MRSA legislation in Maine

cmawrule · Feb 7, 2009

AMEN!! I am so sorry about your Dad. We need MRSA prevention in every state. If we can't cure it we can at least prevent others from getting it.

I work in a small acute care facility-we screen every new admit for VRE and MRSA. Until we get the cultures back, we put them in isolation. If the cultures are negative, we take them out. Of course its an acute care floor...a surprsing amount have MRSA and don't know thats the problem.

kmoonshine, RN · Feb 8, 2009

You know what I'd like to see?

I'd like to see a law passed that makes it mandatory for nursing homes/assisted living facilities to disclose a pts "infection" status prior to ED arrival.

We almost always (over 90% of the time) get a phone call from the nursing home/assisted living facility prior to a pt coming to our ED. We'll hear about why the pt is being transfered to us (ie "abnormal labs", "increased confusion", etc). But we are never told that the pt is +MRSA, +C.diff, etc.

It is mandatory for us in the ED to fill out EMTALA transfer forms (doc-to-doc and accepting MD prior to transfer to another facility); otherwise, we face hefty fines well over $50,000. Shouldn't it be mandatory that skilled nursing facilities disclose that the pt has some "super infection" prior to the pt arriving in the ED?

I almost never find out about the pt's previous infection status until either the pt is registered (and shows up in the history), or until I'm flipping through a stack of papers sent by the nursing facility. And by then, I've been in and out of the room multiple times - PCXR was done, EKG was finished, multiple nurses and techs at bedside and exposed, etc.

Yesterday I had an elderly man who was sent for "SOB". The nursing home left out the fact that he had just been discharged from another hospital 6 days earlier after having severe pneumonia, pneumothorax, and who tested + for c.diff that very day (they sent the results, but that doesn't do a whole lot of good when its buried in a stack of papers - most which are useless, BTW). This pt sent for "SOB" came in with dark and cloudy urine, core temp of 95F, lactate >6, BP 80/40, and HR of 140 with decreased cap refill and purple fingers...sepsis, anyone? Grrrr...and so as I'm working to prevent the pt from coding, I'm totally unaware of his MRSA/MRO/C.diff status.

If they can copy the pts chart and call us before the pt arrives in the ED, then they can disclose the fact that the pt tested positive for some super-infection. They don't even disclose this to EMS responders when they arrive to transport the pt...

Mammy1111 · Feb 8, 2009

Although my legislative proposal is about MRSA, my hope is that it will open dialog about other HAIs. I have addressed the issue of MRSA in LTC patients in the proposal. A new form will be added to charts of patients who are being transferred to or from a LTC. A green form means the pt is not MRSA positive and a red one means they have MRSA and details the location of the infection or colonization. It is a simple but very meaningful step in helping the receiving facility to be prepared and use the appropriate isolation and precautions.

Hope this idea helps.

My ultimate goal is to come up with an effective and necessary mandate in Maine. But ultimately it is what we need nationwide to fight the plague of MRSA. Maybe our new administration will actually force the CDC to do what we expect them to do, by mandating effective MRSA prevention in the entire country.

Thanks for your support in this.

MaineEMT2RN · Feb 9, 2009

Reading this thread reminded me that in my EMS training, the only discussion of infection control is in protecting yourself. I never had any training, or even awareness of my role until I began working in the hospital. In the field, the linens are changed, but it's seldom that stretchers get cleaned, equipment gets wiped down or that hands are even washed between patients. I'm sure pre-hospital is where many of these bugs are transferred from one pt to another and "hospital acquired" may really be PRE-hospital acquired.

Disclosure of infection status as well as effective and mandatory training on infection control for ALL care providers is critical.

Mammy1111 · Feb 9, 2009

I agree that edcuation of all care givers (including EMTs) in the area of infection control is essential. Part of my legislative proposal is education, of everybody involved in patient care including all caregivers, patients AND their families and visitors. That would include EMTs. Transparencey and acknowleging the fact that MRSA and other hospital acquired infections is indeed a problem that is NOT going away is a big first step in prevention..

I would recommend to any EMT to demand infection control education regarding safe and clean transfer of infected patients. Effective cleaning after each patient is essential as is appropriate precautions. These steps help to protect EMTs and any patients they transfer after an infected patient.

MaineEMT2RN · Feb 9, 2009

Absolutely - but I can honestly tell you that as an EMT in the field I was totally unaware of the risk of cross contamination OR of the value in preventing it. It just isn't part of the culture. Not once in all of my EMS training was I educated about DRO's

After reading about what you're doing, I'm thinking about pouncing on this with a letter to the state EMS board and offering to put together some training with the company DH and I work for. I can see great benefit from education and training in the EMS community.

Mammy1111 · Feb 9, 2009

I think your idea is 100% warranted, and you should do it. I honestly believe the dialog about DROs should be open and honest. All of us caregivers need to be aware of the numbers of infections there are and how to avoid contracting it ourselves and how to protect our patients from contracting it. There has been a culture of secrecy. I believe it is because hospitals and doctors are afraid of liability and accountability when it comes to these horrible infections. WE need to overcome the fear and get smart, become proactive and help patients avoid these infections. We need to put patients lives first .

If you do produce a program make sure it is in compliance with the latest CDC and SHEA recommendations, and then get it out there. Research what other EMS services are doing. It is important that all healthcare workers are on the same page and offering standardized and consistant courses. Almost all of my proposal for Maine comes from information that is already out there. The big difference is that I am proposing MRSA screening of high risk patients being admitted to the hospital. EMS doesn't have the luxury of screening and results of cultures. YOu do however have access to patients history and you need to ask the right questions of your patients. Are they high risk (ie cancer, diabetes dialysis, COPD, very elderly or very young, Long term care patients), have they ever had MRSA, are they caretakers for MRSA patients, do they have fever of unknown origin.......a lot of questions enter my mind. My best advice would be to treat all patients as though they have a DRO until proven otherwise. Strict handwashing and gloves are always called for....contact precautions. If the patient is coughing and feverish, put a mask on yourself or your patient if they can tolerate it. If there is lots of drianage from wounds or urine, a gown is necessary. It is much the same as in the hospital.

Cleaning or covering the stretcher with impermeable cover is important. Frequent cleaning of frequently touched surfaces is necessary.

If you want me to speak to your EMS people I would be happy to do that. You are absolutely right when you say EMS needs some serious infection control training.

Mammy1111 · Mar 8, 2009

My proposal to for MRSA prevention in the State of Maine finally has a title and LD number. It will be introduced to legislators in the Senate and House in Maine this week. It has taken a lot of work and several language revisions, but it is printed and ready to go.

Now the work begins. My representative Adam Goode of Bangor ME will introduce it and he will solicit support and cosponsors. We have 8 so far. Maine State Nurses Association will lobby for this proposal as well. I am very excited about this. I have never wavered on my opinion that we CAN prevent most MRSA infections in hospitals by following the right steps, with every patient, every time. Consistancy, standardization, firm policies will stop MRSA, and many other MDROs as well. The 1200 recommendations that CDC has for MRSA are confusing and weak. Standard, straight forward steps, in every hospital, for every health care worker to follow is what it will take.

My proposal includes 1) SCREENING OF HIGH RISK PATIENTS 2) ISOLATION OR COHORTING OF ALL COLONIZED AND INFECTED PATIENTS 3) PRECAUTIONS, EARLY, APPROPRIATE AND STRICT 4) REPORTING AND PUBLICIZING OF ALL POSITIVE MRSA CULTURES IN HOSPITALS 5)THOROUGH DISINFECTION OF ROOMS AND EQUIPMENT WITH EPA APPROVED CLEANSERS 6) NO DISCRIMINATION AGAINST MRSA PATIENTS SEEKING CARE IN HOSPITALS OR NURSING HOMES.

Once we pass this legislation, nurses will make this mandate work. Without powerful infection control policies, nurses are powerless to make change. After hospitals have a mandate, the rules will be the same for everybody, including doctors, nurses, support staff, cleaning personel, and administrations. The confusion and MRSA "gossip" will be gone. Transparency and prevention will begin and nurses will lead the way.

Any nurse who is interested in doing this for their own state can contact me and I would be willing to help. It is named for my father who died on January 9 this year from HA MRSA pneumonia. He went into his trusted hospital for a minor fracture of his ankle. While he rehabilitated there, MRSA invaded his lungs. He died after 3 months of suffering.

Christie RN2006 · Mar 8, 2009

We have started a strict MRSA surveillance where I work. All patients admitted to the critical care units are placed in glove precautions. Any patient admitted to the ICU is screened for MRSA using a nasal swab and if the screen comes back positive they are placed in contact precautions and receive a daily bath using a special cleansing agent and bactroban to the nares.

lamazeteacher · Mar 8, 2009

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).

lamazeteacher · Mar 8, 2009

How are "glove" and "contact" precautions different from Universal/standard ones?

As an experienced IC nurse, that worries me.