pt with MRSA in sputum ambulating in hallway with no mask

[unsaint77]

I am a new grad working at a longterm care TCU. I found one patient with MRSA in sputum walking in the hallway without mask. He even eats at the same table with other patients. I asked the supervisor about it and she told me if I was concerned I should call the MD to get a proper order.

My question is...

1) Is it really up to an MD whether to confine the pt to the room or have the pt wear a mask in the hallway?

2) Could there possibly be a facility policy that allows this pt to sit with other patients at the same table for meals?

Thanks.

[unsaint77]

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[unsaint77]

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[xandarosa]

I didn't read all the post but wanted to add something I thought was funny. My son has MRSA. To take him downstairs for a Doppler, the nurse made him wear a mask. Just one little thing, he has a trach and no she didn't cover the trach.

[canned_bread]

At my hospital, infection precautions are started by the nurse (and infection control is informed by it being placed into the computer that the patient is an infection patient), not by doctor. It is not a doctor order. Once the nurse is aware of it, the patient is informed and isolated, the infection trolley placed by the door, and signs put up.

If it is detected in his sputum, whether it was coincidental or a current infection, the protocol in my hospital is infection precaution now, and for life. Sucks but it's the way it is.

However, I used to work in a long term care facility, and they would not have isolated him unless it was an active infection. After all, 70% of the normal population has MRSA on them!

[RNfaster]

However, I used to work in a long term care facility, and they would not have isolated him unless it was an active infection. After all, 70% of the normal population has MRSA on them!

Not sure where you are getting that statistic.

MRSA infection: Causes - MayoClinic.com

"According to the Centers for Disease Control and Prevention, less than 2 percent of the population carries the type of staph bacteria known as MRSA."

Statistics | MRSA Survivors Network

"In a 2003-04 study, approximately 29% of the US population was colonized with staph. aureus and 1.5% with MRSA. But studies from hospitals that are conducting universal screening upon admission of all patients have seen colonization of MRSA as high as 12%.

MRSA infections and colonization has steadily increased over the years and in 1974. 2% of all staph. aureus infections were MRSA, 22% in 1995 and in 2004 it was 64% with an estimate of over 70% of all staph is now MRSA. In the community, it is estimated that 60% of all skin and soft tissue infections that doctors treat are MRSA infections."

Further comments from me:

Perhaps the 70 percent comes from "70% of all staph is now MRSA" as listed above --BUT that does not equal 70 percent of the population has MRSA. Please read carefully.

Hand hygiene and compliance with infection control practices are important. I have noticed some say it (infection control practices, hand hygiene) doesn't matter as most of us are colonized. It's important to know the facts. Evidence suggests that most of us are not colonized --with staph or MRSA.

[rngolfer53]

So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?

There's a good chance you have MRSA in your nares at least. Will you be eating in the garage or basement at home? Or wearing a mask all day?

[RNfaster]

There's a good chance you have MRSA in your nares at least. Will you be eating in the garage or basement at home? Or wearing a mask all day?

But there isn't really a "good chance" that most of us healthcare workers have nares colonized with MRSA. The data does not support it.

If one is colonized in the nares - Bactroban ointment would be a great option. Hibiclens for the body...some doctors also suggest Dial soap as a routine soap for folks with MRSA. And while one is colonized, good idea to pay attention to hand/body hygiene and household cleaning/laundering...

I like the image you put out rngolfer53 - made me laugh. :) Thanks!