Poll: Does your unit use Bactroban for MRSA colonization?

  1. This topic was brought up in another thread and I thought it was worthy of a poll, considering the fact that MRSA is getting to be quite an issue in our hospitals...

    Bactroban is a cream that is applied intranasally on patients who are colonized with MRSA. We only used it once in our NICU (with good results as baby swabbed negative after treatment) but haven't used it again. I'm guessing part of the reason many units are hesitant to use this medication has to do with the fact that there hasn't been much research done on the effects of Bactroban when used on infants. However, with MRSA becoming a problem in many NICUs, I can't help but wonder if it wouldn't be better to completely get rid of the MRSA rather than just cohorting patients.

    My own unit swabs babies on admission and then every week after that. Positive infants are cohorted, and we use gown/glove precautions at the bedside. Once a baby tests positive for MRSA, he or she is on isolation precautions until discharge. Even the parents have to gown and glove, since they touch more than just their own infant when visiting (water fountains, door knobs, etc.).

    What are your Neonatal ICU units doing?
    Last edit by Gompers on Feb 18, '07
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  2. Poll: Does your unit use Bactroban for MRSA colonization?

    • Yes

      30.77% 8
    • No

      61.54% 16
    • Other - please explain

      7.69% 2
    26 Votes
  3. 9 Comments

  4. by   blue_red23
    in our unit, critical care adult, once a patient
    diagnosed with mrsa, depending what kind of strain they have either mrsa15 or mrsa 16.we treat mrsa 16 vigorously, we use bactroban for the nose and pure hydrex solution for the skin until the pt is clear from mrsa.also, the microbiologist will prescribe vancomycin. mrsa 15 is a normal strain everyone can have it without knowing it.
  5. by   Mags4711
    Gompers, I don't know if you saw the thread I started about what do other units do for precautions:
    http://allnurses.com/forums/f33/help...ol-203350.html


    And the old one I dug up about MRSA:
    http://allnurses.com/forums/f33/infe...icu-62621.html

    But they might offer some insight about what some folks are doing.

    We cohort the MRSA babies and gown and glove for them. Every baby gets tested on admission, whether inborn or transported in, we also do weekly MRSA swabs on Mondays on every baby and once a baby tests positive, that baby is considered positive for the rest of their stay. Also, we do bactroban ointment to the nares and umbilical cord (if they still have a cord attached) BID for five days, and Hibiclens baths (12.5ml in 500ml water) daily for seven days after they are positive. We triple dye all cords immediately on admit to the NICU if not already done. Apparently someone read an article that the triple dye has an agent in it that kills the bad bugs. Our neonatologists have no problem putting in lines through a dyed cord.

    We are having issues galore right now and were just told we cannot wear our wedding rings-or any ring, and they are now enforcing a long-standing ban on watches and bracelets. I understand the bracelet/watch thing, and I even understand the ring thing, but parents are allowed to wear their rings. And we do NOT have them do a two or three minute scrub (just have them wash their hands or use Purell). And the visitors for any positive babies (MRSA, C-Diff, VRE) do NOT have to gown/glove!!!!!!!!!!

    Burns my butt to the core (and I have a huge butt) that IC keeps saying it is not necessary for visitors to gown/glove but somehow it's now necessary for us to remove rings. And yes, they expect that if someone has to have their ring cut off, they will!!!!!
    Last edit by Mags4711 on Feb 18, '07
  6. by   BittyBabyGrower
    Since we had a big breakout since our last MRSA post we have really tightened up. Everyone does a 3 minute scrub....they still allow us to wear our wedding rings since we are all gloving. We have warned parents about their fake fingernails. We test everyone once a week....positives get bactroban up the nose and to the bellybutton...we don't use triple dye at all anymore...we don't even carry it. Over 1200 grams, they get a Hibicleanse bath. Once they are positive, they are isolated until dc. All visitors must gown and glove. We have had 4 cases of CA-MRSA, all of which were traced back to the mothers. One had to have a lobectomy since her lung was so badly damaged, one died and the other 2 are still with us, but very, very sick.
  7. by   Gompers
    Quote from faithmd
    Gompers, I don't know if you saw the thread I started about what do other units do for precautions:
    http://allnurses.com/forums/f33/help...ol-203350.html

    And the old one I dug up about MRSA:
    http://allnurses.com/forums/f33/infe...icu-62621.html

    Oh yes, I remember those threads!!! However, what I am really interested is in the number of NICUs who are using Bactoban for MRSA colonization rather than just cohorting babies. In another thread, a NICU nurse reported that her unit does use Bactroban and she thought it was standard practice. From what I've read in the above threads, cohorting is the standard for most units - BUT I wanted to do an actual poll to see if anyone else is using Bactroban as well.

    Just wanted to find out if my unit is the oddball or not!
  8. by   Mags4711
    I just wanted to make sure you had seen those threads as in them, several people had replied about what their units did. :smilecoffeecup:

    I really like your poll, I think it's a great idea! I am very interested in MRSA right now, myself. I'd love to also see a poll here and in General about whether visitors gown and glove.

    I can't wait to see what the results of this one are, thanks for starting it!
    Last edit by Mags4711 on Feb 18, '07
  9. by   Gompers
    What's strange is that none of the babies who've tested positive for MRSA on our unit have been actually sick with it - they're just colonized, probably came from the mom or something. If one of a set of multiples comes up positive, we isolate the whole group because their families will be touching all of them on a daily basis. Since the nurses have to be cohorted during that shift, it makes sense to cohort the families as well.

    We haven't had too many kids positive lately, though. But last year, we had like 8 or 9 at the same time! We cohorted them all in the same room, and we all dreaded being back there. Most of us hate to gown up all shift long because we get so HOT in those things!!!

    One of our clever charge nurses coined that room "The MRSA-ry" (rhymes with nursery)

    Soooooo...BACTROBAN in the NICU? Anyone??????????
  10. by   Mags4711
    We've only had two babies actually test positive for MRSA in their blood (and be sick from it) in the five years I've been there.

    I agree with you, Gompers, it seems they are just colonized, and that in itself is not a huge problem.

    Our IC did question a correlation between our positive babies and those whose moms delivered via c-section. Both the inborn babies as well as the ones transported in.

    I LOVE it, MRSA-ry! I'm using it! We've been calling that room "The Pit" or "The Pretty Blue Party Gown Place."
    Last edit by Mags4711 on Feb 19, '07
  11. by   grlgid
    we seem to go in clusters none for a while and then a big group of kids all positive. we don't routinely swab unless someone turns up positive then we keep swabbing until there are no more new cases. I know we used bactroban recently on one of my babies but his was strictly colonized in his nares.
  12. by   SteveNNP
    We have never used bactroban intranasally, however we use it occasionally as a preventative measure on skin breakdown. When our staff was swabbed last year and a secretary and 2 RN's came back positive, they had to bathe with hibiclens, swab nares with bactroban, and do 14 days of rifampin/biaxin before reswabbing, at which point they were decolonized. (Of course they didn't work while being treated)

    The staff in my unit are now using 3M's Avaguard, which is a chlorhexidine/alcohol "rub" which you rub on your arms up to your elbows once at the beginning if the shift, instead of scrubbing in for 3 min. IC says this stays on your skin even after washing for up to 48hrs and the bacteria count on your skin drops like crazy. (apparently the OR's are using this instead of scrubbing now!) We still wash hands and use calstat in between babies. The rub is kind of slimy, but fine after you wash the lotion part off later. It's just weird not "scrubbing" your skin, but rubbing. It sure has made my skin clear up, though, between the cold weather and constant handwashing....
    Last edit by SteveNNP on Feb 19, '07

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