MRSA again- Are You Kidding Me???

[WannaBeNrse]

Hi,

I posted recently about mrsa and lack of infection control in LTC, but it gets even better, and I really don't know what to do.

Last night, I cared for a resident (hs cares). After I left the room, I saw the sign on the door: Contact Precautions. I had not seen the sign before because the door was open, and there was no PPE outside the door. So anyway, I talked to the RN and asked her why contact precautions. She told me that resident has MRSA in her sputum. So I asked her, shouldn't she be on droplet precautions then? The RN said No, because she really hasn't been coughing all that much lately. EXCUSE ME??? So I just hope and pray that she won't have a coughing fit while I am doing her cares?? But okay, I guess I am not the one doing the care plan, so I asked the RN if she could at least show me where the gowns for contact precautions are, as there were none outside this resident's door. And her advice was, well, if you're concernded, you can just wear a resident night gown over your uniform. EXCUSE ME AGAIN???

I really don't know what to do here. I have to care for this resident for the rest of the weekend, and she is a nice lady, I don't want to give her any less attention. But I do not feel safe.

This facility is expecting state surveyors any day now. Tell me if I am wrong, but there is no way that these practices are in accordance with state and cdc regulations, are they....?

[achot chavi]

with all due respect- I treat every wound, urine and feces with Universal Precautions, safer that way, and if a pt is coughing, move back- 3 feet or more, there is more MRSA than we know, why take chances and for goodness sakes, dont wear your dirty uniform home- change to street clothes and bring your uniform in a bag- wash appropriately- you dont want to share the germs with your busmates and family.

[Mammy1111]

well the pt's MRSA could be colonized ( not infectous anymore and you have to meet critera for this). which means the pt does meet the critera not to be in droplet precaution the hospital i use to work in had critera to take the pt out of droplet. the droplet includes.... 1. no fever for 24 hours 2. not coughing 3. on antibotics such as iv vancomycin for 24 hours. i always took people out of droplet when they were able to reach this critera. they are not infectous so why keep them in isolation...?? so the RN did the right thing if the critera of the hospital was followed. remember.. just because you hear the word MRSA does not always mean infectious. but if you feel safer wearing a mask then do so.

Do not make the mistake of thinking a MRSA colonized patient is not contageous. They are indeed contageous, and are considered reservoirs of MRSA. Most Hospitals and LTCs don't bother to screen for colonization in non symptomatic patients and that is probably a big reason there is so much MRSA in all facilities. CDC doesn not have a recommendation about when to stop Contact/droplet precautions. Why are you writing one? Better safe than sorry if you believe your patient is colonized.

Any coughing patient with respiratory MRSA infection or colonization should have contact precautions and mask. If you are doing anything that involves contact with the patient and or his immediate environment, handwashing, gloves, gown and mask.

To protect yourself, just do it. Is it against the rules to protect yourself in your LTC?