Contact isolation for MRSA question

RNKPCE · Jan 4, 2009

wow all patient who have been previously hospitalized on contact precautions. Most of our unit would be in isolation.

We swab anyone from a nursing home or hospitalized within 30 days of current admission.

Any hospital swabbing their staff? I bet they don't want to know how many would come up positive. That would open a can of worms.

Editorial Team / Admin · Jan 4, 2009

We're the same way- anyone with just a history of anything requiring isolation is put in isolation until cultures come back negative. We also put anyone from a nursing home/ care facility into isolation until a nasal swab for MRSA comes back negative.

Our unit actually did swab a few people who work with the same surgeon on a routine basis- his cases were testing positive at a high rate. None of the staff tested turned up positive.

jeninthedesert, BSN, RN · Jan 4, 2009

The Mayo Clinic has some information about MRSA and colonization: http://www.mayoclinic.com/health/mrsa/DS00735/DSECTION=causes

Sometimes MRSA is an opportunistic infection in people with compromised immunity, so the contact precautions are also put in place to prevent the staff from transmitting MRSA to other patients (blood pressure cuffs, stethoscopes, lack of handwashing, etc.).

More Info:

http://www.medicinenet.com/mrsa_infection/article.htm

http://www.webmd.com/skin-problems-and-treatments/understanding-mrsa-methicillin-resistant-staphylococcus-aureus

*ac* · Jan 4, 2009

The Mayo Clinic has some information about MRSA and colonization: http://www.mayoclinic.com/health/mrsa/DS00735/DSECTION=causes
Sometimes MRSA is an opportunistic infection in people with compromised immunity, so the contact precautions are also put in place to prevent the staff from transmitting MRSA to other patients (blood pressure cuffs, stethoscopes, lack of handwashing, etc.).
More Info:
http://www.medicinenet.com/mrsa_infection/article.htm
http://www.webmd.com/skin-problems-and-treatments/understanding-mrsa-methicillin-resistant-staphylococcus-aureus

I understand that we are trying not to spread it from one pt to another... I totally get that when it's c-diff or something that I definitely don't have, but what's keeping us from spreading MRSA from us to the pt? Assuming most of us are colonized with it.

jeninthedesert, BSN, RN · Jan 4, 2009

There is no guarantee in that regard, which is why we take precautions against nosocomial infections with the proper hygiene and asepsis techniques (washing hands before contact with patient, equipment, etc.). We can help break the chain of transmission with good hygiene practices, whether it is transmission from us to a patient or transmission from patient to patient. :)

Virgo_RN, BSN, RN · Jan 4, 2009

We're NOT all colonized with MRSA, just like we're not all infected with herpes or HPV.

Even if you were colonized, think about the route of transmission. MRSA likes a warm, moist environment, such as the nares, a wound bed, or the bronchial passages (I've even heard of a strain that likes the anal region).

Do you go to work with an open, oozing, infected wound and spread the secretions on your patients? Do you go to work with an active lung infection and not wear a mask when providing patient care? Do you scratch your bottom, then touch the patient without washing your hands? If the MRSA is in your nares, how often do you place your fingers in your nose and then provide patient care without washing or gelling?

When a person with MRSA is hospitalized, generally they're not jumping out of bed to wash their hands every time a nurse walks into the room. They're usually hacking, coughing, oozing wound secretions, and touching themselves wherever, and if they get out of bed, they probably only wash their hands after using the restroom (if that), or before eating (again, if that). So when you walk into that room, think about all the microorganisms clinging to the many different surfaces in that room.

This is why you use contact precautions to enter the patient's room. Not only do they potentially have MRSA on their person, but it's highly likely that they have spread it to fomites such as their bedside table, faucet handles, their water pitcher, the bed rails, their linens, etc. MRSA can live for a long time on fomites.

You, as a health care worker, are expected to wash your hands before and after every patient contact. One would think you'd have the sense to avoid touching your face, wash your hands after using the bathroom, and to not spread infection by showing up for work with oozing wounds or infectious respiratory droplets.

Can you see the difference?

caringchic · Feb 19, 2009

I totally understand but...how is it then that dietary trays are not isolation trays, and shall we evern mention the docs? How many times have I not seen a doc suit up! They are germ proof?!

Roy Fokker, BSN, RN · Feb 19, 2009

I totally understand but...how is it then that dietary trays are not isolation trays, and shall we evern mention the docs? How many times have I not seen a doc suit up! They are germ proof?!

You're talking 'sense' now.

Remember - nursing isn't supposed to "make sense".

Our primary goal is to fill out papers.

Stop questioning authority!! Must I send you to the JCAHO-lag?

Equinox_93 · Feb 19, 2009

I understand that we are trying not to spread it from one pt to another... I totally get that when it's c-diff or something that I definitely don't have, but what's keeping us from spreading MRSA from us to the pt? Assuming most of us are colonized with it.

... What's keeping you from spreading it? Your handwashing, gloving and other PPE.

As far as what makes one pt become infected while another may only be colonized- that depends on immunity, opportunity- the entire chain of infection... Some have compromised immunity, others have health conditions such as lymphedema that predisposes them to staph infections due to slowed lymphatic circulation etc. Some are just unlucky and have a cut in the skin and it gives the little buggers a toe hold to latch onto and multiply.

Also- what I've heard is that *some* are colonized with staph- not MRSA, just regular old staph... Not sure on that point as far as the colonization *rate* (how many are colonized)...

Virgo_RN, BSN, RN · Feb 19, 2009

I totally understand but...how is it then that dietary trays are not isolation trays, and shall we evern mention the docs? How many times have I not seen a doc suit up! They are germ proof?!

I don't know how it works at your facility, but where I work, you glove up, go retrieve the tray from the room and place it directly into the cart, then perform hand hygiene. The kitchen workers wear gloves when they empty the carts of all of the dishes, and the dishes and trays are sanitized at a high temperature that kills bacteria. The insides of the carts are cleaned with antimicrobial agents. Infection control has approved this process.

As for doctors, I'd say that most of them where I work use appropriate PPE, and we are encouraged to speak up if we see a doctor failing to use the appropriate precautions.

Ms.Smart E Pants · Feb 19, 2009

I work in Oncology, specifically Bone Marrow Transplant and Stem Cell transplants...our facility has the same policy as some I've seen posted here...pts who have ANY history of MRSA or VRE are placed in iso (it's a case of guilty till proven innocent). If they come back neg we take them off iso. It's at least 7 days til we get their culture results back. Our pts are usually with us for some time. Each Sunday we do two swabs. The reason this is being done is because of Medicare. The gov is refusing to pay for treatment of these pts who get these bugs in the hospital, just like decubs, etc. So we swab to determine if they had it when they came in. It's sad it all comes down to the bottom line, but lets face it...without our facilities caring about that bottom line, we wouldn't have a job, or one that pays anything. :twocents: