Ever take care of a patient for a while to later find out...

[wanderingRound]

They had some sort of disease/illness you could have transmitted from them but nobody realized they had the condition until later on?

I had a patient from prison this last week and I took care of him for a total of 6 nights (12 hour shifts) to find out on my last night that the day nurse looked at the results of his sputum culture and saw he has respiratory MRSA. He had really been coughing pretty badly for the past few nights which makes me paranoid about the whole situation. Myself and the CNAs who had been caring for him are frustrated about it and wish we would have known sooner, especially since many of us have small children at home.

The sputum culture was taken from the day of 5/17 and no one realized he had respiratory MRSA until the morning of 5/20 and at that point he was placed in airborne isolation. I know it can take a couple days for cultures to come back, but I'm guessing the results were back for atleast a day without anyone checking the microbiology report to see what type of culture was growing. Could this place the nurses that were caring for him who should have checked the report (and subsequently initiated isolation precautions) under any liability if someone were to be infected with respiratory MRSA and push the case?

[jorjaRN]

Unfortunately, this kind of thing happens all the time. It's not realistic to place every patient that could possibly have some drug resistent bug on isolation until it is ruled out. There wouldn't be any patients not on isolation. I used to work in a facilty that placed patients in isolation on admission if they had any positive results on the records of previous hospitalizations until they were ruled out, but the place I work now doesn't do that. I took care of a patient not too long ago that had a recurring abcess that had been positive for MRSA previously. There was a culture ordered, and he wasn't on isolation until the results came back. Of course they were positive. I had been treating the room like an isolation room as much as possible even before that, because I figured it would, but it's about the money, and isolation supplies cost a lot of it.

Honestly, I figure I've probably been exposed to MRSA and who knows what else multiple times by this point, and I try not to stress about it. Like others have said, there are people in the community coughing all over the place with who knows what kind of germs. I try to think on the bright side and figure I'm developing a killer immune system

[cb_rn]

Ever go to a store that doesn't have those nice sani-wipes for the handle of the shopping cart?

(this is a general YOU, not one exclusively to the OP)

Do you think everyone that shops at your grocery store washes their hands the way they probably should after going to the bathroom? Or picking up the tripping package of ground beef? How many cough without covering or (gag) sneeze and cough in the their hand and then push the cart around some more?

I understand the crappy feeling of not knowing someone was on isolation - I have 3 kids under age 5 and spent nearly half of the last 6 years pregnant at work; I really feel your pain.

However a very wise nurse once told me as I complained about another late contact precaution that I should be treating everyone with universal precautions, be generous with using gloves, and really follow the thorough handwashing procedure.

Makes sense to me. Not to disparage housekeeping but I really doubt they do a 100% smashup job on any patient room. There are probably all kinds of cooties left over from previous isolations. I make it an art form to touch as little as possible, no matter what setting I'm in. In home care you don't even use isolation precautions per se even when the wound is known to be contaminated with MRSA.

I put masks on myself all the time when I have a drippy nose, with the patient has a drippy nose, when the family looks like a walking petri dish....

And another thing. I get home from work and strip pretty much at the door. Straight into the shower, before I ever touch the boys. Everything from work, including shoes is always washed seperate.

There are some good points raised about your hospital's standard of infection control however. Heck, it may be discriminatory in a way, but all dialysis pts and people from SNFS and LTC are automatic contact precautions until the cultures get back.

Try not to sweat it, you are probably way more of a danger to the patients with the compromised immune systems (kids are dirty cesspools you know!) than they are to a healthy individual.

[dee78]

Yep, same thing happened to me a few weeks ago. I'm getting my LPN, first clinical assignment was at the nursing home. I took care of a patient all week and then on Friday she was put on precautions for respiratory MRSA.

[belgarion]

ERs, clnics, dialysis facilities, admission departments, and on and on have wheelchairs sitting by the front door for patient use. After that patient is through, the chair is put back by the door for the next patient. GOK how many and what kind of cooties are crawling around on the seats, backs, and handles. And this doesn't even include the scooters and courtesy wheel chairs at the grocery, Wally World, Target, etc.

[SlightlyMental_RN]

Happens all the freakin' time. I just try to get enough rest, drink plenty of fluids, eat as healthfully as possible, and hope for the best. So far, my immune system is doing a pretty dang good job. (thanks, body!)

[Zookeeper3]

i agree with Hagatha...any pts admitted to my facilty who is suspected of anything is immediateley put on the necessary precautions...i dont understand y ur facilitly doesnt practice this ave oneas well...sorry to hear about that but mayb u should speak with ur manager r QA about situations like this

yeah, we are not a prison but we have a standard respiratory screening that would have put this patient in isolation. You never need an MD order to wear a mask to protect yourself, and with a coughing patient you should have. I'm not being nasty, but at work, I protect myself and never would have entered this room without the door closed, a mask and called the MD for a TB room until ruled out.

well we all have mrsa at this point, but we're just not active... but get a TB or H1N1... yeah... you need no one but your self to protect you, just do it.

Employee health will follow up with your exposure but its too late. You can never trust the doc or EH to immediately protect you, that's why you have the equip. It's there for you to use. Use it my nursing friend... smooch

[neutrophil]

It does happen a lot. I have worked in places where I was told to put isolation precaution signs on the door of a patient after taking care of this patient for 4 hours.

When I was a CNA I worked per diem at ER, people don't go into the ER with a sign on their chest.

In a nursing home, I had to have the CNA, bathe a patient and change the linens of patients that I would put Elimite cream, because they were found to have scabies. This was after working with him for some time.

Nursing, this is nursing. Simply put.

[nursel56]

ERs, clnics, dialysis facilities, admission departments, and on and on have wheelchairs sitting by the front door for patient use. After that patient is through, the chair is put back by the door for the next patient. GOK how many and what kind of cooties are crawling around on the seats, backs, and handles. And this doesn't even include the scooters and courtesy wheel chairs at the grocery, Wally World, Target, etc.

One of the EMS bloggers I read did an entire pictorial post pointing all the yuck on their backboards, which you could actually see in the crevices and indentations on the equipment----really nasty.

[tvccrn, ASN, RN]

In the facilities I have worked in, once a patient is suspected to have MRSA and swabbed they go into isolation until proven otherwise. Is this not common practice?

[Penelope_Pitstop, BSN, RN]

One unique thing that you learn in child psych, and probably on any pediatric unit, is that lice aren't THAT easy to catch unless your head comes in contact with the patient's head, or in contact with an object that has been on their head. They can't jump or fly. :) Universal precautions should be sufficient.

If you insist.

I'm sitting here scratching my head just from reading about it, though.

:)