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!

[Penguin67]

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.

Agreed. This is what I have a big issue with. Aren't L/D units supposed to be "clean"?

[Penguin67]

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?

I'm absolutely sure of my facts, as my friend has been quite open with me about this situation. Frankly what scares me is her nonchalent attitude about it. I know she is scared about a wound that isn't healing, but we must also consider our patients. Even if a nurse is "doing everything right", MRSA can be spread unknowingly. Check out www.cdc.gov or Google MRSA.

Not sure how you are generating my "assumptions" regarding this situation, but please recall what the act of assuming will do to you. I do resent the implication that I don't have the facts straight.

[Penguin67]

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:

That is what I thought a few years ago. But there is a strain of the virus called community acquired MRSA (CA-MRSA). It is discussed on cdc.gov

[Penguin67]

Thank you for all of your thoughtful responses. I have really grappled with this issue, especially since it involves a friend that I've known for a long time. I appreciate the responses that everyone posted and thanks for your input.

[Virgo_RN, BSN, RN]

This situation sounds like a lawsuit waiting to happen. I'm not a sue happy individual, but if I contracted MRSA while at the hospital giving birth, and my infant or I went septic and a death resulted, you bet I'd be holding the hospital accountable for allowing this to happen. I'm really surprised risk management isn't involved.

[Scrubby]

Sorry double post

[Scrubby]

I can speak from personal experience here. I'm an OR nurse and several years ago I contracted MRSA after having an IM injection which lead to an abscess which as it turned out was MRSA +ve. I had surgery but was left with a deep wound which took about a month to fully heal. I agree that if you have a weeping open wound which is contaminted with MRSA you shouldn't be working in the OR and should tell your infection control department straight away. Even with an occlusive dressing you can't always get out to change it if it gets too saturated.

But it wasn't easy at all for me. There was no policy at all for someone in my situation and they kept giving me conflicting information. I was told one week that I was allowed to go back to work, I'd turn up and be sent home. They did a nares, wound and groin swab and i was told if it was in my nostrils and groin i'd have to go through treatment even though the infection was in my wound.

However, I did argue about being sent home and forced on sick leave so I was allowed to do non patient care stuff like admin, auditing, helping out with research while my wound was healing etc which was interesting.

After many weeks of arguing and the nursing union becoming involved it was decided that once my wound had closed over there was no danger to my patients or myself and I could go back to the OR even if my nares and groin swab was +ve for MRSA. I wouldn't have involved the union at all but i wanted some straight answers on when I could return to work.

So I do believe your friend had a duty to report to her infection control department but she may have a fight on her hands. I was told that i'd have to tell every hospital i apply for ajob for about it, and that i could be refused employment in some areas.

BTW there is a policy on staff with MRSA at my work now thanks to me!

[Nightcrawler, BSN, RN]

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:

Actually, they are finding that the majority of MRSA infections now ARE coming from a community source. You very well can pick it up on the street or the subway, and many do everyday. Look at all of the stories last year about the infections that were in the schools. As much as I hated the hysteria that was blown up in the media, it did show just how prevalent MRSA is in the community

[oramar]

If she got the wound post operatively, in other words if she were a patient whe she aquired it, would that would not be different situation than having picked it up as an employee?

[lpnflorida]

Seems each of us has skipped around the elephant in the room here.

Talk with your friend, express your concerns, perhaps direct her to this site where she can view the different concerns people have expressed. It might anger her that you brought the issue to this forum. I would hope she would understand the angst that you feel.

I see this as a ticklish situation as it is your friend and you feel great concern for the patients she is around. Real friends get mad at us that is true, but a real friend will look at the whole picture and in the end still be your friend.

You need to be true to yourself.

[nerdtonurse?, BSN, RN]

Let's talk about CA-MRSA for a second.

1 -- MRSA can live for 11 days on a non-porous surface

2 -- The actual MRSA staph is no more aggressive than non MR staph; it's just that it doesn't react to most antibiotics

3 -- People can be colonized, and then their bodies fight off the infection on their own -- had people that were + in the nares come in and get a clean swab x2 with no antibiotics or interventions to kill the MRSA

4 -- We had a pt who was MRSA + everywhere -- blood, skin, sputum, nares, pretty much everywhere they could swab who was released from the hospital after a major debridement of a wound that wasn't healing. I pulled in to the local fast food place, and guess who's handing me my food out of the window? You guessed it. She had unbandaged cuts on her hand, and she's handling money and handing out food/ketchup packets/napkins. How many people do you think she's infected? I took the food, and threw it away and doused my hands in germx -- I couldn't ask someone else to fix my food without violating HIPAA when the manager asked me why, could I?

I remember what an old TB nurse at church told me. She said you couldn't give TB to some folks, even if you tried; others, if you just whispered "TB" in their ear, they'd come down with it. She said that she figured MRSA would end up being the same thing -- some people would catch it, seemingly from nowhere, others you wouldn't be able to deliberately infect if you wanted to..

[Vito Andolini]

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.

How is she doing wrong if her wound is occlusively dressed and her technique is impeccable?

I know the OP said the drainage saturates her scrubs, which I do not understand (why is she allowing this to happen?). But if a person is not allowing their drainage to get out of the wound or off of the dressing and if the person is being 100% with her clean and sterile technique, as called for by whatever procedure she is performing, I don't see how she is doing anything wrong.