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..
the va article notes that "mrsa is now carried by an estimated 2.3 million americans, most of whom show no signs of illness." the article also notes: "despite the growth of the community strain of mrsa, about 80 percent of mrsa infections occur in hospitalized patients."
there are 299 million people in the u.s. so if 2.3 million are mrsa carriers, that adds up to less than one percent. ---less than one percent of people in the u.s. are mrsa carriers. ---so several folks on this board are quite mistaken that mrsa is part of the normal flora of our skin. --the disease is out --surely the numbers of carriers and active infections will rise. but by attempting to control mrsa, understanding it, and respecting it, we can make a difference. --i worry that some folks might think --well it's on just about everybody so what can we do? --why bother to try to contain it?
hmmm...here is another interesting study: methicillin-resistant staphylococcus aureus in the community: a hospital-based study by angella goetz, rn, mned et al. "independent risk factors for mrsa included organ transplantation, employment in a healthcare facility, pressure sores, tube feeding, and hospitalization within the preceding year."
Per your post, I think the RN may have been misinformed or there was some other misunderstanding going on. Check out the Pittsburgh hospital study at URL in above post from me. In this study, they swabbed patients upon admission to detect MRSA carriers.
I think it more likely that hospitals might make a MRSA detection test upon admission part of protocol. Then healthcare workers would address the carriers and/or those with active infections. I also think it possible that hospital workers might be routinely tested to detect whether or not they are MRSA carriers (you don't have to manifest an infection to be a carrier).
On the other hand, I think the layering she describes makes sense.
Per everything I am reading, frequent and rigorous handwashing is one of the most important preventive steps against MRSA. You just hope that your teammates are doing it well, too. (Data shows healthcare workers are lax on this, unfortunately.) Otherwise they may be transferring microbes to the nursing station, charts, etc., where you might pick it up even though you've washed.
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.
Per your post, I think the RN may have been misinformed or there was some other misunderstanding going on. Check out the Pittsburgh hospital study at URL in above post from me. In this study, they swabbed patients upon admission to detect MRSA carriers.
I think it more likely that hospitals might make a MRSA detection test upon admission part of protocol. Then healthcare workers would address the carriers and/or those with active infections. I also think it possible that hospital workers might be routinely tested to detect whether or not they are MRSA carriers (you don't have to manifest an infection to be a carrier).
On the other hand, I think the layering she describes makes sense.
Per everything I am reading, frequent and rigorous handwashing is one of the most important preventive steps against MRSA. You just hope that your teammates are doing it well, too. (Data shows healthcare workers are lax on this, unfortunately.) Otherwise they may be transferring microbes to the nursing station, charts, etc., where you might pick it up even though you've washed.
I read the article. That was good. I've coped it off and am taking it to work.
Commonly used computer keyboards also worry me. I clean ours occasionally with clorox wipes. Don't know if it helps, but I feel better doing it.
I work in a facility with MR people. I don't think they get very good handwashing and some of our people like to pick at their wounds.
Some will not keep a bandage on. Put it on there and they immediately pull it off. I guess they don't like the feel of something like that on their skin, but we try to keep wounds and sores treated to heal things up, but a few of them do like to pick and keep things sore and bleeding.
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.)
I never said that MRSA is on the skin, I said that a current theory says it is. It makes sense.....staph aureus is normal flora, and MRSA is methicillic-resistant staph aureus. And there's this:
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.
You're right, the question itself is valid. However, I have a problem with someone with experience asking a question that a new grad should know the answer to. Bala has asked questions before that he should know the answers to. No, he doesn't have years of experience like some of us here, but he has enough time in that he should know he cannot afford to freak out at what our pts have. If he does, he should not be a nurse. Sorry, that's my two cents and I'm stickin' to it. We are not talking Ebola or hanta here.
You're right, the question itself is valid. However, I have a problem with someone with experience asking a question that a new grad should know the answer to. Bala has asked questions before that he should know the answers to. No, he doesn't have years of experience like some of us here, but he has enough time in that he should know he cannot afford to freak out at what our pts have. If he does, he should not be a nurse. Sorry, that's my two cents and I'm stickin' to it. We are not talking Ebola or hanta here.
Many people on this thread, including yourself, seemed to think that the OP was lacking information that a working nurse ought to have. But many of these people also seemed to think that MRSA was part of the normal flora of the body, and something that most of us carry. That, as Sonoran demonstrated well, is not true. The OP's observation that you can pick up MRSA just by touching them or objects in their surroundings is actually true. Whether or not you become infected--which isn't likely--you can carry it to another patient. Hence infection control policies at hospitals.
I think it's appropriate for a relatively new nurse to be concerned (I hardly think "freak out" is accurate) about infection control if they don't yet grasp fundamentally what the issue is. I think a lot of people--experienced nurses included--don't fully grasp the reason for MRSA precautions. Asking questions, discussing, and critical thinking = greater protection of patients, greater protection of yourself.
I never said that MRSA is on the skin, I said that a current theory says it is. It makes sense.....staph aureus is normal flora, and MRSA is methicillic-resistant staph aureus. And there's this:
This is a great article. It talks about staph aureus that is part of our normal flora that can evolve into MRSA or MRSE with the use of antibiotics that can be excreted through sweat onto the skin. It does not say that MRSA is part of the normal flora. It says it's development is associated with antibiotics. MRSA is not a normal skin bacteria.
Staph aureus, and RESISTANT staph aureus are VERY different.
category: special report - updated by crp website administrator on november 30th, 2002 at 10:11
mark tovey and leeanne horner
what is mrsa?
methicillin resistant staphylococcus aureus is a particularly resistant strain of the bacteria s. aureus. s. aureus is part of the normal flora of the skin and is found in mainly the damp areas of the body, the axilla, groin, perineum and nose all being areas that are readily colonised. however, when protective barriers are breached, this bacteria can also cause infections including boils, abscesses, septicaemia and pneumonia. it is estimated that a third of all wound infections are caused by s. aureus.
hospitals encourage survival of resistant strains of bacteria due to the extensive use of antibiotics. with hospitalisation, patients' skin flora is replaced with the hospital flora. mrsa is able to replace the colonising strains of s. aureus on the skin of patients, especially if the skin is slightly damaged. normally, this process occurs without causing infection, but serious infections can occur if the bacteria is allowed to enter the body during invasive procedures.
the main worry of patients colonised with mrsa is that they act as a reservoir for other patients and staff. nurses treating patients' infected or colonised with mrsa are often found to have mrsa on their own skin. the natural antibacterial properties of skin usually prevent survival and multiplication of the bacteria on this person, but in the time immediately after contact, the bacteria can be spread to other people and objects.
again, i never said that it is a fact that mrsa is definitely a normal skin flora. i said that there is a theory about this. is it something that we grow naturally? no. is it something that 99.9% of the population walks around with on their skin and most never know it? very possibly. if the op is so worried about taking care of an mrsa pt, then he should first have every inch of his own skin swabbed and tested.
perhaps the base of this whole problem is the wording of his question. i may be wrong but i get the feeling that english is not his first language. if this is correct, and rather than asking "what would you do in my shoes?" he meant to ask "how should i handle this?", then i apologize to bala for my attitude. however, in what i've seen of his posts on this forum in the past, if he really did mean "what would you do?", then i stand by my original statements.
i love students and new grads. i love answering questions. i love to teach. bala, however, said
hi, i graduated last year from school...from that time, i seen quite a few patients with mrsa. most of the staff acted normal and just wore gloves and then good handwashing...
if he has seen quite a few mrsa pts and has seen how experienced nurses deal with them, then why is he asking what we would do in his shoes? that, i have a problem with. teaching is answering questions from someone who has never dealt with a situation before, or one who has dealt with something one way and then been told that s/he should be doing it another way.
tazzi - excellent article, thanks for sharing it with us.
when "theory" is used in relation to a medical subject, i take it to mean a theory as accepted by the scientific and medical community. i don't think there is a theory of that sort that describes 99.9% of the population being colonized with mrsa. i think you may have meant a theory of laypersons who are speculating without factual data.
i reiterate the datapoints i posted earlier today:
"mrsa is now carried by an estimated 2.3 million americans, most of whom show no signs of illness."
there are 299 million people in the u.s. so if 2.3 million are mrsa carriers, that adds up to less than one percent. ---less than one percent of people in the u.s. are mrsa carriers.
"despite the growth of the community strain of mrsa, about 80 percent of mrsa infections occur in hospitalized patients."
this does not mean that 80% of patients have mrsa, it means 80% of mrsa infections are in hospitalized patients.
i'm being a stickler for accuracy on this subject as i find it disturbing that some people are equating all staphylococcus aureus with mrsa. i have seen some of my coworkers put out bad information on the subject. one told me that he didn't think mrsa was anything to worry about because most of us have it already. this guy had been in the business for almost a decade. he was trying to teach me. scary.
i am waiting for a slot in nursing school. i was surprised that bala asked the question as he's an lpn and the prereq of microbiology should have addressed the subject and given him an idea of where to find the info. on the other hand, there seems to be a lot of misinforrmation out there among folks at various levels. --i think some of this may come from the way we speak about things. --for instance, i took tazzi's reference to theory to mean a scientific theory as opposed to a general public speculative theory. i guess this board and communications are how we work such things out...and grow...and learn.
i think it's good that bala is seeking information.
i have learned a lot from this conversation. i am thankful to all of you for sharing.
again, i never said that it is a fact that mrsa is definitely a normal skin flora. i said that there is a theory about this. is it something that we grow naturally? no. is it something that 99.9% of the population walks around with on their skin and most never know it? very possibly. if the op is so worried about taking care of an mrsa pt, then he should first have every inch of his own skin swabbed and tested.
perhaps the base of this whole problem is the wording of his question. i may be wrong but i get the feeling that english is not his first language. if this is correct, and rather than asking "what would you do in my shoes?" he meant to ask "how should i handle this?", then i apologize to bala for my attitude. however, in what i've seen of his posts on this forum in the past, if he really did mean "what would you do?", then i stand by my original statements.
i love students and new grads. i love answering questions. i love to teach. bala, however, said if he has seen quite a few mrsa pts and has seen how experienced nurses deal with them, then why is he asking what we would do in his shoes? that, i have a problem with. teaching is answering questions from someone who has never dealt with a situation before, or one who has dealt with something one way and then been told that s/he should be doing it another way.
"Theory" is an unproven statement, belief, whatever you want to call it. It has not been proven. It does not mean that it's been accepted as fact.
I did not say that 99.9% of the population has MRSA on their skin. I said: "Again, I never said that it is a fact that MRSA is definitely a normal skin flora. I said that there is a THEORY about this. Is it something that we grow naturally? No. Is it something that 99.9% of the population walks around with on their skin and most never know it? Very possibly. "
Before you believe so heavily in fact and refuse to consider that a theory just might be correct, remember that several years ago it was believed that homosexuality was a choice. Remember that every woman who had PID was considered a whore, or her partner had slept around and given it to her. Remember that doctors believed that every baby with failure to thrive was being neglected by the parents, that it couldn't possibly be physiological. All of these also had theories that were later proven to be fact: homosexuality is not a choice, it's how you are born. PID is not just an STD. FTT can indeed have a physiological reason, not just neglect.
Specializes in icu, er, transplant, case management, ps.
Many people on this thread, including yourself, seemed to think that the OP was lacking information that a working nurse ought to have. But many of these people also seemed to think that MRSA was part of the normal flora of the body, and something that most of us carry. That, as Sonoran demonstrated well, is not true. The OP's observation that you can pick up MRSA just by touching them or objects in their surroundings is actually true. Whether or not you become infected--which isn't likely--you can carry it to another patient. Hence infection control policies at hospitals.
I think it's appropriate for a relatively new nurse to be concerned (I hardly think "freak out" is accurate) about infection control if they don't yet grasp fundamentally what the issue is. I think a lot of people--experienced nurses included--don't fully grasp the reason for MRSA precautions. Asking questions, discussing, and critical thinking = greater protection of patients, greater protection of yourself.
I wish that more of the medical and nursing community would listen to you. My S.O. niece was admitted to a hospital, in NYC, for a problem related to her M.S. A foley was inserted and several days later, she developed what was assumed to be a bladder infection. It turned out to be a kidney infection and the bug that grew out was MRSA. She was all ready in a private room but the only person who followed any precautions was the housekeeper. The attendings, the house staff, the nursing staff, none even followed basic precautions. We learned two weeks later that several other patients, on her floor, had developed MRSA infections. Someone please tell me that this was just a random happening.
"Theory" is an unproven statement, belief, whatever you want to call it. It has not been proven. It does not mean that it's been accepted as fact.
I did not say that 99.9% of the population has MRSA on their skin. I said: "Again, I never said that it is a fact that MRSA is definitely a normal skin flora. I said that there is a THEORY about this. Is it something that we grow naturally? No. Is it something that 99.9% of the population walks around with on their skin and most never know it? Very possibly. "
Before you believe so heavily in fact and refuse to consider that a theory just might be correct, remember that several years ago it was believed that homosexuality was a choice. Remember that every woman who had PID was considered a whore, or her partner had slept around and given it to her. Remember that doctors believed that every baby with failure to thrive was being neglected by the parents, that it couldn't possibly be physiological. All of these also had theories that were later proven to be fact: homosexuality is not a choice, it's how you are born. PID is not just an STD. FTT can indeed have a physiological reason, not just neglect.
Tazzi, please read this article Sonoran posted earlier--it is really excellent and should be a reminder to us that MRSA is not something HCP's should feel overly comfortable around:
Theories are based in evidence. There is no evidence that 99.9% of America has MRSA on their bodies. In fact, there is evidence to the contrary. Again, this article is great. By the way, I recently was swabbed--I don't have MRSA. I'm sure there have been times that I carried MRSA on my gloved hands before I properly disposed of the gloves and then washed my hands according to hospital protocol.
infection control and mrsa
RNfaster
488 Posts
this subject is quite interesting. i have been surfing and reading for over an hour now.
did any of you see the recent study put out by a pittsburgh hospital on the subject of mrsa? they screened patients upon admission! here is an interesting report from the va on the subject http://www.va.gov/pittsburgh/public_affairs_news/boston_globe_8_21_mrsa.htm
the va article notes that "mrsa is now carried by an estimated 2.3 million americans, most of whom show no signs of illness." the article also notes: "despite the growth of the community strain of mrsa, about 80 percent of mrsa infections occur in hospitalized patients."
there are 299 million people in the u.s. so if 2.3 million are mrsa carriers, that adds up to less than one percent. ---less than one percent of people in the u.s. are mrsa carriers. ---so several folks on this board are quite mistaken that mrsa is part of the normal flora of our skin. --the disease is out --surely the numbers of carriers and active infections will rise. but by attempting to control mrsa, understanding it, and respecting it, we can make a difference. --i worry that some folks might think --well it's on just about everybody so what can we do? --why bother to try to contain it?
hmmm...here is another interesting study: methicillin-resistant staphylococcus aureus in the community: a hospital-based study by angella goetz, rn, mned et al. "independent risk factors for mrsa included organ transplantation, employment in a healthcare facility, pressure sores, tube feeding, and hospitalization within the preceding year."