pt with MRSA in sputum ambulating in hallway with no mask - page 2

I am a new grad working at a longterm care TCU. I found one patient with MRSA in sputum walking in the hallway without mask. He even eats at the same table with other patients. I asked the... Read More

  1. Visit  CompleteUnknown profile page
    6
    Quote from unsaint77
    1) Thank you for all your thoughts.

    2) I would not let my elderly mother sit in the same table with that patient just because that pt "might" cough. In fact I would be upset if the facility let the patient walk down the hall without mask on, again, just because the pt "might" cough.

    3) I wish someone would actually tell me any existing protocol regarding pt with MRSA in sputum.
    Not sure what you're after.... what does your own facility policy say about this situation?

    I honestly think you're worrying too much about this -your elderly mother is more at risk from the resident who is coming down with a cold and sneezes all through lunch than the one with MRSA in his sputum, unless there are special circumstances (eg the patient with MRSA spits onto the table and it doesn't get cleaned up or something).

    None the current guidelines that I've seen say the resident should wear a mask in the hallway or not be allowed to to go the dining room (unless there are reasons such as a productive cough with spitting).

    With the possible exception of some the 'epidemic' community-acquired strains, don't forget that MRSA is not more virulent or dangerous than 'normal' staph, it's just resistant to many antibiotics and so it's hard to treat. That's not good if you're in ICU and have surgical wounds and tubes and lines that are likely to become infected, it's a different matter when you're talking about a resident in a nursing home. This isn't saying it's something to be complacent about, but over-reaction is just as bad.
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  3. Visit  Esme12 profile page
    0
    Quote from unsaint77
    1) thank you for all your thoughts.

    2) i would not let my elderly mother sit in the same table with that patient just because that pt "might" cough. in fact i would be upset if the facility let the patient walk down the hall without mask on, again, just because the pt "might" cough.

    3) i wish someone would actually tell me any existing protocol regarding pt with mrsa in sputum.
    check you policies at your facility. but i did give you the cdc recommendations. go to their web site......my respone #7 of this thread.

    the cdc provides information about health care-associated infections. i have provided you links.
    cdc - long-term care settings - hai
    cdc - prevention tools - hai
  4. Visit  Esme12 profile page
    24
    Quote from saint 77
    The following is from an article from MRSA Topic MRSA

    "Furthermore, asymptomatic (ie. non-infected) MRSA carriers can easily pass this bacteria on to others through direct contact or even just by living in the same environment. This is especially scary because while your immune system may do just fine dealing with 1,000,000 MRSA bacteria per square inch in your nose, your 80-year old grandmother, 6-month old infant, or cancer-fighting spouse may not be so lucky. This is exactly the reason why initiatives are popping up all over aiming to have all patients screened for MRSA prior to admittance into hospitals. There are simply too many immunocompromised patients, too much movement, and too great a risk within those walls to allow free passage of bacteria living silently on unaware carriers."


    There are many immunocompromised patients in nursing homes. Do you not mind getting the bug from someone who has MRSA colonized, just because the pt is not having an active infection? I don't think so.
    The reason patients are being tested/screened prior to admission is to document the pre-existence of MRSA so that if the patient gets MRSA the hospitals reimbursement isn't penalized. There ARE different requirements/recommendations for long term care versus acute care. But think about it..... do you wear a mask for CONTACT precautions?

    This is this man's HOME even if he is in a "facility". He isn't a leper and isn't highly contagious in a communicable way. He needs to be treated humanely and respectfully. Those other residents are at more risk from the staff and visitors bringing in flu and other viral illnesses that this man walking with "known" MRSA in his sputum. We all have staph just some of it is more difficult to get rid of than others.

    "Next time, I am going to escort the patient back to the room and have him eat meals in the room. If my supervisor gives me hard time, she just going to have to write me up".

    Making a patient go back to and stay in their room, without an order and just cause, is a form of restraint and can be considered assaultive. That, can get you fired and put your license in jeopardy.

    I applaud your dedication and enthusiasm but......I would choose
    your battles wisely.
    grownuprosie, nu rn, michelle126, and 21 others like this.
  5. Visit  amoLucia profile page
    1
    Esme - re: your response #15 ... well said and kudos!
    loriangel14 likes this.
  6. Visit  KelRN215 profile page
    2
    Ditto what Esme said. I have never once worn a mask around a patient with MRSA in the nares nor have I had a patient with MRSA wear a mask to leave the room. MRSA does not require droplet precautions.
    grownuprosie and loriangel14 like this.
  7. Visit  BlueDevil,DNP profile page
    6
    I don't understand the big deal here. Half the staff probably has it. Half the people at the market, and the kid scooping my popcorn while wiping his nose at the movies. Why does everyone freak out about MRSA? It's everywhere. Meh.
    rngolfer53, grownuprosie, KelRN215, and 3 others like this.
  8. Visit  Nascar nurse profile page
    3
    Quote from bluedevil,dnp
    i don't understand the big deal here. half the staff probably has it. half the people at the market, and the kid scooping my popcorn while wiping his nose at the movies. why does everyone freak out about mrsa? it's everywhere. meh.
    op - this is my exact sentiments. if you have been in nursing any length of time you would probably test positive for mrsa of the nares.

    otoh - c diff is starting to scare me. will we all die someday pooping our brains out? but, even with this - it is just as likely to be picked up in the community and you'll never know when the exposure occurred.
    WeepingAngel, loriangel14, and Altra like this.
  9. Visit  brainkandy87 profile page
    3
    IMO, you are exposed to MRSA as soon as you walk into a hospital. I have no doubt that 90% of nurses at any given hospital would have a positive nasal swab for it. Just touching the front door of the ER exposes you to a ridiculous amount of nastiness.
    canoehead, KelRN215, and loriangel14 like this.
  10. Visit  loriangel14 profile page
    0
    I work in a hospital and we don't restrict MRSA + folks from leaving their room. We just ask that they wash their hands.
  11. Visit  unsaint77 profile page
    0
    So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?
  12. Visit  blondy2061h profile page
    11
    Depends if they were coughing or if I even knew they had MRSA. Do you ever eat at restaurants?
    Anna Flaxis, grownuprosie, KelRN215, and 8 others like this.
  13. Visit  kids profile page
    4
    Quote from unsaint77
    So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?
    Yes, I would and have, I even *gasp* lived with someone with MRSA in their sputum and slept in the same bed. As long as the person is not coughing uncovered and is washing their hands there is no risk to people around them.

    There are people walking around everywhere with MRSA, your coworkers, your children's schoolmates and likely even your doctor.
    zofran, loriangel14, Altra, and 1 other like this.
  14. Visit  rn/writer profile page
    12
    Quote from unsaint77
    So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?
    Yes. As long as there is no active coughing, or he is good about covering a cough.

    While I applaud your zeal and enthusiasm, I'm a little bothered by the fact that I haven't seen any mention of regard for this resident as a man. HE is not MRSA. HE is a person and you are coming into his home. Isolating him and treating him as if he is some kind of menace for carrying an organism that a good portion of the population harbors seems to exceed diligence and cross the line into disgust.

    Look at what the CDC has to say. Read the policy and procedure for your facility. Speak with someone from infection control. But never lose sight of the fact that this is a human being you are talking about.

    If he needs reminders about covering a cough or washing his hands, please, learn how to do this without being insulting or giving him the impression that you think he's unfit to have contact with other people.

    When HIV and AIDS were new and beyond scary, some folks thought that infected patients--including babies and children--should be treated like lepers and made to live in separate colonies. Thank goodness, the panic and hysteria eventually died down and wiser heads prevailed. Unfortunately, a lot of hearts were broken on the way to universal precautions.

    I hope you can find a way to temper your vigilance with wisdom and respect.
    grownuprosie, zofran, loriangel14, and 9 others like this.


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