, but that doesn't mean that someone is oozing MRSA out of every possible place in their body, and it's actually usually localized; in a wound, in the sputum, in skin folds, etc. MRSA infections are treated, simple colonizations or getting some MRSA on you, or even in your eyes, should not be treated with antibiotics."

MRSA stands for "methicillin-resistant Staphylococcus aureus," and not anything else. An enterococcus is not a staphylococcus. We don't call anything that's methicillin-resistant "MRSA." Calling anything that's resistant to methicillin "MRSA" is inaccurate and misleading, and bespeaks an indication to go back to your micro textbook for a refresher. Here's a good article that also clarifies what's infection and what's colonization, and how that works specifically in people with MRSA.

http://www.nfid.org/content-conversion/idarchive/staph.html

Furthermore, recent research indicates that swabbing nares with mupirocin (Bactroban) for every patient in the ICU, without regard to whether cultures were done or not, reduced the number of MRSA infections in the unit as a whole. So yes, prophylaxis is becoming standard in those settings.

[FineAgain]

That sounds much more reasonable. If you had MRSA 10 years ago...and you came to my hospital...you would be put in precautions. I think your way is better!

[KelRN215, BSN, RN]

Out of curiosity...our hospital, once you test positive for MRSA or VRE, you are always considered positive. I know that not all hospitals do this, and I think it might be expensive and redundant. What do you all think? When my Dad was positive for both, the hospital (many states away from mine) policy there was that if you had 3 (weekly I think) negatives, you were considered "clear".

Very interesting also, about the prophylactic treatment. I don't think we are doing that but you can bet I will be asking our Infection Control...

When I worked in the hospital, patients who had tested positive for MRSA in the past had to have three separate negatives from three sites (nares, axilla and groin) on three separate encounters. Outpatient areas never followed through with testing the patients when they came back for their follow-up appointments so pretty much if someone tested positive for MRSA, they were on precautions for that hospitalization and the next three (which could be YEARS apart depending on the patient's diagnosis).

[brillohead, ADN, RN]

One facility I did clinicals in also considered you "once a MRSA, always a MRSA" with full contact precautions. And ANYONE who came from a LTC was automatically put on contact precautions. It was a great big PITA, lemme tell ya!

[FineAgain]

It is a giant PITA! I know that a good many of these "once MRSA always MRSA" patients would test negative...

It is also uncomfortable for the patients, I am sure. I was on the receiving end once (I had meningitis) and let me tell ya how much fun it is to have people practically hand you your trays on the end of a stick through the door.

[Morainey, BSN, RN]

My hospital doesn't do the "contact precautions for life" for people who have had MRSA. We swab people if indicated through a screening process, and if they're positive then they're placed on precautions with a decolonization protocol and then reswabbed after treatment, I think it's 48 hours?

Those places that do "once positive always positive" must go through a heck of a lot of iso gowns!

[FineAgain]

I think my hospital buys iso gowns by the train full. Every car of the train overflowing with them.

[Nurse Kyles, BSN, RN]

At my hospital if a person is MRSA once, they are always on contact precautions until cleared on an outpatient basis. To be cleared in this manner, they must have 3 negative nasal swabs with at least a week between each. The providers are trying to set this up on discharge, but it doesn't seem that many people follow through.

[nurseprnRN, BSN, RN]

Yes, that was bad editing on my part. It initially read "Many people are colonized with staph a, and if some of that bacteria... I then decided I didn't want to give the OP in the other thread the impression that those who are not SA colonized are otherwise sterile, so I changed the first part of that and then neglected to change the second part, my bad.

Although it would seem that the other statement specifically declaring that not all bacteria resistant to methicillin are MRSA would have helped you realize I didn't believe that all bacteria resistant to methicillin are MRSA, it seems like to bent over backwards to ignore that actually.

That's the problem with this sort of forum-- believe it or not, you don't have to bend over backwards to know there really are people who think that anybody with any kind of methicillin-resistant bugs has "MRSA," because they really don't know that "MRSA" isn't shorthand for "any old bugs that are methicillin-resistant, could be anything." They either didn't take micro or forgot the "S. aureus" part of it. :)

Thanks for the clarification. :flwrhrts: