Ethical Issue: Nurse with MRSA

[Penguin67]

I have a nurse friend who had surgery several weeks ago, and the wound is still weeping alot and hasn't healed, despite abx. The wound was cultured, and found to be MRSA positive. This nurse is in an OR setting for c-section deliveries, as well as working on the labor delivery floor. This nurse is now taking a MRSA drug (clindamycin, and will progress to vanc if needed), but continues to work-on a clean l/d unit as well as in the OR.

My questions:

1.) I know many health care professionals are MRSA positive, but doesn't having a weeping wound that has saturated your scrubs merit some sick time? It's hard for me to understand why she is putting her patients at risk. (And everything that I've read on MRSA states that it is ok to work, but only if the wound is covered and not weeping.)

2.) How do you disinfect a room after an MRSA patient leaves it? Furthermore, how does one disinfect their home after their MRSA weeping wound culture is negative? (ie Should we make a visit there to see her or not?)

3.) What should the rules be for mandatory sick time for a MRSA positive nurse?

She is not even in the same town or state as I am, so we are not working together. I'm left wondering if she isn't protecting her patients form MRSA, then would her home be "clean" for guests? I'm not sure that a simple discussion with her would work, as she would view it as a confrontation.

The reason I am thinking so deeply about this is that about two years ago, the l/d unit I work on had several post c/s patients return with MRSA infections, and Infection Control mega analyzed the situation and resulted in many many many preventive interventions for all staff. Such as wearing in street clothes, and changing into scrubs at work, as well as a more indepth post op prep.

If anyone has any ideas on this topic, please post.

Many thanks in advance!

[lpnflorida]

I am assuming your friends wheeping wound has an occlusive drsg so that any drainage would be contained underneath it. I am assuming she is changing her dressing before the drainage gets onto her uniform. Again these would only be assumptions. Going one more step perhaps she has no more sick time/pto left to her so working is not exactly one of choice. I assume she has discussed this with her supervisor and was okay'd to return to work.

I have no answers for the rest of your thread. I would have to think long and hard on it. As my initial " oh my god ,she should be home, verus the second thought considering what might be going on that she is working, will lead me to think of the other aspects this brings up"

This is a great topic to explore.

[BelleKat, BSN, RN]

I would assume nothing and think that this nurse is working to keep from having to call in and has not had any conversation with her supervisor or she would be at home. I know nurses who had to stay home from working in a dirty unit when they had positive mrsa in their nares. Even with an occlusive dressing assuming she has impeccable technique she is endangering her pts and should at least be transferred to another unit until her wound is closed. That is an egregiously unethical practice imo.

[Virgo_RN, BSN, RN]

1.) I know many health care professionals are MRSA positive, but doesn't having a weeping wound that has saturated your scrubs merit some sick time?

I would think so, but as mentioned above, perhaps her PTO bank is empty and she simply cannot afford to be without a paycheck. This prompts me to strongly consider taking out some STD insurance in case something similar happens to me!

2.) How do you disinfect a room after an MRSA patient leaves it? Furthermore, how does one disinfect their home after their MRSA weeping wound culture is negative? (ie Should we make a visit there to see her or not?)

Chlorine bleach kills MRSA. If it were me, I'd disinfect my home by washing all washable fabrics in hot water and drying them on hot. I'd wipe down all surfaces with a beach/H2O solution. Any upholstery/drapes/carpeting that is not easily washable, I'd have steam cleaned. I would think that a visit for the purpose of determining whether her home is clean would be an invasion of her privacy.

3.) What should the rules be for mandatory sick time for a MRSA positive nurse?

I would think it would be appropriate to return to work if the nurse is on an appropriate antibiotic and the wound is covered and not draining. If the nurse is having difficulty containing the secretions, then, to me, it would seem to be inappropriate to enter public buildings.

[Quaffetti]

I'm sure your friend is between a rock and a hard place.

I was discussing the MRSA issue with my manager the other day, cause we admitted a pt who three years ago has a wound with mrsa in it and we had to put her on contact precautions, despite the fact that the wound is totally healed. My manager said we had to do a nasal swab and get a negative result before we could take her off precautions.

I said to my manager, "Suppose they did nasal swabs of all the nurses here. I bet at least half of us would have positive swabs, yet we aren't isolated." She agreed.

The discussion went on and I said if the hospital started requiring that (and it actually looks like we are headed in that direction) that I could collect L&I since I would have gotten MRSA from my job and my manager said there is no way I could prove that and therefore I wouldn't qualify for L&I.9

I imagine your friend is in the same kind of predicament. Her wound is probably mrsa positive; she probably got the mrsa at the hospital, but has no way to prove it so they won't help her out, and she is probably out of sick time.

I mean, what else can a nurse do when she can't be a nurse anymore? The skills really don't translate to the rest of the work world. I always think about this in the context of if I screw up and lose my license. Really, what else could I do with my current skills?

[BelleKat, BSN, RN]

I realize it's a difficult situation,that it's not black and white but also the pts don't deserve to be exposed to mrsa by someone who has a mrsa + draining wound,especially the babies who don't even have a efficient immune system yet. What a way to start out life.

[wooh, BSN, RN]

You aren't working with her (by your own admission, you're in a different state), so I wonder how many of the facts of the situation you really have straight. Why assume she's not protecting her patients? Perhaps she is doing everything right and protecting her patients. You seem to assume she's spraying pus from her wound on everyone and everything around her. Why are you so sure she's not looking out for her patients?

[Simba&NalasMom, LPN]

I'm sure your friend is between a rock and a hard place.

I was discussing the MRSA issue with my manager the other day, cause we admitted a pt who three years ago has a wound with mrsa in it and we had to put her on contact precautions, despite the fact that the wound is totally healed. My manager said we had to do a nasal swab and get a negative result before we could take her off precautions.

I said to my manager, "Suppose they did nasal swabs of all the nurses here. I bet at least half of us would have positive swabs, yet we aren't isolated." She agreed.

The discussion went on and I said if the hospital started requiring that (and it actually looks like we are headed in that direction) that I could collect L&I since I would have gotten MRSA from my job and my manager said there is no way I could prove that and therefore I wouldn't qualify for L&I.9

I imagine your friend is in the same kind of predicament. Her wound is probably mrsa positive; she probably got the mrsa at the hospital, but has no way to prove it so they won't help her out, and she is probably out of sick time.

I mean, what else can a nurse do when she can't be a nurse anymore? The skills really don't translate to the rest of the work world. I always think about this in the context of if I screw up and lose my license. Really, what else could I do with my current skills?

Unfortunately, your boss is probably right from a legal standpoint; however, where on earth else would an RN pick up MRSA if not on the job? It's not something you just pick up on the street or a crowded subway (at least, not yet).

It absolutely sickens me that nurses run the risk of losing their livelihoods because nosocomial infections are so out of control. :argue:

[GadgetRN71, ASN, RN]

Actually, there is MRSA out there in the community and it's pretty ugly. There have been a couple of people who have died from it too. You don't see people in the public on precautions. They're going to the same gyms as us, using the same salad bars etc.

The other thing that ticks me off is when they allow pts to go down to the cafeteria to get something to eat..they're in jonnies, with their germy IV pole. Nasty.

[Virgo_RN, BSN, RN]

where on earth else would an RN pick up MRSA if not on the job? It's not something you just pick up on the street or a crowded subway (at least, not yet).

Ever heard of CA-MRSA (Community Acquired MRSA)? It is on the rise.

[lpnflorida]

We all want our patients to be safe, especially as someone has already pointed out new Born's deserve the best start. Our populations in the hospital setting , the SNIFS etc. are already so compromised no matter their age or socio-economic status.

This leads me to think of when any of us are sick example having the flu or a cold let alone MRSA or something else. On the one hand we know we should be home as we recognize we do not want to pass our illnesses onto the patient or to our fellow coworkers.

Yet the reality remains, if we stayed home each and every time we were sick, we would end up reprimanded at work. As the vary institutions which are for the sick frown on their workers calling off sick. Yes, we can get our doctors to write us excuses. Reality is how many of will bother them for a cold or flu.

Perhaps this is something that needs to be address. Caregivers get sick, yet we drag ourselves into work sometimes out of fear , sometimes out of loyalty, sometimes as we just can not afford to stay home one more day.

I once worked at a facility which gave us 12 paid sick days a year, but you had better not use them. I work now where we do not have sick days, we have PTO but again you had better not use them often for being sick.

How often have I been guilty of thinking you are sick " stay away from me I cannot afford to get sick" Or been guilty of thinking oh sure so and so called in sick again.

Once again I find myself with no perfect answers, no real solutions, just more questions and thoughts than the original theme of the post.

[Penguin67]

I am assuming your friends wheeping wound has an occlusive drsg so that any drainage would be contained underneath it. I am assuming she is changing her dressing before the drainage gets onto her uniform. Again these would only be assumptions. Going one more step perhaps she has no more sick time/pto left to her so working is not exactly one of choice. I assume she has discussed this with her supervisor and was okay'd to return to work.

I have no answers for the rest of your thread. I would have to think long and hard on it. As my initial " oh my god ,she should be home, verus the second thought considering what might be going on that she is working, will lead me to think of the other aspects this brings up"

This is a great topic to explore.

The dressing is not occlusive, and leaks.She noticed after a c-section that the dressing was saturated, as well as part of the scrubs. Not sure about the sick time, as she's been at the job for less than 2 years, and I don't know how much she has accrued or used.