MRSA legislation in Maine

A comment on gloves & charting.
When we have an isolated patient, we do not take the chart in the room. All charting that must be done in the room, is done with a pen that does not leave the room. The only papers that go in the room are ones the patient must sign. The rest of the charting is done without patient contact. Since we are doing our medications on the computer now, I take one of the portables (on wheels) to the door, and use the counter space to chart so that I am distanced from the patient when charting, but still able to speak to the patient. I am in contact with the patient when appropriate, but cannot chart until after I take my gloves off and wash my hands.
Every facility needs to work out an isolation protocol that really works. Then all staff need to use the same rules all the time for it to work. With this problem, there is room for creativity to solve the crisis, but not room for individuality in carrying the duties we have.

When are the gloves changed in the room? I suspect they're changed when contaminated by blood/body fluids of the patient, with handwashing before reapplication of gloves. That's UNIVERSAL precautions.

"Contact" means just that, when in contact with the patient's blood/body fluids, a gown is to be worn if spash of blood/body fluid is expected (ie when changing dressings, drawing and administering blood, giving and removing bedpan/urinal, delivering a baby, cleaning newborns, adminiustering vaginal medication, inserting rectal or vaginal suppositories, dealing with nasal, oral and aural discharge such as irrigations, or any open skin lesion/burns). That's UNIVERSAL PRECAUTIONS!!

If your hospital, LTC or other facility has more than Universal, Protective/Reverse and Respiratory/droplet isolation, it is seriously in need of updating their infection control guidelines/procedure books.

Usually the charts of patients in isolation needn't be in the isolation room, if hand held computer components are used to record vitals, I&O, and other items. That piece of equipment can be cleansed before being removed from the room. Usually no pen is needed, when those are used.

When dangerous pathogens such as MRSA have been found upon culture, no other precautions than universal ones are employed. Care needs to be taken to prevent the spread of all contagious and potentially contagious microorganisms, as if they were MRSA or HIV. Signs aren't appropriate outside rooms, to preserve privacy. Anyone entering patients' closed doors must have permission from the nurse for that patient who, in privacy, will tell anyone caring for that patient, what the situation requiring isolation is, and explain/see that official precautions are followed. Those may be posted in medication rooms.

Here are the CDC's recommendations. This is the bottom line on the subject, and must be followed, lest dire JCAHO fines and discredit will occur. Read the disposable blood pressure cuff requirement!

It sounds like your Infection Control Committee (the docs on it), need to grab their colleagues by their neckties, (unless it's a bowtie), and the patient isn't known to sneeze or cough, if MRSA has been cultured from the respiratory tree. They should discuss the necessity/possibility of running cultures on the docs! So write that in a report to your Infection Cintrol nurse, regarding your observations of docs' neckties on possibly contaminated articles. You'll need to name names and dates of the occurrences.

Guideline for Isolation Precautions: Preventing Transmissionof Infectious Agents in Healthcare Settings 2007 , should control the spread of MRSA in most instances. Additional measures for prevent the spread of MRSA are described in Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 PDF (234KB/74 pages)
Standard Precautions

For more detail see Standard Precautions
1) Hand Hygiene Perform hand hygiene after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Perform hand hygiene immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. When hands are visibly soiled with blood or other body fluids, wash hands with soap and water. It may be necessary to perform hand hygiene between tasks and procedures on the same patient to prevent cross-contamination of different body sites.
2) Gloving Wear gloves (clean nonsterile gloves are adequate) when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur. Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination. Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens.
3) Mouth, nose, eye protection Use PPE to protect the 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. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.
4) Gowning Wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated.
5) Appropriate device handling of patient care equipment and instruments/devices 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. Clean and disinfect surfaces that are likely to be contaminated with pathogens, including those that are in close proximity to the patient (e.g., bed rails, over bed tables) and frequently-touched surfaces in the patient care environment (e.g., door knobs, surfaces in and surrounding toilets in patients' rooms) on a more frequent schedule compared to that for other surfaces (e.g., horizontal surfaces in waiting rooms).
6) Appropriate handling of laundry Handle, transport, and process used linen to avoid contamination of air, surfaces and persons. Contact Precautions

For more detail see Contact PrecautionsContact Precautions should be followed for some patients. To determine if a patient needs to be placed on Contact Precautions see page 37 of Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 PDF (234KB/74 pages)
In addition to Standard Precautions, Contact Precautions consist of:
1) Patient placementIn Patient placement in hospitals and LTCFs, When single-patient rooms are available, assign priority for these rooms to patients with known or suspected MRSA colonization or infection. Give highest priority to those patients who have conditions that may facilitate transmission, e.g., uncontained secretions or excretions. When single-patient rooms are not available, cohort patients with the same MRSA in the same room or patient-care area. When cohorting patients with the same MRSA is not possible, place MRSA patients in rooms with patients who are at low risk for acquisition of MRSA and associated adverse outcomes from infection and are likely to have short lengths of stay. In general, in all types of healthcare facilities it is best to place patients requiring Contact Precautions in a single patient room. To assist with decision making about patient placement in various types of healthcare facilities see page 84 of Preventing Transmission of Infectious Agents in Healthcare Settings 2007.
2) Gloving Wear gloves whenever touching the patient's intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails). Don gloves upon entry into the room or cubicle.
3) GowningDon gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment. After gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in possible transfer of microorganism to other patients or environmental surfaces.
4) Patient transport In acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes. When transport or movement in any healthcare setting is necessary, ensure that infected or colonized areas of the patient's body are contained and covered. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the transport destination.
5) Patient-care equipment and instuments/devicesIn acute care hospitals and long-term care and other residential settings, use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient. In home care settings limit the amount of non-disposable patient-care equipment brought into the home of patients on Contact Precautions. Whenever possible, leave patient-care equipment in the home until discharge from home care services. If noncritical patient-care equipment (e.g., stethoscope) cannot remain in the home, clean and disinfect items before taking them from the home using a low- to intermediate-level disinfectant. Alternatively, place contaminated reusable items in a plastic bag for transport.
6) Environmental measures Ensure that rooms of patients on Contact Precautions are prioritized for frequent cleaning and disinfection (e.g., at least daily) with a focus on frequently-touched surfaces (e.g., bed rails, overbed table, bedside commode, lavatory surfaces in patient bathrooms, doorknobs) and equipment in the immediate vicinity of the patient.
7) Discontinuation of Contact Precautions No recommendation can be made regarding when to discontinue Contact Precautions.Control of MRSA Outbreaks

Information regarding the control of MRSA outbreaks see Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 PDF (234KB/74 pages)
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Date last modified: October 10, 2007
Content source:
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases

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Related Guidelines

• Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006
  PDF 235KB / 73 pages
• Hand Hygiene in Healthcare Settings - 2002
• Isolation Precaution 2007

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• • Standard Precautions
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  • Control of MRSA Outbreaks

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".......The CDC has never mandated any of their steps for prevention. EVER! Hospitals still hold the final say on what they will or will not do. So, if they choose not to isolate patients because it is not fiscally beneficial, or there is an emergency of their own definition, or just plain because....they can and they will......" quote from mammy's post

Well it seems the answer to my several times posed question, "where are you getting these ideas?" has been answered - they're your own!

Since you have provided evidence in your posts that you have never attended education courses for Infection Control nurses, you don't realize the power the CDC has, and the great minds that collaberate to present policies that are generally accepted as the last word on surveillance, and procedures to prevent transmission of communicable diseases.

After taking the accreditation courses that Infection Control nurses do, their word is law regarding the local control of infectious diseases. They can close specific units where microorganisms are spreading, or the whole hospital, carrying out the dictates of that august organization.

Please bite off what you have the authority and ability to chew, mammy.