Doctor postponing surgery over MRSA Colonization (nares)

[Gr8Dane]

First time I have ever seen this. The doctor was in for medical clearance, he saw the patient has MRSA colonization of the NARES. He is now postponing the surgery for 5 days for treatment (Bactroban ointment in nose).

The surgery was a PLIF but now the patient has to wait a week and redo everything.

Anyone ever hear of this? I could understand active MRSA but colonization of nares...

[Virgo_RN, BSN, RN]

What's a PLIF?

[HouTx, BSN, MSN, EdD]

This is becoming much more common. MRSA is a deadly threat - and getting worse. At our local VA, MRSA screening is part of the admission process so they can implement prophylactic isolation as needed. I say KUDOS to the doc for being up-to-date with current medical practice.

[Gr8Dane]

Posterior lumbar interbody fusion or something like that.

I forsee problems with it personally. So many are colonized. The bactroban treatments are not proven effective last I knew, studies stated it doesnt not prevent recolonization, more of a temp fix.

[Mammy1111]

I am currently working on MRSA mandates and legislation in the State of Maine. This doctor is doing exactly the right thing by postponing the surgery. Even colonized MRSA can be spread from one patient to another and from that colonized patients nares into a would after surgery. Other steps will also help that patient to avoid MRSA infection after surgery. Clipping instead of shaving hair and hibiclens showers.

I am curious if this patient is either isolated or cohorted with another MRSA positive patient. If not, she should be.

There are a lot of things that can be done to prevent MRSA in hospitals. I work so hard at it because my father just died of MRSA pneumonia that he contracted in a hospital while rehabing from a minor fracture.

[Gr8Dane]

The preops were hibiclens showers night before and am prior to the surgery. Bactroban ordered twice daily applied in nares as soon as cultures came back positive. There was already preop 1gm vanco ordered prior to the surgery.

And you are wrong about cohorting a nares colonization with another MRSA...That is the biggest mistake everyone makes, especially my hospital. Why would you put a COLONIZED patient w/ a possible ACTIVE patient. MRSA should be private no other way. Can not trust all health care providers to take proper steps (Universal precations, contact, etc) all the time.

[Mammy1111]

Isolation is always the first choice. Cohorting is only the second choice. The goal is to NEVER put a MRSA patient, either colonized or infected in with a MRSA negative patient.

Precautions, EARLY STRICT and APPOPRIATE....handwashing, handwashing handwashing...when entering a room and between patient contacts if 2 MRSA patients roomed together.

Maybe someday all doctors will be as smart and the doctor in this post and do the screening prior to patient admission. I know screening isn't always possible in advance, but it is certainly possible in non emergent surgeries.

[Gr8Dane]

Let me ask you as while I am familiar with general policies and have readup on MRSA fairly extensively. Is there not a difference between active and colonized? (But still have not found the answer to this question)

As in, how could it be acceptabled to place a patient with a positive MRSA wound culture in with a patient whom has colonized MRSA in their nares undergoing bactroban treatment per say?

[Mammy1111]

MRSA is contageous whether the patient is colonized or actually infected. If a person touches inside his nose, has MRSA in nares, then touches an uninfected patient or their personal items, he can spread that disease to another person. He can also spread it from his nares to other parts of his body...this is why they use bactroban to clear MRSA in the nares, so they won't spread it into their surgical wounds.

Ideally, everybody would have a private room and cohorting wouldn't be an issue. But, since that is not available in most hospitals or nursing homes, cohorting is a second choice, after full isolation.

I have made a study of MRSA because my father died 3 weeks ago with HA MRSA pneumonia. I have been in touch with experts about this including Jeanine Thomas, the woman who has written and gotten passed the first MRSa bill in the US in Illinois. She is very knowlegable and is a victim of MRSA herself. She uses the guidance of two infectious disease physicians. She has helped me to write a proposal for MRSA screening, prevention, and reporting in the State of Maine. It is being reviewed and written into legislation as we speak. We all have to start somewhere with prevention. I am sick and tired of hearing about what hospitals CAN'T do, because I know there are things that they CAN do.

[Mammy1111]

And yes, there is a difference between a colonized MRSA patient and an infected or active MRSA patient. The infected patient has symptoms of infection, fever, weakness, drainage from wounds, infected sputum...according to where the infection is. Respiratory MRSA patients absolutely need to be isloated because they produce droplets...whether they are infected or colonized. If they are coughing, masks along with gloves and gowns are called for.

[Gr8Dane]

Interesting. I truely feel MRSA isnt treated with the respect it deserves but by the time it is everyone will have it.

[Mammy1111]

If this is any consolation to you, Richard Durbin of Illinois is sponsoring a bill in the Senate to address Hospital Acquired infections. YOu can go on the Consumers Union webpage and write to your senators and representatives to support it. CDC has been dragging it's feet for way too long. Their recommendations are just that...and nothing is mandated. That is why a hospital in my town may have a different policy than yours. My father's hospital did absolutely no nasal cultures for screening purposes. NO wonder he is the 3rd one to die in the last few months of MRSA from that hospital. The other two were joint replacements. This is in a small 25 bed community hospital. If they don't know who is MRSA positive, they don't have to deal with it, and they are NOT held accountable in any way. They don't even have to report the infections to the State CDC or to the Federal CDC. That is outrageous. When my proposal passed, hospitals in Maine will do business differently and the policy will be the same in all hospitals. No more picking and choosing.

A doctor in Dad's hospital said to me that precautions "are a nursing thing". Is it possible that doctors NEVER get dirty? We need a complete culture change in hospitals....a culture that keeps patients safe and protected from these horrible infections.