Unusual situation, Rooming-in with MRSA

[TiffyRN, BSN, PhD]

I've just finished 4 days in a row of working and volunteered to work in our isolation room with a single infant who has had persistant positive cultures for MRSA (infection not likely active, but infant's nose colonized). Some of our nurses hate working in isolation because they can't stand to be socially isolated, to me, it's not a big deal. The isolation room is a small room that comfortably fits 1-2 infants with their equipment and there is an ante-room where the nurse generally sits and charts.

I just had one infant and he was a very stable feeder-grower on NC. The last two nights the infant was rooming in but of course someone needs to be available to go in and help the mom and relieve her for meal breaks (she was alone rooming in). Our policy states that a nurse caring for an MRSA positive infant cannot care for other infants in the unit. So the past two nights I have been sitting in this empty isolation room basically babysitting a phone (mom would call with questions or needs). I could walk the 20-30 feet to the rooming-in room anytime I felt the need but otherwise I was sitting alone in an empty room. I was bored stiff though I did have a radio and a couple of books I took. I was actually happy when the mom wanted to take a lunch break because I would go to their rooming-in room and sit with the infant or even pick him up and rock him (fussy chronic kid). It was easier for me to go to his room than transport him with his oxygen and monitor back to the isolation room. The mom had a back-up number to call in case I had to run to the restroom or for my lunch break (I always told her if I was going to be out of the room).

Am I complaining? I guess not really, it was just really strange and didn't really feel like work. I guess more than anything I felt guilty because the last few days have been very busy at work and I saw all my co-workers running past my room so busy all night.

Will I volunteer to work isolation again with a similarly stable infant?

You betcha

[Gompers, BSN, RN]

OMG I hate isolation!!! It's not so much the social aspect of it, as there are always lots of magazines to read and the computer is right there with internet access. It's wearing the gown and mask and gloves all night. I feel like I'm suffocating and I get hot and itchy. We only have one isolation room, and it's only big enough for one baby. The only time we use it is for RSV, infant admitted from home, or an unknown organism (like a baby born with a really bad rash). It's got the reverse airflow and all that. So if we're in there, we're wearing a mask. (Our MRSA babies are cohorted in the regular unit with their own nurse.) The room is big enough for one rocking chair and one regular chair, so no room for a parent to sleep. A nurse has to be actually in the room at all times, as our ante room is just a tiny pass-thru of a room with a sink and all the isolation garb. If we need a break, another nurse has to come and relieve us.

I was once back there for two weeks straight. I was signed up for this one baby who contracted RSV while on the unit, so he was in isolation for two weeks straight. At first, he was sick (got reintubated) and I was busy. But the last week was so boring!!! He was off the vent, cranky, and NPO. It was just me and him, all night long. There was a lullabye tape he liked to have on at all times. I found myself siniging these songs to myself at home, in the car, in the shower...

One night his mom asked if I had his tape playing. She said, "Yeah, I think he's a little obsessed with that tape." My reply? "I think I'M a little obsessed with that tape!!!!!!"

For one baby with MRSA, we used Bactroban cream in the nares, BID, for like two weeks. She was then negative and was no longer on isolation precautions. I wonder why we don't do it anymore...

[sunnysideup09]

Wow! I'm amazed that you were only assigned to this one patient in isolation! When we have kids on isolation for MRSA, we still take a full assignment. We have an isolation room, but we have never taken just that one patient. We are paired with other stable feeder growers. With the right precautions, there is not a big risk of spreading MRSA.

Christine, RNC, BSN

[Gompers, BSN, RN]

If we have a MRSA baby in the general unit, we still are cohorted. So if it's down to one feeder-grower, we'll just have that one baby. It's silly, I think. It implies that we don't believe the precautions work!!!

If we have a baby in the isolation room, for whatever reason, we're always 1:1 because it's down a hallway in the unit and no one can see the monitors and baby unless they're in the room. We have to call for coverage to leave, even if the parents are there. What's funny is that any nurse can come and relieve, and even deal with the baby while you're on break...then go back to their assignment. Yet we're "dirty" for that night if we're assigned to that room.

[TiffyRN, BSN, PhD]

Gompers; our unit deals with MRSA like yours though we generally are only relieved by the charge nurse or delivery nurse. That makes sense right? Having the delivery nurse who gets exposed to the most delicate infants and goes to c-sections is our relief for Isolation.

One thing they did stop doing though that I thought was absolutely silly. It used to be that once you were assigned an isolation infant you had to stay with that assignment until you had a day off (to decontaminate?). The exception was if you were a delivery or charge nurse who happened to be taking an assignment some night (and that assignment was isolation). You could be charge/delivery when you came back the next night. Some of us nurses started all but opening mocking the management on that policy saying things like "I can't wait to be trained as delivery, that's when you get the magic shower. Or; "I'm just a regular nurse, I'm not trained on how to shower and change clothes when I go home".

I believe that following contact precautions should be enough (gowns/gloves, careful hand hygiene). However our Infection Control department feels differently and until the policy changes we must abide by it or risk liability.

[dawngloves, BSN, RN]

I would do it every now and again, but consistantly I'd beat my head against the wall. If I have a 1:1 I'd want to be busy for the most part.

And we take non isolation with isolation pts all the time. I don't recall any cross contamination, even when I did adults.

[walkingrock, ADN]

I can't believe an assignment with only 1 MRSA pt!! We do keep them in the same spot in the unit once a positive culture until discharge and try not to bring any different pts in that room, but the other pts stay usually in the same spot also until they are DC'd and also are cultured. However, we get a full assignment and use contact precautions and good handwashing. When I floated to our PICU recently, they are so used to multiple MRSA pts they just move them around wherever they need to and say, pretty soon they will have to start isolating the ones that DON'T have MRSA to protect them, because it is so prevalent out in the community and comes into the hospital from outside frequently now!