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Hi, I graduated last year from school...From that time, I seen quite a few patients with MRSA...Like many CNAs and other staff dont even know sometimes that patients have the disease..Most of the staff acted normal and just wore gloves and then good handwashing...
I have to care for a patient that has MRSA..He is infected with signs and symptoms of MRSA..His skin is in bad shape and has many dressings on him because of the disease..
If you were in my position what would you do?
There's a difference between being cautious....what most nurses are....and totally freaked out, which is what the OP is.Bala, did you know that the current theory is that MRSA is possibly a normal organism on everyone's skin? Like E. coli or yeast, it's there but it's not a problem unless it gets out of control. If this thought makes you panic and you tear through your house sterilizing everything, then perhaps you need to think about another profession.
Agree.
OP, MRSA is not a disease. It is a bacterium - methicillin resistant staph aureus. Once a patient is identified as having been colonized with MRSA, they will be considered isolation patients whenever hospitalized regardless of whether or not the presence of MRSA has anything to do with their current acute condition.
Certainly caution is called for - handwashing, contact precautions when there are open wounds, etc. I'd recommend doing some additional reading -- here's a link to the relevant CDC article.
One more thing to add--a few posters have commented on MRSA being part of our normal flora, like benign strains of E. coli. I don't think this is true--it is a nosocomial infection, and has evolved to survive early generation antibiotics. So, it is not something that should normally be living on you. Vancomycin Resistant Enterococcus is another one of those bugs you probably want to avoid getting, cause if it DOES make you sick, it's not so easy to treat, ie, it's resistant to strong abx.
Not all staph are resistant to penicillin as far as I know, and there are many benign strains. Staphylococcus is just a description of the morphology of a microbe.
-Kan
Hi, I graduated last year from school...From that time, I seen quite a few patients with MRSA...Like many CNAs and other staff dont even know sometimes that patients have the disease..Most of the staff acted normal and just wore gloves and then good handwashing...I have to care for a patient that has MRSA..He is infected with signs and symptoms of MRSA..His skin is in bad shape and has many dressings on him because of the disease..
If you were in my position what would you do?
I am scared that I might get it...Since this patient is like a long term patient..And one of the nurses there cared for him for six years..He just told me to wear gloves during his dressing changes..quote]ead, you can get MRSA through just casual contact like touching skin or the bed sheets!![/b}ote]
can get it thru casual contact..And people have MRSA but shows no signs or symptoms..]/B]
To the new grads/students: tell me again that he's not freaked out.
A "you should know this by now" attitude does nothing but discourage new nurses from asking questions. Again I applaud you for addressing this.
I agree with this. As a student nurse who will be finishing soon (and I know full well that I will have LOTS of questions), a new nurse who doesn't ask questions either is 1) a genius who is absolutely amazing, or 2) a nurse that I don't want working on me.:uhoh21:
Please don't discourage us from asking questions - that's how we learn! I didn't think the OP seemed "totally freaked out".
Asking "Is wearing gloves really all you need to care for MRSA pts?" is learning. Asking "What would you do in my place?" is not.
MRSAa hospital-acquired staph infection that is resistant to many penicillins. There are many strains, of those only some are pathogenic. Pathogenic ones tend to live in open wounds or in the nares. Pt's have increased susceptibility with any parenteral treatment. Contact precautions are used to prevent the transmission of MRSA--I dont know how long it can live outside a host (definitely not as long as C-diff or Hep B), but healthcare providers--who are seeing many patients in a short amount of time--can transmit it if they don't follow precautions. They won't necessarily become infected themselves, but if, say, a nurse were to--god forbid--do a dressing change on a patient with MRSA without gloves, then administer an insulin injection to a patient without washing their hands--they could effectively give the MRSA a new home.
Since most MRSA is actually spread this way in the hospital, most institutions have included it in their contact precautions protocol. Many nurses will not gown up to hang a med in a MRSA room. Some other nosocomial infections that require contact precautions--ie, the dreaded C-diff--nurses tend to be more careful about since it is easier to get it, and harder to remove it (alcohol sanitizer has been shown not to kill it).
So, I think if you're new to MRSA or nursing practice, wear a gown and gloves. Rarely does MRSA require airborne/droplet precautions, and I imagine you would be well notified in advance if you needed to wear a mask in your patients room.
And in response to Tazzi, it's not so much about whether a bug which is part of your normal flora gets "out of control"--it's what strain you get. For instance--I'm fine with having some E. coli in my gut--but if it's 0157:H7, I'm no longer fine. :barf01:
Hope this helps!
-Kan
One more thing to add--a few posters have commented on MRSA being part of our normal flora, like benign strains of E. coli. I don't think this is true--it is a nosocomial infection, and has evolved to survive early generation antibiotics. So, it is not something that should normally be living on you. Vancomycin Resistant Enterococcus is another one of those bugs you probably want to avoid getting, cause if it DOES make you sick, it's not so easy to treat, ie, it's resistant to strong abx.
-Kan
Both of you are way behind the times. MRSA is no longer a nosocomial, hospital-acquired infection. It hasn't been for quite a while. That's why we're seeing so much more of it than we did before. Most MRSA pts actually have community-acquired MRSA, which is why it's very possible that we do have it on our skin.
Kanzi, yes, I am aware that the type of strain makes some of the difference, but not in all cases of all infections. Here's a mild but miserable example: yeast candidiasis. Perfect example of normal flora that gets out of control.
I stand by my comments.
Bala, we've followed you for quite a while now, and really, you should know better by now..
Such a shame the "newbies" don't get an idea of who they're posting about before making their inflammatory remarks.
Bala, you really should know better....as anyone would know if they'd followed your story.
Such a shame the "newbies" don't get an idea of who they're posting about before making their inflammatory remarks.Bala, you really should know better....as anyone would know if they'd followed your story.
I admit, I did not research who I was responding about, however, the only inflammatory remarks I have seen have been from seasoned allnurse members. Please, I - you - we, all know it is best to ignore and not provoke intentional troublemakers. I did not read between the lines on this one. I am signing out and moving on - I apologize for my part in spurring this on. Let's all go discuss nursing topics that are of a professional caliber - egads, I may put my foot in my mouth on this one.
With humble respect,
Sincerely
Sun
We were just talking about MRSA at work yesterday and how it is being dealt with today.
The RN who was relaying some information said that what she's been told that MRSA is so much everywhere that the protocol for people in the general public or like where I work will be to have "2 layers" which consists of a dressing over wounds and clothing, gloves when changing dressings, and good handwashing. She also said something that we might have to start using Bactroban in our nares to prevent us from giving it to someone else, but if it's everywhere and in everyone's nares what good will it do to put it in just staff's nares?
And I can't see myself being able to apply Bactroban to approximately 45-50 people every shift that I work.
BUT.......I've worked there 28 years and I've worked around staph wounds with using only gloves and handwashing and have never caught anything.
RE: HA vs CA MRSA--I think big picture is looking at what MRSA is--it's a staphylococcus that's resistant to some penicillins. So, it's root is in evolving to withstand antibiotics. So, to the OP--if you get it in the locker room, or get it in the hospital, whether or not it's part of modern day "normal flora", it's stronger than some other staph bugs. And yes, based on how many people have it, it doesn't seem weird that people are now getting it without ever having been in a hospital. If you have a surgery, or some open wound, or need any sort of parenteral treatment, and MRSA gets into your bloodstream, you need more heavy duty antibiotics to get rid of the infection. This is the whole danger of overuse of antibiotics--cause then those MRSA bugs will evolve to withstand the stronger abx, etc.
Tazzi mentioned one good example of "out of control" normal flora--yeast infections. Which, surprise surprise, are also frequently associated with using antibiotics, since the microbes that usually take care of the yeast are killed giving the yeast free reign.
So, to recap: sure, MRSA might not make you sick. But if it does, it's harder to treat. So, we try to contain it in a hospital setting where there are vulnerable patients who are trying to heal. The very fact that it is epidemic and now springing up the community should be a warning to us about how we approach infection control in our work setting and in our lives outside of work.
And it's totally valid to ask what another nurse would do in your position--cause then you can learn why. If you ask "should I wear gloves or not"--that shows that you can follow commands that don't require critical thinking. Wear the gloves, know why you're wearing the gloves. And keep your job as a nurse. I find it absolutely stunning and horrifying that an experienced nurse on this board would suggest you do otherwise.
I would love to see evidence that indicates MRSA is part of the normal flora of most people's skin. Does anyone have journal data or university study references to back that statement up? If not, it seems to me that folks are confused on the matter, i.e., thinking that one staph strain is automatically a MRSA. (I think folks are confused on the matter.)
Per Clinical Microbiology Made Ridiculously Simple by Mark Gladwin and Bill Trattler, "MRSA is a strain of Staphylococcus aureus that has acquired multi-drug resistance, even against methicillin and nafcillin. These strains tend to develop in the hospital where broad-spectrum antibiotics are used. These antibiotics apply a selection pressure that favors multi-drug resistance in bacteria (usually acquired by plasmid exchange)."
Healthcare environments such as hospitals are especially supportive of MRSA because of the ANTIBIOTICS that are being used. A benign strain of S. aureus may evolve into a virulent (virulent isn't equivalent to viral) variety when a patient is receiving antibiotic therapy for other reasons. --The antibiotics create an environment that pressures the bacteria to evolve (e.g., via the plasmid exchange referenced above) --and survive the antibiotic. Additionally, as Kanzi mentions, patients undergoing or having recently completed antibiotic therapies are more vulnerable to invading microbes, e.g., MRSA, because their normal flora that check the proliferation of invading microbes have been destroyed. Finally, there are patients in the hospital who have extant MRSA that is derived from the community and/or healthcare settings.
I would venture to say that a MRSA strain found in a hospital is likely to be resistant to more antibiotics vs. a MRSA strain found in the community. --The MRSA found in the community will not be under the evolutionary pressure/support that MRSA in the healthcare setting where antibiotics are more prevalent.
Kanzi - I really enjoyed your posts on this subject.
Here's a great fact sheet on MRSA: http://hcd2.bupa.co.uk/fact_sheets/html/MRSA.html by BUPA and reviewed by Dr. James Quekett.
I have a background in analysis. As I read the fact sheet above, I kept asking myself where folks where likely getting confused. I still think it is over the strain issue. I also think it may be over issue of subsets ---the fact sheet at the URL notes "MRSA strains (types) account for over 40 percent of S. aureus infections in England" --that is a subset of a fraction of the population that gets any staph infection. The article also notes that a third of people (in England) carry S. aureus (not necessarily of the methicillin-resistant variety) in their skin, nose, or back of their throat. --I can't help but wonder if data such this has been read to quickly with the result that some folks to think that a third of people carry MRSA.
I would like to better understand more precisely how MRSA invade a wound and get into the bloodstream. The article notes the following: "When the bacteria are simply being carried on the surface of the skin, they are not harmful to a healthy person. Because of this, most people are never aware that they are carrying the bacteria. They can become harmful if they get under the surface of your skin where they can cause an infection such as a boil or abscess. This can happen if you have a wound of some kind. The bacteria can also get into the blood stream and cause blood poisoning."
kanzi monkey
618 Posts
I think, with limited experience with precaution patients, the OP is asking a valid question. Probably needs to read up a bit, ask some questions--changing careers MIGHT be a little extreme.
MRSA is a hospital-acquired staph infection that is resistant to many penicillins. There are many strains, of those only some are pathogenic. Pathogenic ones tend to live in open wounds or in the nares. Pt's have increased susceptibility with any parenteral treatment. Contact precautions are used to prevent the transmission of MRSA--I dont know how long it can live outside a host (definitely not as long as C-diff or Hep B), but healthcare providers--who are seeing many patients in a short amount of time--can transmit it if they don't follow precautions. They won't necessarily become infected themselves, but if, say, a nurse were to--god forbid--do a dressing change on a patient with MRSA without gloves, then administer an insulin injection to a patient without washing their hands--they could effectively give the MRSA a new home.
Since most MRSA is actually spread this way in the hospital, most institutions have included it in their contact precautions protocol. Many nurses will not gown up to hang a med in a MRSA room. Some other nosocomial infections that require contact precautions--ie, the dreaded C-diff--nurses tend to be more careful about since it is easier to get it, and harder to remove it (alcohol sanitizer has been shown not to kill it).
So, I think if you're new to MRSA or nursing practice, wear a gown and gloves. Rarely does MRSA require airborne/droplet precautions, and I imagine you would be well notified in advance if you needed to wear a mask in your patients room.
And in response to Tazzi, it's not so much about whether a bug which is part of your normal flora gets "out of control"--it's what strain you get. For instance--I'm fine with having some E. coli in my gut--but if it's 0157:H7, I'm no longer fine. :barf01:
Hope this helps!
-Kan