Exposed to MRSA resident

Editorial Team / Admin · Apr 7, 2018

Food for thought: all those patients in isolation in health care leave those precautions behind when they are discharged. They're at the grocery store, touching the handle of the grocery cart you're using or the produce you buy. They're at your church, shaking your hand as the service ends. They're at your child's school cheering on his teammate. MRSA isn't just a health care facility bug. You may have been exposed out in the activities of daily life.

Then there's the difference between colonization and infection. Colonization simply means that the bacteria are present, not that one has an actual infection. The nares are a common testing site when screening. Presence of bacteria does not equal infection- we carry an astounding number of microbes on our skin every day- yet we are not infected by them.

Take a deep breath. This is not the end of the world.

**NICU Guy, BSN, RN** · Apr 7, 2018

I have heard the claim that all healthcare workers are colonized with MRSA. If you were to swab the back of any experienced nurse's neck, it would be positive for MRSA due to the fact that nearly every nurse puts their stethoscope around their neck.

Atelophobia · Apr 7, 2018

That is a very good point..it reminds me to always take precautions no matter what the setting. The facility I work at does not seem to be taking the measures needed to prevent the spread. We are not even provided protective gowns, and the update sheet does not specifically state the resident has MRSA, it instructs us to assist her in the bathroom more often (She has UTI MRSA). Nothing else mentioned.

chare · Apr 7, 2018

The CDC states that standard precautions should control the spread of MRSA in most instances. As for contact precautions, the following is from the CDC's Precautions to Prevent Spread of MRSA:

CDC recommends contact precautions when the facility (based on national or local regulations) deems MRSA to be of special clinical and epidemiologic significance. The components of contact precautions may be adapted for use in non-hospital healthcare facilities, especially if the patient has draining wounds or difficulty controlling body fluids.
These contact precautions should be followed for some patients. To determine if a patient needs to be placed on Contact Precautions see page 38 of Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006.

Wuzzie · Apr 8, 2018

You're more likely to get MRSA from the handle of the grocery cart you use or the equipment at your favorite gym, the gas pump, door handles and just about anything else you touch in public. MRSA is everywhere and causes no problem in intact skin. There are NO special precautions required for MRSA outside of standard. No need for tears.

KelRN215, BSN, RN · Apr 8, 2018

What, exactly, are your concerns with being exposed to MRSA? I don't see why this is any reason to cry one's eyes out or run to the doctor. We've all been exposed to MRSA. I was actually quite surprised that I tested negative for it when I was screened the last time I was in the hospital. That was 8 years ago though, I'm probably positive by now. I literally have no idea as a community case manager now if any of my patients are MRSA positive. Some of them probably are. And, MRSA or not, you should remove your PPE prior to leaving the patient's room unless the patient is on airborne precautions, then you leave your respirator on until you're in the ante room but you would still remove your gown and gloves in the room.

m1lkofamnesia · Apr 8, 2018

Lol after being a nurse for X amount of years...I probably have MRSA. :whistling:

Atelophobia · Apr 9, 2018

What, exactly, are your concerns with being exposed to MRSA? I don't see why this is any reason to cry one's eyes out or run to the doctor. We've all been exposed to MRSA. I was actually quite surprised that I tested negative for it when I was screened the last time I was in the hospital. That was 8 years ago though, I'm probably positive by now. I literally have no idea as a community case manager now if any of my patients are MRSA positive. Some of them probably are. And, MRSA or not, you should remove your PPE prior to leaving the patient's room unless the patient is on airborne precautions, then you leave your respirator on until you're in the ante room but you would still remove your gown and gloves in the room.

According to CNN, "Twenty-five to thirty percent of the population is colonized with staph, and less than 2% is colonized with MRSA".

My concern is being colonized with it and spreading it to my loved ones. After I told my family what happened, they were the motivating factor into me giving a two week notice to my manager today. The money I was making at my job ($11/hour, 70 cents less than my retail job) was not worth being exposed to a resident that had MRSA, whose room was not frequently sanitized and would not wash her hands after using the bathroom unless instructed. To me that signals that everything she then touches, and providing her dressing assist, I was more than likely exposing myself to MRSA on a higher scale than I would be comfortable with. She frequently used the public toilet (2 seperate public toilets on our floor) other staff and residents use, over which time I had no idea she has had issues with MRSA UTI's in the past. When I gave my two week notice, I needed to discuss my concerns with my manager. He, just like a couple of you, had not understood where my concerns are coming from. No, I don't have a compromised immune system, neither does anyone in my family. But should I really give up on my stance and say it's okay, that I don't mind being part of that 2%? I absolutely mind, and if I can help it, I will do what I can to prevent that. Yes, if I become a nurse I can potentially be exposed to bacteria and/or viruses that are just as bad - or worse. Maybe I am wrong, but from my perspective being a RN in a hospital or nurses office, you are exposed to that patient with adequate tools to protect yourself from them, as well as being in a controlled environment, rather than their home. I believe the fact the information about her having a MRSA UTI not actively being notified to staff assigned to her was what made me most upset about the situation. My manager responded to this saying probably over 50%+ were colonized with MRSA. I feel this is something that should be adressed and notified to staff about the prevalance of highly contagious, antibiotic resistant bacteria being prevalent in our workplace. The use of multiple antibiotics to rid yourself of an infection involving MRSA impacts your microbiome, which then impacts other parts of your body and perhaps quality of life. The use of chemicals on your skin to rid yourself of colonization are more than likely harmful one way or another. I really do care about others, and am happy to take care of them. That is obviously why I had chose to pursue nursing. But I guess the only thing I missed in the job description was surrendering your peace of mind that you and your loved ones are safe from the infections of others if proper hygeine practices and PPE regulations are followed. It's like playing the lottery when you are caring for a resident, and you don't have the slightest clue about their medical history or current condition because it is not provided to you.

Source: MRSA Fast Facts - CNN

KelRN215, BSN, RN · Apr 9, 2018

According to CNN, "Twenty-five to thirty percent of the population is colonized with staph, and less than 2% is colonized with MRSA".
My concern is being colonized with it and spreading it to my loved ones. After I told my family what happened, they were the motivating factor into me giving a two week notice to my manager today. The money I was making at my job ($11/hour, 70 cents less than my retail job) was not worth being exposed to a resident that had MRSA, whose room was not frequently sanitized and would not wash her hands after using the bathroom unless instructed. To me that signals that everything she then touches, and providing her dressing assist, I was more than likely exposing myself to MRSA on a higher scale than I would be comfortable with. She frequently used the public toilet (2 seperate public toilets on our floor) other staff and residents use, over which time I had no idea she has had issues with MRSA UTI's in the past. When I gave my two week notice, I needed to discuss my concerns with my manager. He, just like a couple of you, had not understood where my concerns are coming from. No, I don't have a compromised immune system, neither does anyone in my family. But should I really give up on my stance and say it's okay, that I don't mind being part of that 2%? I absolutely mind, and if I can help it, I will do what I can to prevent that. Yes, if I become a nurse I can potentially be exposed to bacteria and/or viruses that are just as bad - or worse. Maybe I am wrong, but from my perspective being a RN in a hospital or nurses office, you are exposed to that patient with adequate tools to protect yourself from them, as well as being in a controlled environment, rather than their home. I believe the fact the information about her having a MRSA UTI not actively being notified to staff assigned to her was what made me most upset about the situation. My manager responded to this saying probably over 50%+ were colonized with MRSA. I feel this is something that should be adressed and notified to staff about the prevalance of highly contagious, antibiotic resistant bacteria being prevalent in our workplace. The use of multiple antibiotics to rid yourself of an infection involving MRSA impacts your microbiome, which then impacts other parts of your body and perhaps quality of life. The use of chemicals on your skin to rid yourself of colonization are more than likely harmful one way or another. I really do care about others, and am happy to take care of them. That is obviously why I had chose to pursue nursing. But I guess the only thing I missed in the job description was surrendering your peace of mind that you and your loved ones are safe from the infections of others if proper hygeine practices and PPE regulations are followed. It's like playing the lottery when you are caring for a resident, and you don't have the slightest clue about their medical history or current condition because it is not provided to you.
Source: MRSA Fast Facts - CNN

I hate to break it to you but if you're going to quit your job every time you're exposed to something infectious/contagious without knowing it first, you're not going to last very long in healthcare.

In the hospital, patients are generally placed on contact precautions once the MRSA cultures are sent. But not every hospital swabs every patient that walks through the door so you may very well be taking care of a patient who has MRSA for days without knowing it until there's reason to send the test off. We only put our patients on contact or droplet precautions when I worked in the hospital if we specifically sent cultures off for MRSA, VRE, C-Diff, the flu or strep throat. If we just sent urine or blood cultures as a part of a fever work-up or clinical suspicion for a UTI we wouldn't put the patient on precautions. So in the case of your patient, if a urine culture was sent it would be standard/universal precautions. The initial culture would come back as positive for gram positive cocci but then the lab would need to further identify the species. Again, no special precautions would be indicated and we'd all be taking care of someone with a MRSA UTI with no contact precautions until the lab identified the species. Since the MRSA is limited to her urine, though, and standard/universal precautions tell you that you should wear gloves when handling her urine and wash your hands after removing said gloves, that would be an effective means of preventing transmission.

Atelophobia · Apr 10, 2018

I hate to break it to you but if you're going to quit your job every time you're exposed to something infectious/contagious without knowing it first, you're not going to last very long in healthcare.
In the hospital, patients are generally placed on contact precautions once the MRSA cultures are sent. But not every hospital swabs every patient that walks through the door so you may very well be taking care of a patient who has MRSA for days without knowing it until there's reason to send the test off. We only put our patients on contact or droplet precautions when I worked in the hospital if we specifically sent cultures off for MRSA, VRE, C-Diff, the flu or strep throat. If we just sent urine or blood cultures as a part of a fever work-up or clinical suspicion for a UTI we wouldn't put the patient on precautions. So in the case of your patient, if a urine culture was sent it would be standard/universal precautions. The initial culture would come back as positive for gram positive cocci but then the lab would need to further identify the species. Again, no special precautions would be indicated and we'd all be taking care of someone with a MRSA UTI with no contact precautions until the lab identified the species. Since the MRSA is limited to her urine, though, and standard/universal precautions tell you that you should wear gloves when handling her urine and wash your hands after removing said gloves, that would be an effective means of preventing transmission.

"Generally, when patients are placed on isolation precautions, there will be a sign at the door of their hospital rooms to remind visitors and healthcare workers which isolation precautions are needed. All healthcare workers and visitors need to follow these guidelines. Healthcare workers should not eat or drink in isolation rooms and should always clean their hands before entering the room and upon exiting the room."

Source: Follow all Posted Precaution Signs | Infection Prevention and You

"Transmission Based Precautions: Use personal protective equipment (PPE) appropriately, including gloves and gown. Wear a gown and gloves for all interactions that may involve contact with the patient or the patient's environment. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens."

Source: Transmission-Based Precautions | Basics | Infection Control | CDC”

The situation you are defining I do not have a problem with. What happened at my workplace was a resident was tested for MRSA (no precautions taken during this time), the results were positive, and the only thing her caregivers were universally informed was to make sure the resident is washing her hands, using the toilet frequently, and not using the public restroom anymore. My manager tried to tell me that universally enforced isolation PPE was not needed as the MRSA was in her bladder, and that MRSA should not be such a big concern of mine if I plan to work in the healthcare field. My whole issue with this situation is they were having her tested, no precautions were taken or caregivers informed. She is positive for MRSA, and still I feel measures were not taken to make sure ALL of the caregivers were informed of her condition so they may protect themselves. There are other situations where I feel they had not made it adequately known to caregivers that a resident was contagious.

Please let me know if there is something I am misunderstanding about this whole situation. I truly would like this to be a learning experiance, if anything. I've already been accepted into the nursing program at my desired university. I definitely need some sort of wake up call about nursing if it is typical for a serious concern about contagious bacteria to be seen as irrational, as my manager made me feel.

NICUmiiki, DNP, NP · Apr 10, 2018

Please let me know if there is something I am misunderstanding about this whole situation. I truly would like this to be a learning experiance, if anything. I've already been accepted into the nursing program at my desired university. I definitely need some sort of wake up call about nursing if it is typical for a serious concern about contagious bacteria to be seen as irrational, as my manager made me feel.

Staphylococcus aureus is normal skin flora. It's there on you already. Living peacefully in your skin, hair, throat... It is only a problem when your immune system is low and it overgrows in a wound, in your bladder, in your trachea, etc.

MRSA is Staphylococcus aureus that has developed a resistance to methicillin (a penicillin-type antibiotic) and thus many antibiotics that work the same way as penicillin. It also lives peacefully in your skin, hair, throat, etc... It is also only a problem when your immune system is low and it overgrows in a wound, in your bladder, in your trachea, etc.

If you work in healthcare, you are most likely colonized. It's not really a problem. Don't pick your nose and rub it on stuff. Wash your hands often (you're supposed to anyway).

As a nurse, you will be exposed to germs. I thought that was kind of like universal knowledge. People with normally functioning immune systems will be fine. Patients come in positive for stuff (MRSA, MRSE, VRE, flu, herpes, TB, contagious meningitis) before we know it and put them on precautions, so every patient is a potential exposure whether or not they have a sign on the door.

We aren't all dropping like flies with our MRSA-filled noses...