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 these MRSA positive sputum patients? Should we use these precautions until the patient has been tested again for MRSA?
May 23, '02
Our hospital policy (& that of I.D) is that droplet procautions always for any MRSA pt. Gown, gloves, mask. I know there has been some controversy in the past, but our I.D. dept stands tough on the masking/gloves/gown and we have never had a major outbreak. (touch wood)
My advice? Be save, err on the side of caution. Mask!
May 23, '02
I'm with Tiki-when I did agency nursing in ICU, that was that hospital's policy also-never knew a nurse to even become a carrier, and we had no in-hospital spread. BTW, we used the same policy in ER whenever we got radio report that someone with MRSA was coming in from a NH, and so did EMS.
May 28, '02
Over kill is not always the answer. For many reasons Pts do not understand why we wears masks when just entering the room if bug is in urine and they have a catheter... and there is nothing that shows it decreases the risk of spreading. Poor handwashing on the other hand... now there is documentation of that impacting the spread of many things.
But when something runs the risk of being spread via an airborne route, a maks is alwasy a very good idea.
I suggest you look at the www.APIC.org
website. (assoc. for Infection Control Practioners). They have very good educational things available and an IC list serve as well.
Last edit by bernarma on May 28, '02
May 28, '02
In most UK hospitals MRSA is a constant
If it is detected in sputum yes we wear masks otherwise we just use contact precautions
Patients with known MRSA are treated with Aquasept baths and Bactroban nasal cream
Does this help?
Jul 8, '02
no one mentioned , is the mrsa colonized? if so no precautions are needed.
Jul 8, '02
if it's colonized no precautions are needed. sorry.
Jul 11, '02
Why would a colonized resident not need precautions?? Colonization just means the bacteria doesn't make them sick, but can still be transferred to other residents in the facility via heathcare workers. Am I crazy for thinking this way?
Aug 3, '02
In our facility, if the MRSA is colonized then we don't observe isolation prec. I had a pt just admitted w/MRSA of the skin. (MRSE) thinking that is what it was, anyway She got sick quick on me, pulmonary edema. She had started a cough that went down hill in hours. I masked immediately when I noted her cough. If it is respiratory MRSA, our pts may come out of their room but w/a mask on until we get a report stating it is colonized. We have another one w/MRSA of her eye. She must wear an eye patch to come out of her room. Tex
Aug 16, '02
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.
Aug 23, '02
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.
Sep 18, '02
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: