If a baby in your normal newborn nursery

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    Came up with a positive MRSA surveillance culture, what would your unit do? I'm asking because we had this happen, they NP's freaked and wanted the kid to go to NICU....which was refused because they didn't have any MRSA kids to co-hort this kid with and also the insurance wouldn't pay for the NICU stay as this is not a reason to send the kid to NICU. So now they have to come up with a game plan, such as keep the kid in mom's room until d/c and if detained, then moved to the ped floor for a private room.

    Just curious if any nurseries have a game plan.
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  3. 9 Comments so far...

  4. 0
    I would see about possibly repeating the test. Could be an error.
    If it bad enough to freak the NP that would be the most logical
    approach. To rule out error.
    I am not sure how prevalent the occurance is but based on the OP context does not seem very common.
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    I'm not working in the hospital setting, so I'm probably way out of touch with current practice. But why was a surveillence culture done? Was it because mom is known to be (+), or is this some new infection control plann? Seems like most normal newborns would be out the door before cultures came back.
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    The only time we culture a baby is if Mom has a hx. We treat the baby as if he were + until proven otherwise. Last time we had a baby come back +MRSA, we put him in an isolette and used gown/gloves for care. I think the latest from our infection control, though, is that we can leave them in an open crib as MRSA is spread via contact only and not droplet.
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    ......and then send him out to the general public without precautions....hmmmm
    RNfloatpool likes this.
  8. 1
    Unfortunately MRSA is so invasive that community acquired is becoming more common than hospital acquired and supposedly is also more virulent.

    We recently discharged a baby whose urine came back positive for MRSA. Mom was initially (prenatally) in isolation for C.diff. The baby had started out in isolation just to protect as best we could from cross- contamination. The urine culture was done when he was displaying some temp instability, poor feeding and increased events....as part of a septic workup.

    We had to keep him in our isolation room until discharge then everything that could not easily be contaminated (unfortunately including some baby books) had to be discarded.

    He was otherwise fine when he was discharged...you can't keep a person in the hospital forever who is colonized with MRSA. Most of us who have spent any amount of time in a health care facility may likely be colonized. What can you do?? We suffer the consequences of unwise choices in the use of antibiotics and the rise of antibiotic resistance.

    :typing
    prmenrs likes this.
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    Here is what happened....mom had a little pimple thing on her leg, so the NP popped it and cultured it, then they cultured the baby. Both mom and baby were positive with a "rare organisms detected". NP's freaked and wanted the baby out of the nursery pronto. What resulted was that baby was sent to mom's room, then they tried to send the kid to us...okay, we sure don't want MRSA in our unit, thanks, but no. The whole nursery got swabbed (before they consulted with ID) and 3 more kids came back positive, most likely from mom.

    So, now they are trying to get a protocol set in place in case this happens again. Our case managers did call several insurance carriers to see if this would have been covered and they said no, since the baby was not sick enough to be in ICU. Interesting to see how this plays out.

    That being said, we culture all new admits to our unit since hospital acquired infections will no longer be covered by Medicare/Medicaid and we have to show if the kid comes in with it. And if they swabbed most of us, yes we would be colonized just from working in the hospital setting, so we are out in public without precautions, no difference
    Last edit by BittyBabyGrower on Aug 19, '08 : Reason: add
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    It seems that the protocol for the baby should be the same as the protocol for an adult patient on your unit. In fact, when we have a mom on precautions, her baby is also considered to be on precautions and must remain in the room at all times. Absolutely no visits to the well nursery. I can understand why that baby was rejected from the NICU.
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    JMHO

    Don't get surveillance cultures unless you know what you're gonnna do w/the results.

    People get MRSA w/o setting foot in hospitals.
    Elvish, Jolie, and NurseCard like this.
  12. 0
    If the baby is asymptomatic and/or the infant cannot be properly isolated, I can see definitely why not NICU. Why unleash the potential for MRSA amongst 600 gram infants on ventilators with no immunity??

    I understand we all use universal precautions and our unit still requires a two minute scrub...but the safer the better IMHO. I feel our babies have enough mountains to climb to go home....we still even only allow parents and grandparents to visit (and siblings of a certain age) unless the baby is going to pass....then we are more liberal, but we also set up more space around the baby for visitors.


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