MRSA of the nares

[Pneumothorax, BSN, RN]

Whyyyyyyyyyy do they insist on isolating patients for MRSA of the nares if we all carry it? I under stand isolation for MRSA of a wound , but nares?!? C'mon now.

Can anyone clarify?

[Double-Helix, BSN, RN]

MRSA colonization can still be transmitted from patient to patient. Or from hospital worker to patient. You and I, and many patients colonized with MRSA have healthy immune systems (or did when they contracted it) and have no symptoms. But take that colonized MRSA bacteria and drop it in an immunocompromised patient, or one with an open wound and you're going to have a problem.

And we don't all carry it. Yet.

[Pneumothorax, BSN, RN]

MRSA colonization can still be transmitted from patient to patient. Or from hospital worker to patient. You and I, and many patients colonized with MRSA have healthy immune systems (or did when they contracted it) and have no symptoms. But take that colonized MRSA bacteria and drop it in an immunocompromised patient, or one with an open wound and you're going to have a problem.

And we don't all carry it. Yet.

Oh ok, this makes sense. However we have to wear gown/gloves. Shouldn't we wear mask too?

We don't all have it? I mean pts only know bc they jam those qtip swabs in their nose, they were fine before they came in for the elective knee sx or whatnot.

Perhaps it's a cya thing, like if they ID on admit, then it won't be considered nosocomial

[Double-Helix, BSN, RN]

MRSA is spread by contact. It doesn't float around in the air like illnesses requiring droplet precautions. It has to live in the host or survives on surfaces for a short period. I supposed if someone sneezed in your face...

Several members of my unit's staff have been admitted to the hospital for various reasons in the past 6 months or so. I visited almost all of them. None were MRSA positive (and our hospital tests everyone on admission). Some of us probably are, but not everyone. That's one of the reasons we test our patients. So we don't take it home too.

Yes, insurance definitely plays a role in MRSA testing. If the patient isn't tested on admission but later tests positive from some other location, the infection would be considered nosocomial. But if they are positive in the nares, the hospital could claim it was an already present infection.

[Esme12, ASN, BSN, RN]

Oh ok, this makes sense. However we have to wear gown/gloves. Shouldn't we wear mask too?

We don't all have it? I mean pts only know bc they jam those q tip swabs in their nose, they were fine before they came in for the elective knee sx or whatnot.

Perhaps it's a cya thing, like if they ID on admit, then it won't be considered nosocomial

What ashley says is correct and with the new reimbursement regulations that hospital acquired infections will not be reimbursed they are proving it was present before admission. I have a question.....are they treating it pre-op with bactroban nasally?

[Rose_Queen, BSN, MSN, RN]

What ashley says is correct and with the new reimbursement regulations that hospital acquired infections will not be reimbursed they are proving it was present before admission. I have a question.....are they treating it pre-op with bactroban nasally?

Our heart patients get 10 doses of bactroban whether they test positive or not. Those coming in from home don't even get swabbed until either the day before admission or the day of admission. We only swab critical care patients and patients who come from a nursing home, so not sure that all of our other surgical patients get swabbed or treated.

I don't really get the way some hospitals work. You swab, but the patient isn't placed in isolation until the result: negative swab comes back. When I was in nursing school, I had a patient I took care of for the first half of clinical, not in isolation even though he was being tested (which wasn't passed on to me or in the chart that I had limited access to- we weren't allowed access to certain parts). Went to lunch, and when I came back, the patient was in isolation for VRE. Now, no one had been wearing gowns previously, so how did we know that we weren't already carrying VRE on our scrubs and potentially passing it on to other patients? That makes absolutely no sense to me.

[Pneumothorax, BSN, RN]

Our heart patients get 10 doses of bactroban whether they test positive or not. Those coming in from home don't even get swabbed until either the day before admission or the day of admission. We only swab critical care patients and patients who come from a nursing home, so not sure that all of our other surgical patients get swabbed or treated.

I don't really get the way some hospitals work. You swab, but the patient isn't placed in isolation until the result: negative swab comes back. When I was in nursing school, I had a patient I took care of for the first half of clinical, not in isolation even though he was being tested (which wasn't passed on to me or in the chart that I had limited access to- we weren't allowed access to certain parts). Went to lunch, and when I came back, the patient was in isolation for VRE. Now, no one had been wearing gowns previously, so how did we know that we weren't already carrying VRE on our scrubs and potentially passing it on to other patients? That makes absolutely no sense to me.

That's what I'm sayin. Lol

Like droplet isolation I totally get, but really we should all be washing our hands/wearing gloves... A gown isn't gonna do much, in my opinion but I may be over looking something

[Music in My Heart]

I can't quickly lay my fingers of the details and references but during a nursing-school project on universal screening, we found data which showed that MRSA colonized patients are some 40% more likely to develop post-op infections than non-colonized people and that cohorting can dramatically reduce the rates of post-op infections in non-colonized patients.

Additionally, knowledge of colonization status can provide the opportunity to more aggressively prevent the post-op infections. For example, alcohol gel on the patient's table with instruction for liberal and regular use - especially after they sneeze, cough, or face touch.

[guest042302019, BSN, RN]

Could just isolate everyone until MRSA or VRE screening gets back. If patients are being screened for those anyway, why not isolate then wait for results. Isolation will save the finger pointing of "well, maybe those nares have it. Oh, nope, those nares look okay. But, those definitely have it!" See what I mean. I'm not sure if every hospital is screening. Is that going to a national standard? Every hospital is going to that? I say isolate everyone. Full CDC attire! Like we're going into a hot zone of ebola virus! Just playing!

[Sun0408, ASN, RN]

We test every pt that comes into our ICU. If they are positive or are positive pre-op, we do nothing. We did a year study for the CDC. All positive pt received a MRSA baths times 5 days and tx with bactroban in the nairs for 5 days but I have no clue what the results were. Did they retest the pts to see if they are now negative...I don't know. If not, I really don't see the point of the study.

[mcwillinghamRN]

in reading a lot of research and policies, MRSA of the nares is CONTACT precautions (ie, gloves and washing hands). What is the rationale then for families who live with this to have go gown when the patient is in the hospital. If you test positive for MRSA in the nares, our hospital is requiring us to place that patient on isolation for all hospital admissions for a year; and requiring the family to dress out. what are other hospitals doing regarding isolation for a positive MRSA of the nares that was treated already for 10 days?

[NicuGal, MSN, RN]

We have them gown and glove because they are coming in contact with the patients area/room/surfaces. Yes, you can carry it on your clothes, arms, any exposed part. It is a surface /contact pathogen. Also when you have to don that gown you tend to be more conscientious about being careful. You are trying to keep it from traveling from place to place.

We swab all kids on admission. If they are positive, they are isolated until they are discharged. Those poor kids don't know life without the crinkle of the ISO gown or the touch of an ungloved hand