pt with MRSA in sputum ambulating in hallway with no mask

[unsaint77]

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 supervisor about it and she told me if I was concerned I should call the MD to get a proper order.

My question is...

1) Is it really up to an MD whether to confine the pt to the room or have the pt wear a mask in the hallway?

2) Could there possibly be a facility policy that allows this pt to sit with other patients at the same table for meals?

Thanks.

[unsaint77]

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.

[CompleteUnknown]

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.

[Esme12, ASN, BSN, RN]

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

[Esme12, ASN, BSN, RN]

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.

[amoLucia]

Esme - re: your response #15 ... well said and kudos!:yelclap:

[KelRN215, BSN, RN]

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.

[BlueDevil,DNP, DNP, RN]

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.

[Nascar nurse, ASN, RN]

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.

[brainkandy87]

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.

[loriangel14, RN]

I work in a hospital and we don't restrict MRSA + folks from leaving their room. We just ask that they wash their hands.

[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?

[blondy2061h, MSN, RN]

Depends if they were coughing or if I even knew they had MRSA. Do you ever eat at restaurants?