mask for MRSA? - page 2

by Flynurse 15,506 Views | 24 Comments

In our facility we have been coming up with many cases of MRSA. Most of them sputum cases. I have been looking all over in my books and on the internet, but I can't find my answer. Should we be using droplet precautions for... Read More


  1. 0
    Wow, its interesting to see what others are doing in other states.

    MRSA - requires contact isolation.
    If the location is sputum YES YES YES you need a mask, gown, gloves.

    If it is in a wound you only need a mask when working with the wound.

    If it is in the urine you need a mask when working with the foley if they have one.

    If they are colonized they are still required to be in contact isolation until they have 3 totally negative cultures.

    It takes 3 negative sputum cultures to take them out of isolation. These cultures must be done after all antibiotics are completed. They also must be done 24 hours apart.

    Drop me an email if you have more questions.

    Cali
  2. 0
    We don't isolate any MRSA patients unless they have a non-containable draining wound or are unable to maintain proper hygeine with secretions. I've adopted this stance because of the huge number of cultures that are positive for MRSA I've seen coming out of the community - usually these are patients with no recent or relevent history of hospitalization at our facility (one does wonder where else they may have been). Also, when I track down the wound site it is usually a wound incurred at home by the patient and taken care of initially there - they generally come to the hospital or ED or UrgiCare when this wound becomes infected. SOOOO, I pretty much figure that every patient in the community has the potential to be colonized with MRSA and since it is impossible for us to isolate every patient (we don't have but two private rooms) and the culturing of every admit is just not cost effective, if employees are utilizing Standard Precautions and hand washing as they should, we should be taking proper care of those patients who are colonized but not diagnosed! We must be doing something right - in the last 10 years I can count on one hand the numbers of nosocomial MRSA I've see and still have fingers left over! Also, everyone of those were highly compromised patients, who were hospitalized for a long time and on numerous antibiotics - I don't think it is so much a case as "our giving it to them" as our "causing" the stap aureus to develop selective resistance because they have been on so many different antibiotics.
  3. 0
    They have cultures done upon entering our facility and then get a chlorhexadine bath. The cultures have to come back negative three times at 48 hours before the precautions can be discontinued. We were told by our infection control nurse that we did not have to mask if the patient is not coughing. Always mask however until you determine that. :Wavey:
  4. 0
    ADDITIONAL NOTE: the patients that are cultured are ALL nursing home residents!! Sorry forgot to add that little detail
  5. 0
    I wanna work in a place that doesn't isolate these people. I think isolation precautions are cruel and defintely a big hassle for the staff.

    Anybody who has been in a hospital outside of the province during the last year gets swabbed. Also people who have traveled to certain areas of the world. MRSA suspect pt's are not isolated until +ve cultures are proven. If that turns out to be the case, room-mates get swabbed.

    We wear a gown, gloves and mask for MRSA precautions... they say that because MRSA is transmitted by touch and is most commonly found in nares and oral cavity swabs, that the mask is to protect staff from accidentally colonising themselves with the bug while they are in with the pt.

    The kicker? They never, ever swab the staff.

    I know of two nurses admitted as pt's who got swabbed and tested MRSA positive. They got paid leave and had to take antibiotics until they were clear. I bet MRSA is waaaay more prevalent that infection control people are willing to admit. That is why I think it is silly to isolate for it. They also don't take cultures from such things as the Dynamap BP machines, which don't get cleansed between patients.
  6. 0
    I find the comment on usage of the Dynamap machines very interesting.

    Does your facility have disposable isolation blood pressure cuffs?
    That is what we use. We have had a time keeping up with the manual gauges. They seem to get disposed of when the cuff is tossed once someone is dischardge or removed from isolation.

    I think if you talk to someone in Infection Control they will tell you that the staff members are not swab because you will find it colonized in the nares of the majority of staff.

    We have to error on the side of caution. 10 years ago we were uncomfortable with caring for someone with MRSA. Now its not such a big thing anymore. Most staff member feel that we are gong overboard. However, many people do not use the proper technique and when you go into the room a LARGE percent of the room is already contaminated.

    I have seen where it is spread from room to room to room. The same body systems were infected. Part of my job is survelience and education. I speak with staff in inservices and they say all the right answers. Sound very convicted in their beliefs. Last Friday I saw one of our staff members come out of a room after assisting with a bedpan and she went straight for the meal cart. I did not see any handwashing. EEEEeeeeeewwwwwWWWWW!

    When this person was spoken to her response was, "Oh, I didn't know you were still here!". I guess that means when certain people are present and not present her habits change. I can't figure this out. I am very tactful and respectful to my staff. I go the extra mile for them. I am always making myself available to them for clarification of what ever they feel they don't understand.

    I think if we all took 1 hour to follow other direct patient care givers around we would be surprised with the infection control techniques they use.

    Be glad if you are at a facility that isolates MRSA patients. If a patient is colonized yes they do still have the organism in their bodies. Ok, that is a reservior all we need is a mode of transmission to carry this to a susceptible host and we have a good old fashion nosocomial infection. One colonize and one active!

    I could go on forever. This is a subject that I deal with everyday.

    I hope I didn't ramble to much. This is a great opportunity to share and vent my experiences.

    Cali
  7. 0
    what is your hospital policy when a vented patient has positive MRSA in the sputum?
  8. 0
    Our facility still uses droplet precautions even if on vent: what if pt extubates? Even with closed system (in-line) suction, there is still a chance for exposure if, say, the vent tubing comes apart from the ET while the pt's coughing. With universal precautions, if there's a chance for exposure to bodily fluids, do what is necessary to protect yourself.

    I find most people do understand why masks are used--if it has been explained in their native language. Just one of the many challenges nurses get to deal with!

    Good thread--people are thinking!
  9. 0
    Originally posted by ageless
    what is your hospital policy when a vented patient has positive MRSA in the sputum?
    This is a good question? A patient on a vent doesn't always mean they have a closed system. There is still the existance of the natural airway. Even with a cuff you will see patients bring up secrections and need to be suctioned orally. I have seem secretions come around the outside of the trach at the stoma site. Being on a vent doesn't make it safer. It actually increases the risk of spreading infection.

    Each time the circuit is opened for any reason there is a risk of spreading infection. Each time staff enters the room there is a risk of spreading infection. Each time the suction canister is disposed of there is a risk of spreading infection. Each time staff DOESN'T wash there hands BEFORE leaving the room there is a risk of spreading infection. If staff leaves the room without washing theirs hands at the sink inside of the room their hands are ready to contaminate what ever they touch next.

    We are all so aware of what it takes to STOP the spread of infection but many of us in actuality are not practicing these steps.

    If you wash your hands at the sink just before leaving the room of someone if isolation and do not touch anything else in the room once you leave the room it is not on your hands anymore to spread to others. Many people are washing hands but with their bodies they are leaning or making contact with the environment in the room including the sink which is where the organisms are all present since we wash our hands there.

    I think the majority of us do these things without thinking. We are so pressed for time. We are busy and running around like chickens with our heads cut off. When we spread these infectious organism we only make more work for ourselves, increase lentgh of stay, increase the use or antibiotics which make these bugs learn over time to resist the antibiotics, increase the time and expense it takes to culture these patients for follow up to get them back out of isolation, increase medication administration time ...... we have to give the meds not the pharmacy staff, its a snow ball that keeps getting bigger and bigger and bigger.

    So the vent really doesn't make a difference. If the patient was not trached at all and was still mrsa of the sputum for us it is all the same.

    If you stop and think of the equipment we take in and out of the rooms during the day ..... is this equipment properly cleaned prior to being used with another patient? We can not see these organism, Life would be sooooooo much easier if we could.

    Cali
  10. 0
    Thank you sunnygirl!

    More:
    http://www.cdc.gov/ncidod/hip/Aresist/mrsahcw.htm

    Guideline for Isolation
    Precautions in Hospitals" (Infect Control Hosp Epidemiol 1996;17:53-80), should control the
    spread of MRSA in most instances.

    Standard Precautions include:

    1) Handwashing
    Wash hands after touching blood, body fluids, secretions, excretions, and contaminated
    items, whether or not gloves are worn. Wash hands immediately after gloves are
    removed, between patient contacts, and when otherwise indicated to avoid transfer of
    microorganisms to other patients or environments. It may be necessary to wash hands
    between tasks and procedures on the same patient to prevent cross-contamination of
    different body sites. Index
    2) Gloving
    Wear gloves (clean nonsterile gloves are adequate) when touching blood, body fluids,
    secretions, excretions, and contaminated items; put on clean gloves just before
    touching mucous membranes and nonintact skin. Remove gloves promptly after use,
    before touching noncontaminated items and environmental surfaces, and before going to
    another patient, and wash hands immediately to avoid transfer of microorganisms to
    other patients or environments. Index
    3) Masking
    Wear a mask and eye protection or a face shield to protect mucous membranes of the
    eyes, nose, and mouth during procedures and patient-care activities that are likely to
    generate splashes or sprays of blood, body fluids, secretions, and excretions. Index
    4) Gowning
    Wear a gown (a clean nonsterile gown is adequate) to protect skin and prevent soiling of
    clothes during procedures and patient-care activities that are likely to generate splashes
    or sprays of blood, body fluids, secretions, and excretions or cause soiling of clothing.
    Index
    5) Appropriate device handling
    Handle used patient-care equipment soiled with blood, body fluids, secretions, and
    excretions in a manner that prevents skin and mucous membrane exposures,
    contamination of clothing, and transfer of microorganisms to other patients and
    environments. Ensure that reusable equipment is not used for the care of another patient
    until it has been appropriately cleaned and reprocessed and that single-use items are
    properly discarded. Index
    6) Appropriate handling of laundry
    Handle, transport, and process used linen soiled with blood, body fluids, secretions, and
    excretions in a manner that prevents skin and mucous membrane exposures,
    contamination of clothing, and transfer of microorganisms to other patients and
    environments. Index

    If MRSA is judged by the hospital's infection control program to be of special clinical or
    epidemiologic significance, then Contact Precautions should be considered.


    Methicillin-resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial (hospital acquired) pathogen in the United States. In hospitals, the most important reservoirs of MRSA are infected or colonized patients. Although hospital personnel can serve as reservoirs for MRSA and may harbor the organism for many months, they have been more commonly identified as a link for transmission between colonized or infected patients.

    Contact Precautions from the CDC website. Contact Precautions consist of:

    1) Placing a patient with MRSA in a private room. When a private room is not available the patient may be placed in a room with a patient(s) who has active infection in MRSA, but with no other infection (cohorting).

    2) Wearing gloves (clean nonsterile gloves are adequate) when entering the room. After glove removal and hand washing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients and environments.

    3) Wearing a gown when entering the room if it is possible you or your clothing will touch any item in the room.

    4) Limiting the movement and transport of the patient from the room to essential purposes only.

    5) Ensuring that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning.

    6) Dedicating the use of noncritical patient-care equipment and items such as stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single patient. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use on another patient.

    Tuesday, February 25, 2003; Page HE03
    Every year, according to federal health officials, nearly 2 million Americans leave hospitals with infections they acquired there, and 90,000 die as a result.
    So how many reports of life-threatening hospital-acquired infections have been received since 1996, when the nation's primary hospital accrediting body began compiling a voluntary database?
    The answer, according to officials at the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO): 10. Not 10,000, not 10 per day, but 10 total reports during the past six years.
    In an effort to boost the number of reports by hospitals -- and to reduce the number of lethal infections among patients -- the commission has convened an expert panel to recommend ways to strengthen infection control procedures. Some of these recommendations may lead to tougher standards that inspectors will consider during visits by the JCAHO, which is funded by the 17,000 hospitals, nursing homes and other institutions it accredits.
    The 20-member panel represents the third such effort undertaken by JCAHO in the past decade, according to vice president of standards Robert Wise, who is spearheading the effort.
    For years the federal Centers for Disease Control and Prevention (CDC) has tried, largely without success, to persuade doctors, nurses and other health care workers to wash their hands before examining patients. Proper hand washing, CDC officials have maintained, could cut the number of hospital-acquired infections by at least 50 percent.
    One reason for the underreporting of infections, Wise said, is the difficulty of determining whether a death from infection represents a preventable error or is a natural consequence of an illness. For example, did an AIDS patient who contracted a fatal infection in an intensive care unit die because of the infection or because he or she had an impaired immune system?
    "Hospitals will disagree" about whether such an event is a reportable error, Wise said, unlike amputating the wrong leg or transplanting organs from a patient with the wrong blood type -- errors all would agree are reportable and preventable.
    Such debate, he said, is one reason that hospital-acquired infections were not included in a landmark 1999 Institute of Medicine report that concluded that as many as 98,000 hospitalized patients die each year as a result of preventable medical errors.
    But to Charles Inlander, director of the People's Medical Society, a Philadelphia-based consumer group, these arguments obscure a more fundamental problem: the lack of mandatory reporting of hospital-acquired infections.
    "Right now there's no incentive to report," Inlander said. "There's no law. Why the heck would you report it if the hospital down the street isn't?" he added. "Even the CDC just gets voluntary data."
    Wise said that hospitals might decide to participate in order to help educate other institutions and to prevent the repetition of mistakes.
    The CDC's hospital infection estimates are based on information voluntarily reported by 315 hospitals whose officials collect data on infections and drug-resistant bacteria. The identities of the hospitals that report infections to either the CDC or JCAHO are not made public.
    -- Sandra G. Boodman
    2003 The Washington Post Company
    Last edit by pickledpepperRN on Feb 28, '03


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