Contracting Respiratory MRSA After Death?????????

[kstec, LPN]

I took care of a resident who had MRSA of the lungs. Obviously we wore masks, gown and gloves when doing care while he was alive. His wife also wore the above. When he passed, she kept her gloves and mask on. She kept kissing him with the mask on and holding his hand with the gloves on. It looked so sad. I told her that she could take off her gloves and touch him and that to please wash her hands before leaving the room. Then I still felt bad as she kissed him with her mask on. I asked the ADON if the wife could remove her mask and kiss him goodbye or not? His reply was "No". My gut told me that it would be okay, and another nurse also said to go ahead and have her take her mask off and kiss him goodbye. I went to the room and washed the residents face with antibacterial soap and water and told her that she could take her mask off and kiss him goodbye. She cried uncontrollably as she bent down to kiss him. My heart smiled for her, yet broke at the same time. On my way home from work I felt good about my decision to let the wife say goodbye the way she did, but had this nagging feeling of "what if" the wife contracts MRSA. I called a MD I know and a infectious disease PharmD and they both said that they thought the risks after death with no mask and gloves were as probable as using gloves and a mask during life. Next to none. But nothing is guaranteed. So I ask you all, what do you think or know? It seems somewhat controversial, the facility that I worked at before didn't use any form of precaution with resp. MRSA, also when I worked at the hospital I don't think I ever saw a DR. wear a mask, gown or gloves when they went into a MRSA isolation room. Please, help me to think I made the right choice. I'm a very strong family and patient advocate and my only motive was to see a wife say goodbye to her husband with no barricades. Right, wrong or stupid decision????? Try and be nice with responses, please.....

[Virgo_RN, BSN, RN]

Since MRSA of the lower respiratory tract is transmitted via respiratory droplets, and the person was not breathing, then I would think the risks would be low.

[canoehead, BSN, RN]

I agree.

[traumaRUs, MSN, APRN]

Me too.

And it was an awfully nice thing that you did for this woman to allow her to kiss her husband goodbye. You deserve kudos for caring so much. Thank you.

[Tweety, BSN, RN]

MRSA is carried primarily through the hands, not necessarily droplets (the masks keep us from transmitting from our hands to our nares). So by kissing him she indeed had a risk. Isolation remains in effect after death, as does universal precations.

Remember though part of the chain is having a susceptable host. Was she in relatively decent health herself?

I would think if she were healthy, and used good handwashing, etc. she'd be o.k. and you did a good thing.

[lsyorke, RN]

My thought is that this situation warranted the risk. A final kiss goodbye....that takes precedence.

[MrsMommaRN]

what a beautiful thing you did for the wife. i am sure she will remember how special that was.

[bigjay]

Very minimal transmission risk since you cleaned his face before hand. MRSA will only colonize in moist environments (rectum, nares, lungs, etc) or the bloodstream. His face (the surface she touched) would only have had remnant organisms which would likely have been removed by the mechanical action of the washing and/or the anti-bacterial action of the soap used. Since he wasn't breathing no new organisms would've been introduced out of the colony within the lungs.

The more likely contamination would've been from her touching objects within the environment. Hand-washing would likely have resolved that.

[wooh, BSN, RN]

Totally agree with bigjay. And also agree, you did a wonderful thing!