MRSA fear and bewilderment

[mario_ragucci]

Now I have a microbiology class under my belt, and I know what bacterias are. What I am asking here is for anyone to mention a few words of their noteworthy experiences of MRSA, VMR, or C-Diff isolations gone wrong.

For example, I've encountered isolation rooms where the PT can have MRSA in their wound, or in their sputum, or C-Diff in their stool. Yes, C-Diff isolation. (I always want to see if it smells different :-)

I'm trying to understand this from a practical standpoint. How can MRSA harm me if I got it on me directly from a PT, or from cross-contamination? What would my normal body do if I somehow, someway, got C-Diff or MRSA in it? Would it be like getting a fever?

When we gown up, I know we are preventing noscomial, and we discard the isolation masks, gown and gloves after each PT contact. Those gown are sometimes hot to work in, and I start to sweat, especially when you have to wear a mask and work as a cna.

I'd love to hear from anyone who has a story, from their own experience, when MRSA or C-Diff spread from an isolated PT, and who was effected. Wouldn't a normal immune.sys take care of this? I am slightly mistified by MRSA, and how if can effect PT's or nurses if it is spread. Thank you, Respectfully, Mario Ragucci

[Motivated, SN]

Flowerchild:

Thanks for responding. I'll be anxious to hear more if you can

find it.

[Glad2behere]

Stevierae,

Sure made a believer out of me, scariest 3 weeks of my life. I still thank God his kidneys and liver held up.

I still remember reading the patho and culture reports.

RESISTANT

RESISTANT

RESISTANT

RESISTANT

Glad2behere

[flowerchild]

While I was out looking for more info, I read that many health care givers are carriers....MRSA is in our noses but since we are healthy and young...it's no problem. If you get swabbed and are + you can not work until you come back clean of MRSA. I've not been swabbed for resistant strains but years ago in microbiology we swabbed each other and I came back as a strep carrier, oh joy. Wonder what happens to us who have + swabs when we get old and comprimised ourselves???

[stevierae]

Originally posted by Glad2behere

No kidding, Glad2behere! Just reading the words as you typed them...Resistant Resistant Resistant... sent chills up my spine and raised the hair on my arms. How frightened you must have been, especially being a nurse, and knowing what Vancomycin can do. They did use Vanco, right?

I remember in nursing school, taking microbiology--I guess we were pretty cavalier about the bacteria we swabbed onto slides in the micro lab, because one of my classmates got Shigellosis. This was years before anybody knew about universal precautions; I am sure we all went home and cooked dinner right after getting out of micro lab.

I remember, too, in the '80s, the entire ICU being infected with Serratia marcescans (sp?) I am certain no one dreamed it was probably spread from patient to patient by poor handwashing between patients--they assumed it was airborne.

Again, I thank God your son made it through unscathed. What a scare for a mom to have to experience. Did they know about drawing blood for troughs and peaks when this happened, as they routinely do now?

I remember in nursing school; working Peds, there were always kids who'd ended up with some degree of deafness due to Gentamicin; they did draw levels in those days, but I guess by the time the high levels showed up, the damage had already occurred, and was irreversible. Or, maybe it was an unavoidable side effect in those days; I don't know.

[fridae13]

Ototoxicity secondary to mycins and Observations on poor infection control

Have some experience with toxicity. In the early 80's. a 24yo diabetic on erythromycin c/o hearing loss. An alert staff nurse thought 'mycin, hearing loss, toxicity?' The research we read told us that immediately stopping the mycin on the first sign of hearing loss would probably make the damage reversable. Indeed. the patient quickly regained her hearing after we dc'd the drug. Happily, this early warning sign saved her from permanent kidney damage.

Remember that old nursing care plan intervention to test hearing before administration of mycins? On what planet is instant audiometry ordered or available? LOL But I never forgot it in 25 yrs. We were doing peaks and troughs in the 80's on the diabetic floor especially when vanco came along.. Renal damage in a diabetic at that time was inevitable over time.and we monitored for it .

On another note. I have been the unhappy observer of inadequate isolation for years and this week I am leaving the LTC facility I work at for many issues including the fact that the "infection control nurse" feels she doesn't need to tell the CNAs when a pt has MRSA in his foley and C-diff in his stool, Oh. she states, the aides are really good with universal precautions there's no need to alarm anybody, Isolation signs are not posted, pt was not moved to a private rm, the aides are very angry. I feel they had the right to know what they were dealing with. The housekeeping was not stepped up. The side rails still appear dirty. Gowns were not provided, no isolation cart. etc etc. They did put a smallsign at the pts door "check with nurse" and feel that hippa laws prevent anyone involved to know about the pt' s infection to protect his privacy. They also don't want the visitors, families and residents from finding out that these problems are present in the facility. It's only a matter of time , in my opinion, until their luck runs out and a resistant infection will rampage through this >330 bed Veteran's home, But I am no longer welcome there cause I ask too many questions. They keep telling me that acute care is different, But the resistant bacteria, I maintain, can be just as deadly regardless of the level of care. I just shudder every day. It's time to go back to acute care for me cause I just can't even begin to make a change at the "Home" and will certainly be fired if I persist!

in reply to:

Again, I thank God your son made it through unscathed. What a scare for a mom to have to experience. Did they know about drawing blood for troughs and peaks when this happened, as they routinely do now?

I remember in nursing school; working Peds, there were always kids who'd ended up with some degree of deafness due to Gentamicin; they did draw levels in those days, but I guess by the time the high levels showed up, the damage had already occurred, and was irreversible. Or, maybe it was an unavoidable side effect in those days; I don't know.

[jgn]

I am one of those nurses that "caught" MRSA. I always use univeral precautions with non-isolated patients and use barrier precautions for isolated patients. Somehow, though, I wound up with a boil/abcess on my flank (of all places??) that cultured positive for MRSA. I encouraged my doctor to culture, due to the high amount of MRSA we have in our hospital (I work in an ICU). I will tell you, though, how I think I got infected. Not every person uses universal precautions/barrier isolation as they should and it is those people who put everyone else at risk. I watch every day as a physician doesn't put on gloves or a gown for that matter, goes into a patient's room, shakes their hand uses their pen to write stuff down, then come out and use our computer. I of course say something to ones that I catch, but I don't see everyone. We also have family members that don't use precautions, don't wash their hands after leaving a patient's room and so on. Even if the patient hasn't cultured positive, the family could bring it into the room and out of the room. This has really brought it home to me the importance of handwashing before and after each patient, even if you just washed leaving another room or if you only touch an IV pump. My doctors never told me I couldn't work. I called off the night my wound was I&D'd, then didn't go back to work until it was no longer draining. I didn't tell my boss because my doctor said there was no reason I couldn't work as long as it wasn't draining, but now I think I will tell my boss and our infection control nurse so I can do some inservices to the healthcare professionals I work with who never thought they could get MRSA. Sorry this was so long. By the way, mine was susceptible to Septra and I haven't had a problem since, but I think I will treat my nares with mupirocin just in case. All you infection control nurses let me know what you think. My doctor said I just as well could have gotten it in the community as I could have in the hospital.

[jgn]

One more question/statement. In my facility we are only told to use barrier isolation with patients that have MRSA in their sputum. I feel we should have to wear masks. Anyone else have experience with this?

[fridae13]

nosocromial infections. let me relate a little story of a time when i noticed that all the foleys on my floor had pseudomonas. not resistant, not terrible but the vector was a NA who used a 24hr urine bottle to empty the foleys. There was not a toilet in every room as it was the oldest part of the hospital. She had devised a means to save steps. This is how easy it is to transmit when your co-workers are more interested in saving time and steps.

[FirstYear2005]

Just be careful, trust me the isolation is good and you don't want it on you! I got mrsa about a year ago and it was a horrible experience. It was painful and left hideous scars on my leg, one which looks like a cigarette burn. All it takes is a tiny cut. I actually got mine from shaving, not from a knick, but just the shaving. it's scary, you don't wanna mess w it ! :)

[Lorie P.]

i work on a very busy med/surg floor and can not name or count the times that i see family members come and go into a pt's room that has mrsa, vre and never never wash their hands. these people even bring small infants into these rooms and we all know how kids put things in there mouths. scary as :flamesonb . so all i can advise is handwashing, handwashing and more handwashing.

to help i keep a container of clorax wipes in my bagg and everynight before i start i wipe down my medcart and telephone. it may not help but hey it makes me feel better by using them.

[zacarias, ASN, RN]

I've had numerous MRSA patients in my short nursing career. (not as many now since I work tele). I follow common sense. If I'm assessing a patient with a MRSA wound, I wear a gown. If I'm just going to turn off a beeping IV, I wear gloves of course but no gown.

I was recently swabbed under the nares (common MRSA colonization spot) and there is no MRSA.