MRSA is truly becoming an epidemic. Yesterday I was gowning, gloving and masking all day! I'm so tired of it. I shipped one patient who was septic shock from MRSA whose kidney function was going down the tubes, was on a vasopressor, etc. She had a right elbow MRSA cellulitis. She was having multiple problems including needing dialysis for her acute kidney failure
After I got her out the door I picked up one of my colleague's patients since her other one ended up on a vent. He's been here forever and a day with resp MRSA and we can't find LTC placement for him. Very nice, undemanding fellow whose care is of the complex sub-acute type, with multiple problems. Gown, glove, mask, gown, glove, mask, gown, glove, mask......
Those masks have a disgusting chemical smell, and the gowns are yucky and hot. Ugh, I'm sick of MRSA!!!
Which is fine except it blows in my face when I turn the patient. I like masks, even if they smell like old unwashed butt.
And yet ANOTHER reason I'm glad I'm not on a respiratory unit! LOL....I'm guessing that "old unwashed butt" scent might be preferable to skanky vented exhale from MRSA patient?!
We have seldom seen just MRSA lately in someone who's got it in their sputum cultures. It's been paired with let's see... yeast, strep- at least two different kinds, and more yeast, klebsiella and god only knows what else. I don't want any of that. It does get kind of ridiculous when I have a houseful of drunks, all of 'em either on the vent, just off the vent, or narrowly missed the vent, each with a brand of nasty germ that's very similar to the one in the bed next door. The skin on my poor hands is hanging on for dear life, the mask is just about permanently tied on, and what on earth use is a gown, except for the night that they all shat themselves constantly.
So. Umm gross, I'm sick of it, and I fail to see what good a gown does them if they all have it. I guess I could put it on for myself but then, I'll eventually get a rash somewhere from all the sweat.
Now Im concerned. At our hospital, we only do contact precautions. We NEVER wear a gown to enter a patient's room or to do a dressing change on a MRSA infected wound. This thread has got me to thinking. Our hospital takes MRSA so lightly, its sad. They will room 2 patients together (one mrsa, one not) pending the result of mrsa swab. They dont want the added work of moving a patient. Once, they roomed 2 patients together....one with a massive diabetic foot wound (not mrsa) and one with mrsa lung infection who was continually coughing. The other patient ended up with mrsa in his foot wound. He had enough problems prior to being exposed to mrsa and the hospital should not have taken it so lightly. MRSA is taken too lightly by medical staff because we are around it so much....the general public freaks out about it because they havent been educated about it. Within a matter of a few years we are going to be bombarded with so many drug-resistant germs that MRSA will be the least of our worries. Too many people take antibiotics for everything. A friend of mine is dating a doc who will give her antibiotics for EVERYTHING including a cold. She is like a walking pharmacy. She truely believes that you need to take antibiotics for everything including a runny nose. Its that type of behavior that is making drug resistant germs.
I do agree with you that room assignments, as well as nurse/patient assignments, need to take MRSA into account. And yeah, that's like saying we all need to do the right thing all the time.
The nurse who takes care of a whole assignment that's MRSA positive is merely annoyed by the precautions. The nurse whose assignment includes such extremes as neutropenic patients, those with wounds, and MRSA patients is being given too large of an opportunity to spread the nasty around where it can do serious harm. The reason I say it that way is that the precautions annoy the living heck out of anyone who's got to do it more than twice an hour. "Clustering care" sounds good on paper but you know you're gonna forget something once you're all dressed up in the bunny suit and understaffed to the point where there really isn't anyone extra to bring you what you need.
Having been on both ends of that, (having an icu assignment full of MRSA, and then being on the floor with all kinds of differing stuff that don't go together) I think MRSA should automatically be counted as a much higher acuity due to the sheer amount of time it takes to do the precautions properly. The same should go for neutropenic patients. And really, double-bed rooms just shouldn't exist but that's for a perfect world.
I used to get annoyed by the whole gowning, gloving thing but i feel different about it now because i have had an MRSA infection and it stuffed my life up for about two months. It's a horrible thing to have and i wouldn't wish it on anyone.
The sad fact is that yes, its a pain to have a pt with MRSA (or anything else requiring more than standard precautions), because in reality, how many patients go through your unit that have a contagious bug (MRSA, Hep B or C, HIV, AIDS, TB, VRE, etc.), and we never know they have it? Think about it....
This is why the precautions are there. For your protection, and the patients protection. I had a pt whose children were in the medical field, and had been for years. They were visiting, and I was in the room, just checking the pt and doing an IV rotation. One daughter ( a retired RN) made the comment that they never gloved for IV starts or blood draws when she was a nurse. She also stated that she had just visited another retired nurse she knew in the hospital because she had an incurable contagious disease probably related to the lack of precautions years ago. I almost always glove up if I have to do something requiring direct contacy with the pt, or anything they have possibly contaminated with a body fluid (sheets, pillows, O2 cannulas, etc.). If i am just there to give a PO med, I usually won't glove up.
So, really I might hate getting into the gown, mask, whatever, but I don't want to take the chance of spreading anything to myself, or the other patients.
Yes, at some point we all probably could test positive for MRSA, but we are healthy. Our patients are not. Don't make it worse by being too casual about precautions. Take it seriously, and make sure others do also including and especially visitors!.
I used to CRINGE, whenever we received a Home Health Referral for a MRSA-infected patient because their care usually required 2-3 visits/day for wound care, IVAB dosing and labs for Vanco peaks/troughs for weeks (and sometimes) months on end. At times it seemed like they were coming through our Agency as if they were on conveyor belts. Their care was not only VERY expensive, but time-consuming and draining, as well.
RNsRWe, ASN, RN
3 Articles; 10,428 Posts
And yet ANOTHER reason I'm glad I'm not on a respiratory unit! LOL....I'm guessing that "old unwashed butt" scent might be preferable to skanky vented exhale from MRSA patient?!
Oh, the glamour of nursing.