On some units we are starting MRSA screening on all new admits. They have to agree to it, of course. We are supposed to do a nasal and a peri-rectal swab. I was on a unit that just started doing this, it was their opening day of this new policy so I had to ask all my patients to allow me to do this screening. A couple of the patients allowed both areas to be swabbed and a couple only would let me do the nasal swab.
The whole peri/rectal swab thing is demeaning, in my opinion. What a way to start out as a patient at a facility! You have to put on a patient gown and proffer your backside to the nurse, after being asked a bunch of embarrassing questions.
This is why I hate the whole healthcare system whenever I am in the patient role, which has been rare. No wonder people feel powerless. There are a lot of things that contribute to the stripping of human dignity in our healthcare system, and this peri-anal swabbing has got to definitely be in the top 10 list.
I personally would refuse to be swabbed. I wouldn't want it on my medical record that I was MRSA positive. Someone, such as an employer, might use that information against me.
is MRSA of the rectum/orifice even common? and for scheduled admits this could be done in the doc's office prior...isnt MRSA in the urine more common? do they demand a UA C+S on every patient.....and i am sure this is related to the "never" events, a very unrealistic piece of regulation....
I personally would refuse to be swabbed. I wouldn't want it on my medical record that I was MRSA positive. Someone, such as an employer, might use that information against me.
Why would your employer be looking at your medical chart? That would be a big time HIPAA violation.
Maybe it's related to the "never event" rules where Medicare Medicaid will not pay for the cost of treating a MRSA infection. They need to know if a patient had a MRSA infection at the time of admission, so cannot be held liable for a positive culture while as an inpatient
I agree with the above poster.
I think with time, it will become accepted practice, similar to group B strep swabs for pregnant women (some docs will let swab themselves as well).
You can't get MRSA in your stool and you can't get VRE in your nares; that's why facilities are able to use double swabs and save money. The swabs won't test out for c. diff, at least the kind we use at my facility. I think you need a blob of poo for that.
We screen all NH, HD, and "group living" patients, unless it's been done recently or they have a prior positive.
You can't get MRSA in your stool and you can't get VRE in your nares; that's why facilities are able to use double swabs and save money. The swabs won't test out for c. diff, at least the kind we use at my facility. I think you need a blob of poo for that.
We screen all NH, HD, and "group living" patients, unless it's been done recently or they have a prior positive.
i am guessing that MRSA is an aerobe, VRE and anaerobe......but that doesnt mean you couldnt have MRSA anally....
One of the hospitals I did my clinical hours at required us to do swabs at both ends... but only for patients that had been previously admitted in the last 6 months, if they lived in a long term care facility or if they were being transferred or discharged from one health care setting to another.
They were only ever referred to as MRSA swabs, I never heard them refer to the swabs as multi-purpose tests.
Since Canada doesn't have anything to do with "never events" there must be some other reason why this is being done?...
Good point about the patients point of view, glad that you mentioned it. Sometimes being a student, you concentrate so hard on accomplishing skills and techniques you forget to question: why are we doing this.
I have a question to those of you who work in facilities which test for MRSA. What is the plan of action for a positive culture. Do room assignments reflect cohorting? Do you use additional PPE? Do you provide extensive patient education? In other words, what do you do differently?
In the hospital that I referred to, if a patient swab comes back positive isolation precautions are put in place.
The patient is either moved to a private room or cohorts with another patient that is MRSA pos.
Isolation carts are then placed outside the room and signs are placed on the door. Everyone entering the room has to gown and glove before entering. (this includes visitors, cleaning staff, nursing staff, somehow doctors are exempt which makes the whole system questionable)
If a patient does not have test results back, but met the criteria for being swabbed, then they are placed in isolation anyhow until the swabs come back. (gown, glove)
We have discussed in class the efficacy of this, related to extensive use of resources and money, time needed to gown and glove to simply hand a patient a glass of water (or similar) it gets crazy when every other patient on the floor is under precautions.
it will be interesting to hear other people's take on this
ETA: This is primarily concerning positive cultures, not necessarily infection
FireStarterRN, BSN, RN
3,824 Posts
Yes, they will be re-swabbing every Monday.
I personally would refuse to be swabbed. I wouldn't want it on my medical record that I was MRSA positive. Someone, such as an employer, might use that information against me.