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MRSA legislation in Maine



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No. 10
Old Mar 08, 2009, 02:02 PM
Updated Mar 08, 2009 at 02:25 PM by lamazeteacher

Default Re: "An Act to Prevent MRSA Infections" Maine LD 1684
I'm so sorry for your loss, and know your father lives on in you. Your grieving energy is well used, especially the anger reaction to a loved one's death. I'd like to suggest a few more items, some of which which could be ADDED as ammendments to the MRSA bill. I have been an IC nurse for many years.

1. STOP it before it can spread, by not admitting patients who could be treated as outpatients. Certainly that includes a minor fracture when no systemic treatment is involved, and which could be followed up as outpatient status. The person responsible for utilization would list any admission that didn't meet criteria consistent for that, and present it at their committee meetings. Once a responsible spending of health care dollars system is implemented, that will be key to maintaining budgets.

2. Maintain the same rigorous standards for IC and cleanliness in outpatient clinics, physicians' offices, PT, RT, radiology and inpatient PT facilities (I've seen dust and exudate in those places, stay there for weeks, if not all the months where I was treated). I offered to do it, but was turned down, due to OSHA. I'd also include the public's side of drug store prescription area counters.

3. Routine yearly cultures of staff's hands, throats, and ears would allow treatment without charge if MRSA was found, so carriers of it in healthcare settings would be treated; and retention of infected staff occur, once 2 follow up cultures from the area of their bodies where it had been discovered, were negative (unless it was an open wound which had thoroughly healed). There should be no loss of employment for positive staff.

3. Do periodic cultures on all equipment (incl all pillows - covers laundered daily and weights and stretchy ropes) where patients could be exposed (like monthly). That costs $$$, but exceedingly less than treatment and wrongful death for one patient.

4. Do cultures for all open wounds a week following antibiotic treatment, in hospital or after discharge. Physicians or their office staff performing cultures/HH personnel report those negative and positive results in a timely manner, submitting POC with positive ones, to PHD's bacteriology and nursing departments, on reports sent to them. (MRSA is a reportable disease in most states.)

5. When screening at risk patients (which should include newborn, aged, and immunologically compromised, the follow up with a home visit after hospitalization, even if neg. cultures were obtained, would catch any "between the cracks" folks.

6. Last, but definitely not least, is the addition of the words "with soap"
on all "Wash your hands" signs, along with (this is my fantasy) an automateded 2 minute song (like the ones in greeting cards) played every time the water tap(s) are turned on. The taps should be shut off (not allowing rinsing) while that is played. That way, if someone left a patient's
or rest room without properly washing their hands, someone else there would know it, and gently but loudly enough to be heard say, "You forgot to wash your hands with soap!" The same mechanism could be employed at the threshold of patients' rooms - but I'm not sure how it would distinguish those who actually had contact with the patient from those who were not exposed/walking in.

It would be noisier......but perhaps a vibrating, light flashing thing (like restaurants have for those whose table is available) could be used. That would involve engineering, but again at less cost than treatment of a MRSA infected patient.

I'd love to convince hospital administrators to have physicians put a sensor - cleaned, of course, in their pocket upon entering the hospital (at the place where they flick the light on letting their presence there be known), which vibrated at the threshold to patients' rooms if they didn't wash their hands when leaving it. That could also help identify those who billed for a visit without actually seeing a patient....... which would spare $$$ when tax payers' money is involved.

Another method could be a policy that said all physicians had to wear their name badges (with picture that had to be returned when they left the hospital), and a sensor embedded in the badge would light up whenever handwashing didn't occur (again water tap and soap dispensor activated), after they'd been in a patient's room.

Granted, there would always be a few who would try to hack into or ignore the system, but then if they billed for a patient visit they hadn't made.......

I hope this has been helpful. I enjoyed writing it, and hope MRSA will someday be relegated to history (not a patient's).
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No. 11
Old Mar 08, 2009, 02:03 PM

Default Re: "An Act to Prevent MRSA Infections" Maine LD 1684
How are "glove" and "contact" precautions different from Universal/standard ones?
As an experienced IC nurse, that worries me.
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No. 12
Old Mar 08, 2009, 02:06 PM

Default Re: "An Act to Prevent MRSA Infections" Maine LD 1684
Originally Posted by lamazeteacher View Post
How are "glove" and "contact" precautions different from Universal/standard ones?
As an experienced IC nurse, that worries me.
We are required to wear gloves in the room at all times with glove precautions. We can't even chart in the room without gloves on. Contact precautions requires us to wear gown and gloves.
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No. 13
from Mammy1111
Old Mar 08, 2009, 02:44 PM

Default Re: "An Act to Prevent MRSA Infections" Maine LD 1684
Thank you to Lamazteacher for your well thought out response. I have learned a LOT in my work for this proposal. The biggest thing is that mandates come hard and that they are generally incremental. It's too bad that it is so political, because it seems that everybody, including doctors and administrators would want to stop the scourge of MRSA in hospitals. Unfortunately, that is not always the case.
I have considered adding MRSA screening of Health Care workers to include Nurses. But, like Universal Screening (vs high risk screening), it will have to come later. I would love to propose Universal screening for every patient entering hospitals, clinics, nursing homes and any crowded institutions in any state. I do have wording in my proposal to widen the scope of screening if any facility has 50% or more HA MRSA positives. So, that somewhat covers that. There are hospitals that do screen all HCWs periodically, but I just don't see that happening this time around. The first thing we need to do is get high risk screening mandated and then all the subsequent steps to prevent spread within the hospital. If this passes and we continue to be one of the highest HA MRSA infection States, then we will go from there.
Another point I'd like to make is that MRSA colonized patients can also be reservoirs of MRSA and it can spread from them to others and from them into their own surgical wounds. Gloves alone will not prevent spread from colonized or infected patients. IF a patient is colonized, it is essential that HCWs use handwashing (WITH SOAP), gloves and gowns. Add masks to the mix if there are respiratory symptoms. This is important especially if there will be close contact, such as bathing or positioning, or if there are bodily secretions on linens. It is also important to encourage the patient to do frequent handwashing.
Decolonization is addressed in my proposal for patients found to be colonized with MRSA. This is especially important for pre surgical patients. Any patient that is going into hospital for an elective surgical procedure should have a nasal (or other body part, as indicated) culture done. Preoperative decolonization with nasal bactroban and hibiclens bath would be encouraged for anybody who tests positive. Of course, this isn't always possible when a procedure or admission is an emergency. Other measures to help avoid postoperative MRSA is antibiotic predosing immediately before surgery and thermal control of body temperature. Some sutures now fight MRSA as do central line catheters and other products.
I do NOT believe that in this age of heart tranplants, curing cancer, bioinic prosthetics, stopping heart attacks and strokes, and other miraculous advances in medicine and surgery that HCWs are helpless against a little microbe called MRSA. It takes a multifaceted but standard approach, and a lot of diligence. but we can prevent it. It has been done in many hospitals in this country AND all over the world.
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No. 14
from printsess
Old May 01, 2009, 08:02 AM

Default Re: MRSA legislation in Maine
Kudos for going after the legislation. It's disappointing that appropriate healh information is not shared not only on behalf of the staff caring for the patient, but for the sake of the patient. Withholding the information deprives the patient of appropriate care. This should be dealt with as well. onsuming the cThe facility should be supporting you on that pursuit since they will be costs. I am in Washington State, and dealing witht he same issue. Thanks for sharing.
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No. 15
from Mammy1111
Old May 01, 2009, 08:12 AM

Default Re: MRSA legislation in Maine
My original proposal got whittled down considerably, but we did get mandatory high risk MRsa screening. Isolation, cohorting, precautions, reporting, disclosure, education, infected/ill staff, etc, will all be addressed at the Maine Quality Forum. Maine State Nurses Assoc and I will be included in the process of addressing the rest of those issues. Whatever they/we come up with is what Maine Hospitals will do. There is funding for this through stimulus money. So, there is no reason to hesitate or to do something that will be ineffective. The governors office and the Health and Human Services committee both have put the pressure on the MQF to do this and to do it quickly. We have a deadline of Oct 1 to work it all out. Then it can be enacted sooner than the MQF proposed date of Jan 1 2010.
I am very optimistic that we can make Maine hospitals safer and patients more aware. A huge part of prevention is education. Nurses will be the leaders and enforcers of any new policy for Maine hospitals. They will make it work.
I encourage any nurse, group of nurses or other HCWs to do this in their states. CDC is just not doing what needs to be done to stop these preventable infections. Organize a plan and contact your State legislators and get it done!
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No. 16
from seasoned1
Old Aug 22, 2009, 01:31 PM

Default Re: MRSA legislation in Maine
Are any of you aware of mandates to protect patients from staff who have MRSA?
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No. 17
from Mammy1111
Old Aug 22, 2009, 02:12 PM

Default Re: MRSA legislation in Maine
I am not aware of any such mandate. But, I suppose if a patient gets hospital acquired MRSA and it can be traced back to a staff person, there is the possibility of medical liability.
There is a bill in the Senate to protect healthcare workers in cases of infections contracted while working.
My original proposal in Maine included mandating HCWs wear masks if they have an URI. The reason behind that was that nasally colonized MRSA can be spread if it is sneezed or coughed into the environment, just the same as if a patient did that. HCWs should not be working when they are sneezing and coughing and ill with a respiratory illness, but we all know they do. It that case they MUST wear masks. If there is MRSA growing in the nose, it will be contained behind a mask. And of course scrupulous handwashing is a must.
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No. 18
from printsess
Old Aug 22, 2009, 02:31 PM

Default Re: MRSA legislation in Maine
Washington State now has legislation that requires all patients with any history of MRSA (or any resistant bacteria) whether active or not, to be isolated for life now. It is a costly move, but it is a move that protects other patients. All patients must be asked if they have ever had the infection. There are certain patients that are screened for the infection (high risk groups have been identified).
I think it takes aggressive action like this to slow the spread. In the past MRSA was not taken seriously. Now that it is epidemic, I appreciate our legislative response. Kudos to anyone stopping the spread and protecting patients from getting it.
Lives and health are precious. Healthcare workworkers have an obligation to protect them.
Thanks for spreading the word & stopping the disease.
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No. 19
from Mammy1111
Old Aug 22, 2009, 02:50 PM

Default Re: MRSA legislation in Maine
You are absolutely correct. Patients are precious and also they deserve the best and safest possible care.
Alarming increases in MRSA infection rates have gone ignored for 15 to 20 years. Every possible excuse and lie has been used. The most incredible one is when hospitals blame the patient for their infection. That one really gets me. Even if a patient screens positive on admission, it is up to the attending doc to immediately decolonize that patient, particularly if they are going to have anything invasive done. So, even if a patient carries a MRSA colonization into the hospital with them, it does not excuse the hospital from a responsibility to protect that patient (from a full blown infection) and the patients around him as well.
Unless one or a combination of both the Federal bills in the House and the Senate passes, it will take grassroots efforts in every single state to move MRSA prevention forward. WE can't afford to lose more precious lives and see more vicitims disabled by these grotesque infections. And MRSA is at the top of the heap. There are many other infections that hospitals dish out to vulnerable patients. It is really quite frightening. But, MRSA is the most deadly and the most difficult to cure and it is responsible for the most deaths. By addressing MRSA, hospitals will see a ripple effect in a reduction in other HA infections as well. It has happened everwhere there is a solid MRSA prevention
program in effect.
I am familiar with Washington State's new law. There was a huge expose' done by some investigators about Seatle hospitals. The writers won a Pulitzer for their work. It exposed the horror of MRSA in those hospitals. The findings were instrumental in making their legislative proposal successful.
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