VRE patient's on same unit with immunocompromised pt's??

  1. VRE is new to me, as I can never recall us having a patient with it. We received a patient from another hospital, with VRE. On the same unit, we have a hiv+ child who is being cared for by the same nurse. This concerns me terribly, but I've been "blown-off" by my coworkers and by infection control nurse. It just seems highly risky to me to have the same nurse caring for both these patients..this would seem to be a death-wish for the hiv pt if cross-contamination should occur.

    We ARE using strict-strict contact isol with the VRE pt, but from the info I've read on the internet, this stuff is mean.

    What is the policy at other institutions?
    Thanks!
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  2. 20 Comments

  3. by   MishlB
    Hmmm...I think I agree with you! By the way...LOVE the avatar!!!!!!!!!!!
  4. by   majrn
    I work on an adult unit, med/onc, and we too encounter vre,mrsa,pts mixed in with immunocomp pts and neutropenic pts. It is an unwritten practice on our unit that those who have the neutro pts dont care for the contact iso pts to avoid cross contamination problems and worries. I think it is a good practice. It sucks for those with the contact iso pts because they generally get the raw end of the deal but such is the nature of the beast.
  5. by   emily_mom
    The new unit I'm working on has Med Tele, Oncology, and a wing for VRE and MRSA patients. They are put at opposite ends of the floor, but I kind of thought the same thing you did. If you work in one wing, you don't cross over, and there are different nurses' stations.

    Kristy
  6. by   hapeewendy
    I agree VRE is nasty stuff
    we had an outbreak of it on our unit last year (med-surg,GI ,respiratory unit) , and fine I understand the isolation deal ,and I always adhere to it strictly but I dont think the same person should be caring for immunosupressed patients as well as isolation patients
    I spoke with our infection control about the patient assignment I had last week and was also brushed off
    my assignment was as follows
    8 pts
    3 isolations - 1 TB, 1 MRSA and 1 MRSA and VRE
    2 patients ,each placed in the next room to the TB guy, getting chemo for CA
    1 r/o meningitis /encephalitis - initially not placed in a private room (I mean come on , common knowledge ppl! dayum)
    so anyway besides the obvious heavy'ness of this team, I found it problematic to have immunosuppressed patients so close to a patient with active tb and even mrsa and vre for that matter... I know the routes of transmission and the infection control nurse didnt tell me anything I didnt already know ,but still, ahhhh maybe I'm just overly cautious..
  7. by   NicuGal
    We isolate our VRE kids when we have them. If we are really in a bind, we take them with the bigger, fulltermers, but never ever a really sick kid or tiny preemie.

    If I had that assignment I would have to say, uh, need to change a patient people!
  8. by   RNforLongTime
    At my facility, we place our VRE pt's on wha we call MDRO precautions which means that we must glove AND gown before entering the pt's room! It's not uncommon for one RN to have a MRSA pt and a VRE pt. I think it's ridiculous to give one RN two isolation pt's, but that's how it goes sometimes.
  9. by   K O'Malley
    Don't forget that you have lab personnel, respiratory therapy, doctors, and all kinds of other health care workers going from pt to pt who could also be a source of spreading infection.
  10. by   renerian
    As a former hem/onc RN we never did them even on the unit let alone with the same RN........asking for trouble. I would not want to be the patient with the bottomed out white count......could kill them........JMHO

    renerian
  11. by   altomga
    I work on a medical intermediate unit... vents, gi bleeds, ards, TB, renal, etc..anyway, we have PODS with 4 patients to 1 nurse and it is not uncommon to have all 4 patients on contacat isolation and/or droplet b/c of mrsa in the sputum. also at times we even have to take Bone Marrow Transplant overflow (the pt may be in with CA and getting Chemo, etc..not actually tranplanted), but I have never liked it. I feel like I am doing and unjustice to this pt fighting cancer! Besides that the Hem/Onc docs protocols blow my mind b/c I do not normally see them. At our hospital though we have a protocol that any pt from a nursing home, outside facility, dialysis pt on any kind, or if home health was coming to their home get's cultured for MRSA and VRE and placed on isolation until their screens come back negative. Then every tuesday we have what we called weekly sweeps. Every pt that has been in the hospital >4 days and on Antibiotics gets screened. They are not put on isolation though unless it comes back positive. It is our way of attempting to decrease the transmission of these between pt's until we are sure they don't have it. The screening process is one reason we have so many isolation patients though.
    It has helped some; a lot of our screens have come back positive. This pt gets treated for MRSA/VRE when otherwis they might have never been tested!
  12. by   Wannabe RN Kim
    What does VRE and MRSA stand for?
  13. by   researchrabbit
    Sounds like a nightmare waiting to happen...
  14. by   megmermaid
    VRE:
    Vancomycin resistant enterococcus

    MRSA:
    Methicillan resistant staph aureus

    Both are antibiotic resistant microbes...scary stuff

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