Didn't know where to put this, but help?

NurseOnAMotorcycle, ASN, RN · Oct 25, 2013

In my clinical on Wednesday, I was inadvertently exposed to MRSA and VRE. The patient's chart said nothing about contact precautions, there was nothing on the door, and the nurse said nothing about it (and apparently KNEW nothing about it) so I was assigned to that patient because it was a "cool" case otherwise (deaf/mute with a PEG tube and it was my day to pass meds). After I'd been in and done my full physical assessment, Infection Control came upstairs LIVID that not only was there no contact precautions warning, but that a student was taking care of that patient. Apparently, this patient has been the biggest spreader of MRSA/VRE in the hospital, so I don't know why in the world "nobody knew."
Obviously, without knowing she had it, I only used gloves on her. I used my own stethoscope, didn't gown up, and used the BP machine. Everything was wiped down with alcohol before I found out and bleach afterward and I changed from my scrubs to my street clothes before I left, putting my scrubs and shoes in a garbage bag to go straight to the wash when I got home, but I'm so nervous that I'm going to get sick.
Any advice on what I should do? My teacher didn't seem too concerned other than being LIVID that this had occurred, but I want to make sure that I've done all I can to make sure that I don't get sick and/or contribute to the spread throughout the hospital. Luckily, I only had this one patient since it's first semester.

It sounds like you've done everything appropriate in response to finding out they were MRSA/VRE. If you had any open wounds during their care, then I'd watch for infectious processes like a large amount of swelling and pus (kind of like a huge painful pimple) right at the wound site.

I HIGHLY DOUBT that you'll have any problems at all because you performed good hygiene at the time (hand washing, bleach wipes, etc).

I hope this helps..

BeccaC623 · Oct 25, 2013

Thank you! It definitely does help. :)

Esme12, ASN, BSN, RN · Oct 25, 2013

Why were they livid you took care of a patient on precautions? We ALL take care of patients with precautions. We are all exposed to germs in the environment....we all would probably test positive if we were tested for MRSA...it's staph...it's everywhere. Literally everywhere.

Someone talked about this the other day.....MRSA, VRE all these bugs are in your everyday environment. They are on grocery carts, counter tops, restaurant tables, park benches....recently a local high school football team had a MRSA outbreak. It's everywhere.

Check out this thread....https://allnurses.com/general-nursing-discussion/contact-mrsa-now-884504-page5.html#post7582403

BeccaC623 · Oct 25, 2013

Why were they livid you took care of a patient on precautions? We ALL take care of patients with precautions. We are all exposed to germs in the environment....we all would probably test positive if we were tested for MRSA...it's staph...it's everywhere. Literally everywhere.
Someone talked about this the other day.....MRSA, VRE all these bugs are in your everyday environment. They are on grocery carts, counter tops, restaurant tables, park benches....recently a local high school football team had a MRSA outbreak. It's everywhere.
Check out this thread....https://allnurses.com/general-nursing-discussion/contact-mrsa-now-884504-page5.html#post7582403

Thanks! I assumed they were livid because I'm a first semester student and at this particular hospital we're not allowed to do anything on patients with contact precautions, droplet precautions, etc. in our first semester. I planned to follow up with my clinical instructor on Monday just to make sure I did everything the way I was supposed to, so I'll ask her about it.

Thanks for the great information, too. I wouldn't have even thought about it being in the environment for some reason just because of the constant conversation about it being a nosocomial infection.

KelRN215, BSN, RN · Oct 26, 2013

Thanks! I assumed they were livid because I'm a first semester student and at this particular hospital we're not allowed to do anything on patients with contact precautions, droplet precautions, etc. in our first semester. I planned to follow up with my clinical instructor on Monday just to make sure I did everything the way I was supposed to, so I'll ask her about it.
Thanks for the great information, too. I wouldn't have even thought about it being in the environment for some reason just because of the constant conversation about it being a nosocomial infection.

I'm sorry, WHAT? Why can't first semester clinical students care for patients on contact precautions? That might be one of the dumbest things I've ever heard.

How do they know that this patient was "the biggest spreader of MRSA/VRE in the hospital"? It's not like when Johnny James comes back positive for VRE they isolate it and say "oh he got this from Mary Sue in bed 12".

If you have a healthy immune system and no open wounds, you're unlikely to get sick. I don't think I've ever seen a patient symptomatic of VRE. All the ones I've known who had it only found out they had it because of routine surveillance done in the hospitals.

I think perhaps your school needs to include a little more education on MRSA/VRE and the like in its curriculum. The CDC is a good resource:

CDC - VRE in Healthcare Settings - HAI

CDC - MRSA in Healthcare Settings - HAI

BeccaC623 · Oct 26, 2013

I'm sorry, WHAT? Why can't first semester clinical students care for patients on contact precautions? That might be one of the dumbest things I've ever heard.
How do they know that this patient was "the biggest spreader of MRSA/VRE in the hospital"? It's not like when Johnny James comes back positive for VRE they isolate it and say "oh he got this from Mary Sue in bed 12".
If you have a healthy immune system and no open wounds, you're unlikely to get sick. I don't think I've ever seen a patient symptomatic of VRE. All the ones I've known who had it only found out they had it because of routine surveillance done in the hospitals.
I think perhaps your school needs to include a little more education on MRSA/VRE and the like in its curriculum. The CDC is a good resource:
CDC - VRE in Healthcare Settings - HAI
CDC - MRSA in Healthcare Settings - HAI

I have no clue on any of the things you asked lol. All I know is that every morning when we are getting assigned our patients, the patients with contact precautions are taken off of our list, idk if it's a liability thing or what, but that's how it works. I have no idea how they know she's the biggest spreader, either-I thought it was kind of weird when they said it but thought they knew better than me.

Thanks for the information, I'll definitely be doing my reading on it and sharing with my classmates.

futurenursedd · Oct 26, 2013

I guess different schools have different rules. Our clinical instructor will assign us to patients on contact precautions, but it depends on why they are on it. I had a patient with MRSA a few weeks ago. We were just instructed to wash our hands everytime we touched him, wear gloves when coming in contact with bodily fluids and make sure to cover any of our open wounds. So as long as you followed standard precautions you should be fine. It sounds like you did everything right. Just watch yourself for the next week or so for anything abnormal, but I think you will be fine.

EuropaRN · Oct 26, 2013

When I realized I had a higher chance of contracting a communicable disease at a grocery store (thanks for coughing a lung up while walking past me; are you having night sweats?) than in a hospital setting, I stopped being as concerned with MRSA or VRE. Even if I didn't know they had a hx, I still observe universal precautions and that's the best we can do. A small percentage of the general population is colonized with MRSA in the nares, so you could still pick it up from your pt with no hx.

I'm not suggesting to ignore and not gown up when going into a room of a patient on contact isolation, but it's not the end of the world if someone's cultures come back positive on your shift.

I had a similar experience in nursing school. I was in med/surg I, was taking care of this really sweet old lady who was having a lot of diarrhea. I didn't know to look at her antibiotic history and put the pieces together that she probably had a superinfection. I was almost done with my 9 hour day when they bring up the isolation cart and I realize she has c. diff (there was no characteristic smell). I had been using good hand hygiene after cleaning her and changing her bed, but I only used hand sanitizer after leaving her room. I was just sure I was going to get c. diff but I never did.

applesxoranges, BSN, RN · Oct 26, 2013

I am going to guess that the hospital's policy is based on the infection control suggestions or something if they threw a fit that big.

eatmysoxRN, ASN, RN · Oct 26, 2013

Welcome to nursing. We get exposed to everything, and it's almost always before we know it's there. That's why universal precautions exist. Except for wearing face masks, contact shouldn't be an issue if you're wearing gloves and washing your hands regularly. And if I'm dealing with poop, I'm washing my hands regardless. Hand sanitizer makes me feel like I'm rubbing poop into my skin.

truckinusa, BSN, LPN, RN · Oct 26, 2013

Just to scare the crap out of you...my cousin has MRSA and my aunt's boyfriend was cleaning a wound on his arm. Got some in his hand in a wound and died a few days later.

Guess who is the biggest spreader of MRSA and typically carries it on their skin? I wouldn't worry about it, but when u have contact with bodily fluids and especially feces it's best to wear gloves. MRSA is extremely common. The bad thing is when it enters your bloodstream and you are sensitive to it.