ID Question

sixes · Mar 6, 2003

I worked in home care settings. Anyone that has mrsa or vre our guidline is mask, gloves, gowns. We have yet to transmit to other clients. Also if ambulance is needed, the must be told that client is infected to the bus can be prepared properly. All equipment is left in the home ie b/p cuff stethscope etc. When the client is d/c stuff that can be autoclaved is the rest is disposed of. Any un used product is thrown out therefore we only bring in minimal amounts at a time to prevent needless waste

K O'Malley · Mar 6, 2003

I read recently that MERSA has made its way into the community and more and more non-hospital cases are being diagnosed. Can't be too careful.

karenG · Mar 6, 2003

yes its here in the community- lots of people have it if you take nose swabs etc. its only a problem when you get a wound infection and even then not a huge problem- we tend to use inadine dressings and that kills it effectively. we dont have any problems with cross infection- and we dont gown up etc. maybe we have a different strain here. not sure how they deal with it in a hospital setting.

Karen

ThirdWorldGirl · Mar 6, 2003

gown, glove and mask here too

CTRN1 · Mar 6, 2003

I work in OB and we are seeing more and more patients coming in with lady partsl MRSA. It is basic contact pregacutions, gloves, etc but when it comes time for delivery we will gown up with mask and hats too. Equiptment is dedicated to that patient only whenever possible. Mom and Baby are required to stay in their room until discharge, which means no ambulating in the halls during labor or putting the baby in the nursery during the postpartum stay.

tonchitoRN · Mar 6, 2003

my hospital had so many mrsa cases they were not able to put them in isolation rooms, private rooms or alone using a semi-pvt room. they changed to policy to put the mrsa patients together. the mrsa just passed from one to the other.

yes, people can get it from the air and contact. we had a md who specialized in wound care so he had many mrsa wound pts. the nurse who worked with him never touched the pts. but somehow she had to retire because she had it in the sputum and was too sick to work.

Tweety, BSN, RN · Mar 6, 2003

Originally posted by tonchitoRN
my hospital had so many mrsa cases they were not able to put them in isolation rooms, private rooms or alone using a semi-pvt room. they changed to policy to put the mrsa patients together. the mrsa just passed from one to the other.

Only our ID nurse can approve patients being roomed together that has MRSA. Under certain conditions, and I'm not sure of her criteria she cohabitates MRSA patients. We also cohabitate C-Diff patients as well. There's a lot pressure with so many blocked beds to get patients out of the ER to the floor sometimes.

Geeg · Mar 6, 2003

In general, I think there is a rise in nocosomial infection, simply because hospitals have cut down on housekeeping staff, everyone is in such a hurry to clean a dirty slot and get a new pt into it, that adequate disinfection is taking a back seat.

pickledpepperRN · Mar 6, 2003

http://www.cdc.gov/ncidod/hip/Aresist/mrsahcw.htm

Guideline for Isolation

Precautions in Hospitals" (Infect Control Hosp Epidemiol 1996;17:53-80), should control the

spread of MRSA in most instances.

Standard Precautions include:

1) Handwashing

Wash hands after touching blood, body fluids, secretions, excretions, and contaminated

items, whether or not gloves are worn. Wash hands immediately after gloves are

removed, between patient contacts, and when otherwise indicated to avoid transfer of

microorganisms to other patients or environments. It may be necessary to wash hands

between tasks and procedures on the same patient to prevent cross-contamination of

different body sites. Index

2) Gloving

Wear gloves (clean nonsterile gloves are adequate) when touching blood, body fluids,

secretions, excretions, and contaminated items; put on clean gloves just before

touching mucous membranes and nonintact skin. Remove gloves promptly after use,

before touching noncontaminated items and environmental surfaces, and before going to

another patient, and wash hands immediately to avoid transfer of microorganisms to

other patients or environments. Index

3) Masking

Wear a mask and eye protection or a face shield to protect mucous membranes of the

eyes, nose, and mouth during procedures and patient-care activities that are likely to

generate splashes or sprays of blood, body fluids, secretions, and excretions. Index

4) Gowning

Wear a gown (a clean nonsterile gown is adequate) to protect skin and prevent soiling of

clothes during procedures and patient-care activities that are likely to generate splashes

or sprays of blood, body fluids, secretions, and excretions or cause soiling of clothing.

Index

5) Appropriate device handling

Handle used patient-care equipment soiled with blood, body fluids, secretions, and

excretions in a manner that prevents skin and mucous membrane exposures,

contamination of clothing, and transfer of microorganisms to other patients and

environments. Ensure that reusable equipment is not used for the care of another patient

until it has been appropriately cleaned and reprocessed and that single-use items are

properly discarded. Index

6) Appropriate handling of laundry

Handle, transport, and process used linen soiled with blood, body fluids, secretions, and

excretions in a manner that prevents skin and mucous membrane exposures,

contamination of clothing, and transfer of microorganisms to other patients and

environments. Index

If MRSA is judged by the hospital's infection control program to be of special clinical or

epidemiologic significance, then Contact Precautions should be considered.

Methicillin-resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial (hospital acquired) pathogen in the United States. In hospitals, the most important reservoirs of MRSA are infected or colonized patients. Although hospital personnel can serve as reservoirs for MRSA and may harbor the organism for many months, they have been more commonly identified as a link for transmission between colonized or infected patients.

Contact Precautions from the CDC website. Contact Precautions consist of:

1) Placing a patient with MRSA in a private room. When a private room is not available the patient may be placed in a room with a patient(s) who has active infection in MRSA, but with no other infection (cohorting).

2) Wearing gloves (clean nonsterile gloves are adequate) when entering the room. After glove removal and hand washing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients and environments.

3) Wearing a gown when entering the room if it is possible you or your clothing will touch any item in the room.

4) Limiting the movement and transport of the patient from the room to essential purposes only.

5) Ensuring that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning.

6) Dedicating the use of noncritical patient-care equipment and items such as stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single patient. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use on another patient.

Tuesday, February 25, 2003; Page HE03

Every year, according to federal health officials, nearly 2 million Americans leave hospitals with infections they acquired there, and 90,000 die as a result.

So how many reports of life-threatening hospital-acquired infections have been received since 1996, when the nation's primary hospital accrediting body began compiling a voluntary database?

The answer, according to officials at the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO): 10. Not 10,000, not 10 per day, but 10 total reports during the past six years.

In an effort to boost the number of reports by hospitals -- and to reduce the number of lethal infections among patients -- the commission has convened an expert panel to recommend ways to strengthen infection control procedures. Some of these recommendations may lead to tougher standards that inspectors will consider during visits by the JCAHO, which is funded by the 17,000 hospitals, nursing homes and other institutions it accredits.

The 20-member panel represents the third such effort undertaken by JCAHO in the past decade, according to vice president of standards Robert Wise, who is spearheading the effort.

For years the federal Centers for Disease Control and Prevention (CDC) has tried, largely without success, to persuade doctors, nurses and other health care workers to wash their hands before examining patients. Proper hand washing, CDC officials have maintained, could cut the number of hospital-acquired infections by at least 50 percent.

One reason for the underreporting of infections, Wise said, is the difficulty of determining whether a death from infection represents a preventable error or is a natural consequence of an illness. For example, did an AIDS patient who contracted a fatal infection in an intensive care unit die because of the infection or because he or she had an impaired immune system?

"Hospitals will disagree" about whether such an event is a reportable error, Wise said, unlike amputating the wrong leg or transplanting organs from a patient with the wrong blood type -- errors all would agree are reportable and preventable.

Such debate, he said, is one reason that hospital-acquired infections were not included in a landmark 1999 Institute of Medicine report that concluded that as many as 98,000 hospitalized patients die each year as a result of preventable medical errors.

But to Charles Inlander, director of the People's Medical Society, a Philadelphia-based consumer group, these arguments obscure a more fundamental problem: the lack of mandatory reporting of hospital-acquired infections.

"Right now there's no incentive to report," Inlander said. "There's no law. Why the heck would you report it if the hospital down the street isn't?" he added. "Even the CDC just gets voluntary data."

Wise said that hospitals might decide to participate in order to help educate other institutions and to prevent the repetition of mistakes.

The CDC's hospital infection estimates are based on information voluntarily reported by 315 hospitals whose officials collect data on infections and drug-resistant bacteria. The identities of the hospitals that report infections to either the CDC or JCAHO are not made public.

-- Sandra G. Boodman

dianthe1013 · Mar 6, 2003

Originally posted by 3rdShiftGuy
...But I also had a pulmonologist tell me that unless you drink the sputum you can't get MRSA respiratory from a patient's room...

:eek: Blargh! Just...blargh. Ewwwwww. LOL

Donna :)

NurseGirlKaren · Mar 6, 2003

I was thinking of you guys today and this thread. Did an inpatient cath, was transporting the patient back up to the floor, got to the room, saw a contact precautions sign on the door. WHAT?? Went to the nurses' station, pt's nurse said that she had told holding area nurse that the pt had MRSA cultured in a wound in '99 and it's no big deal. "We're not worried about it, the only one who is is that infection control nurse".

Yeah, thanks, let me make the choice for myself whether it's no big deal or not, mkay?

agnewRN · Mar 6, 2003

In the Nursing facility I worked as designated IC nurse- MRSA in sputum meant droplet precautions and PPE included mask. If Pt cane out of room ( which was limited) they had to wear a mask. If it's MRSA in the wound and it's contained with a dressing than contact precautions . Depended on the status of wound ( draining, large etc) whether or not to isolate them. For Respiratory the pt should be isolated or place in room with another MRSA sputum resident. We did not culture nares- which could indicate colonization . I'm afraid there wouldn't be enough beds around to place people if we cultered everyones nares. Hate to see how many of us even would come up colonized. Not sure it's practical in this day and age.

When you're looking at Nursing Facilities regulated by the Govt- you have to look at unneeded precautions and unnecessary isolation. Surveyers love looking at dignity and confidentiality issues regarding this. They always compare your policy against what you are actually doing.