MRSA please help

  1. I need everything you know about MRSA.
    I was called this week by a coworker and friend who has been sick lately and just learned she is MRSA positive ( a carrier).
    She and I worked together on a case that I was on for over a year.
    She called as a friend thinking that I might want to know that she tested positive (I did).
    She called as a nurse who had lost the rest of her team to ask if I remembered when the diagnosis was made because she heard it from the mom but it was nowhere on the home chart or POC.
    She is still on the case and I am with a new baby.
    I replied that MRSA was never diagnosed in the time I worked there and it was never on a POC prior to her starting the case. We would certainly have told her.

    I called the agency DON and asked why we did not have Lab work included in our home charts and what we were supposed to do to protect ourselves without correct information or protective gear.
    I have heard from up my chain of command so far that
    "90% of all nurses have colonized MRSA in their noses".
    "40 percent of the population are carriers of MRSA, no big deal"
    "We are in HIPPA violation for discussing this and should have let the agency handle it by calling us". The original nurse did report to her case manager (whose job it is to keep POC updated).
    The DON of agency is saying that just gloves and handwashing are sufficient precaution for trach. colonized MRSA but she has a call in to the CDC to see what is required.

    So, from that one phone call I am hearing that in the days since they have known about the first nurse testing positive the primary concern of the agency is to contact CDC and see what they are liable for.
    Thanks for the call to warn me and all the other nurses that we might want to get tested.

    I have never NOT felt safe in home health simply because I have always known my babies and their histories and work on average of 1-2 years with each case. This really sux though. I am more angry I think that the agency doesn't care more about us in the field. The DON actually asked me if I could afford the HIPPA fine for talking to my co-worker about this since I was no longer on that particular case.

    My Doctor fit me in at 9 this morning and ordered chest x-ray, CBC, UA with culture and did a throat culture. I just finished all that and now am worried because the other nurse had her nares cultured but he did my throat. I am getting such mixed information and being made to feel like a bad nurse for being worried about my own health.
    The other nurse is on isolation with Hibiclens showers X5days, Doxy, Bactroban swabs to the nares X5 weeks. After the 5 day isolation and Doxy she may return to the outside world and continue meds until reswabbing in 5 weeks or so. Her doctor is certainly not taking it lightly and doesn't think it's ok for her to just be a "carrier".
    What experience does anybody have in Hospital and other settings with dealing with MRSA?

    I think we are getting swept under the rug here because the agency in question is
    a) worried about their own OSHA violations and
    b) getting flack from the mom involved because nurses have refused to go back out on the case without masks, gowns and OSHA compliant protective gear as well as family compliance with isolation techniques when baby has
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    About nursex20

    Joined: Mar '05; Posts: 22


  3. by   Gompers
    I'm not sure if this will answer your question or not...

    But I do believe your doctor should have cultured your nares, not your throat. When we do MRSA cultures on patients at work, it's always the nares. Call your doctor back and find out for sure.

    One thing that we used on a MRSA positive patient was Bactroban cream. It's a white cream applied with cotton swabs in the nares twice a day, for at least five days. If you do a google search on "Bactroban MRSA" you'll find tons of information about it. It has been known to eradicate MRSA in over 90% of people.

    Of course, working in the health care environment, we nurses are always at risk for contracting these types of bugs, over and over again. If hospitals were to do montly swabs on ALL staff (not just nursing), they'd probably find half of them colonized with MRSA at all times, I believe. The only thing to do is continue to use universal precautions and good handwashing. If there is a serious problem, Bactroban may be of some help.
  4. by   nursex20
    Quote from gompers
    i'm not sure if this will answer your question or not...

    but i do believe your doctor should have cultured your nares, not your throat. when we do mrsa cultures on patients at work, it's always the nares. call your doctor back and find out for sure.

    .....i caught that when i got home and talked to my friend and called the lab back, so back on monday for the nares, yuck. the lab also informed me that carriers of mrsa were not allowed to work in hospitals here. interesting when all my superiors are saying that it is no big deal to be a carrier or just have colonized mrsa. i am furious with this don at the agency.

    one thing that we used on a mrsa positive patient was bactroban cream. it's a white cream applied with cotton swabs in the nares twice a day, for at least five days. if you do a google search on "bactroban mrsa" you'll find tons of information about it. it has been known to eradicate mrsa in over 90% of people.

    .....i have been familiar with the bactroban regimen from our dermatologist of all people. he uses a routine for my 8 yr. old daughter where she swabs her nares 5 times a month only to keep down the regular growth of staph. since she has eczema and tends to scratch her skin and it got infected. he knew excatly what he was looking at before the culture came back and immediately began explaining the nose scratch to skin deal with kids with eczema/ allergies. i remember waiting for her nasal cultures to come back thinking please don't let my kid come back with e-coli in her nose, how embarrassing would that be? luckily she had not been scratching her bottom and picking her nose, just good old staph. up there.

    of course, working in the health care environment, we nurses are always at risk for contracting these types of bugs, over and over again. if hospitals were to do montly swabs on all staff (not just nursing), they'd probably find half of them colonized with mrsa at all times, i believe. the only thing to do is continue to use universal precautions and good handwashing. if there is a serious problem, bactroban may be of some help.
    ......i agree and have always liked that aspect of home health and the fact that we can avoid a lot of spreading infection. we had a great team at that house and kept all the equipment immaculate in the baby's room as well as doing all of her laundry etc. all of us are old school home care and travel with clorox pop-up wipes and lysol in our bags. but, to deal that long and without ever knowing it with trach colonization and all the neb treatments, suction with baby coughing in my face and fevers that i nursed her through when her colonization may have been active but we did not have a clue to mask , just thought we had a baby with a cold or mom would use the "teething" excuse for recurring temps. taking precautions as a nurse does not bother me (the baby i am with now has colonized mrsa ). not being informed that i may need special precautions and not having the equipment supplied as per osha regs. and then being threatened with a hippa fine because i did find out about it all, well, that p's me off . i am not really happy with the lack of regs i am finding to protect us in home care either.
    thanks for your help.
  5. by   nurse96
    MRSA can be in bodily fluids, blood, wounds, or via respiratory. A healthy adult will not usually be affected by MRSA. But through Univeral Precautions; washing hands, gloves, gowns, and with resp., masks, I believe this to be inconsequential to nurses. MRSA pts that are immunocomprimised, older or very young, seem to be the ones who are most at risk, since the regular line of antibiotics may not work on them. The hospital I work at seems to have had a rash of MRSA Pts. Most of them aquired before admission to the hospital, but still it would be interesting to know how much of the population is carrying!
  6. by   TheCommuter
    MRSA= Methicillin Resistant Staphlycoccus? Aureus

    You should use contact precautions when dealing with patients who have MRSA. It's colonized in most of us because we're not immune-compromised.
  7. by   nursex20
    There seems to be a lot of emphasis being used on the word colonization and also carrier, at least with my administrative staff.
    Are they just covering there own butts? probably.
    I have decided with my personal physician as did the first nurse who tested positive that if I am carrying we are going to eradicate it.
    I have no desire to be a carrier of any pathogen to another patient or when I am nursing my own children through flus and fevers.
    I think lulling health care workers into a sense of complacence about carrying colonized mrsa is helping to make this the fastest growing resistant pathogen on the planet.
    This is going to be a wonderful opportunity to really look at the infection control issues of home settings.
    As for the R.N. who is case manager and now has 2 of her patients "slipping through the cracks"....another one of hers is mrsa positive in the trach and it is NOWHERE in the POC or chart nor is there protective gear in the home for us to wear....well, she needs to go. I'm mad, she has a job in part because I am in the field doing the patient care and I expect her to do her job and protect me. Maybe a few less latte stops in her car during the day and she could get more done, who knows?
    How hard is it when doing an admission to home health care and taking history, med profile, doing MARS and POC to ask "Why is baby getting routine Tobi nebs?" Even if she didn't have the labs or a good hx from somewhere else that should have been a red flag, it was my first question on seeing the MAR on my first shift with this new patient. Her family was very up front and said she had colonized mrsa in her trach. That's all I need to know to take care of myself and my family. The precautions are different for trach cares and neb treatments and suction than just Universal.
    Anyway, I am just venting now, sorry.
  8. by   Sharon
    Inform your chain of command that HIPPA does not apply to every health care information situation in the world. It specifically does not apply to the following: Work Place Exposures, Injuries, Hazardous Material Incidents regulated under the community right to know act (SARA, Title II), and those rights covered under the Federal Whistle Blower Rights Acts. I could list a whole page of what HIPPA does not cover and the liability the average nurse has for preventing care by wrongly using HIPPA.

    I did do a little research on the following statements: "90% of all nurses have colonized MRSA in their noses". "40 percent of the population are carriers of MRSA, no big deal" Because you specifically mentioned the Center's for Disease Control I went to their website and drilled own in their publications and discovered that what they define a community carrier as is: "Community acquisition was associated with recent hospitalization, previous antibiotic therapy, nursing home residence, and intravenous drug use." 1: Infect Control Hosp Epidemiol. 1995 Jan;16(1):12-7.

    Please note this is a ten year old definition. I cannot find any prospective studies of healthy nurses or of general population of MRSA rates. So the first two statements are not supported at this time.

    So what would I do to cover myself professionally and medically?

    1. Throw the HIPPA crap back in your manager's face in a professional manner.

    2. Another mechanism to move around the HIPPA and notification issues is to give your employer a written release and instruct the employer to notify my co-workers that I have an infectious disease and I want my co-workers notified in order to seek preventive and/or treatment ASAP. I would ask your co-worker who is sick to do this. This will begin to get both of you off of the HIPPA block. Do not rely on your employer to send out the letters you may want to send your own out to your co-workers.

    3. File worker's compensation due to exposure of an occupational infectious disease. The cost of the medical surveillance should be covered by your employer. Medical surveillance should have begun before your placement, during and after.

    I would be interested in hearing how your employer reacts when you point out this is outside of HIPPA.
    Last edit by Sharon on Mar 28, '05
  9. by   nursex20
    Sharon you are awesome ! Thank you so much. I am going to print this and come back to puter after I get my 8 yr old to bed, was on duty last night and just saw this now. Will be back and update, thanks again.
  10. by   nursex20
    We are now a month almost past the first nurse who called in to the agency with positive mrsa results and since then not one nurse that she has worked with has been notified that they may need testing.
    Not one patient chart in the home has been updated.
    OSHA compliance from the agency re: gloves, masks and gowns in the home has not happened.
    Many home health nurses still buy their own protective gear and carry it in car.
    The original nurse is still being talked about by case managers as being in trouble for hIPPA violation. ( Who's talking about who here?)
    Another very young patient with this agency just came up with positive, full blown mrsa and is on IV vanco and two ther antibiotics.
    I am amazed that nobody seems to care that we are not doing more about this when we are constantly moving patients back and forth between hospital and home.
    None of the patients that I now know to be mrsa positive ever go into isolation when they are hospitilized because they do not have accurate chart info. or accurate POC's.
    I am tired of fighting the whole system.
    Time to get out of home health again and before I leave this agency I will have learned how to file complaints with OSHA.
    So many nurses in the field believe that it is Medicaid supply companies at fault for not supplying gloves etc. in the homes and have no idea that it is an employer responsibility and OSHA mandated. The home supply companies are for the patient needs and Medicaid.
    I am going back to Hospice.
  11. by   DOCBUCS
    Ive most recently been diagnosed with MRSA. Started out with a nice size boil located inside my Left nare. Was treated with antibiotics and went quickly away but was cultured and showed MRSA. I am an ICU RN by profession. Despite following strict precautions with handwashing and Isolation of patients with MRSA I seem to have contracted it anyway. Prior to this I was a completely healthy 31 year old who ran marathons and competitively cycled. Shortly after the Nare boil healed I developed multiple boils despite antibiotic treatment upon my lower extremeties leading to surgical intervention. Today, 4 weeks after the start of this ordeal, i am still recovering from surgery for removal of multiple abcesses and if i tried running or cycling would fall directly on my face due to general weakness and fatigue. I since have been off of work for a month now and have a professonal headhunter searching for a sales job outside of the hospital setting. The CDC and NIH need to put emphasis on a cure. Its not only killing patients in the hospitals its erradicating the nurses also and if anyone hasn't noticed there are no extra nurses standing in line for jobs! Whats it gonna take for the CDC to put emphasis on finding a cure....We thought AIDS was gonna be the next Holocaust; I beg to differ. Someone recently asked me if I had persued any Legal actions against the hospital. DO I have a case? Workmans Comp? If there is anyone out there with information please help
  12. by   nursex20
    ........Despite following strict precautions with handwashing and Isolation of patients with MRSA I seem to have contracted it anyway...........

    The problem with that is poor teaching and support even among professionals. People have no idea that MRSA is the fastest growing pathogen on our planet. They continue to demand antibiotic treatment at the first sign of a cold. They are not being taught that once they are infected with mRSA they may be contagious whenever they are sick and do not tell hospital staff on admission if they have had MRSA befoe. Maybe hospitals do know and are still not putting these people in isolation when they admit with a hx. of MRSA.

    I am not sure how effective a workmans comp claim would be in your case. It would seem that they could reply that there was no baseline to determine that you did not have colonized mRSA before you were employed there but you might look into it.

    I am more concerned with MRSA as a nurse than with HIV every day. I do continuos care now for Hospice patients and I assume that they are all infected due to reent hospitilazation or nursing home care. It is much easier to deal with having only one patient at a time and a big tub of clorox or lysol wipes in my on duty bag. that bag lives in my car trunk and never comes into my house, and in hospice we are not about a lot of agressive treatment so there is not as much patient contact. Everything I touch and use in the patient area including the table I write on and the siderails of the bed get lysoled or cloroxed for my shift.
    Let me know how you are doing.
    The nurse I was working with when this thread started did finally get her nares free of MRSA but she went through the whole iV Vanco series and then some. All of her personal items at home had to be thrown away and replaced etc, etc.
    It is a mess.
    Good luck.
  13. by   DOCBUCS
    Nurse 20,
    Thanks for your input. I like i said am recovering slowly and am determined to beat this. I have many a marathons to run and many competative races to cycle. Nevertheless have decided to give up on caring for others and pursue my career elsewhere. When it gets to the point that there is a question whether a company will cover a claim that nearly took my life then I know that NO JOB IS WORTH THIS CRAP!!!! I AM DONE WITH PATIENT CARE...I Plan as stated before to utilize my experience in acute care to sell medical devices. My first Interview is on thursday and have 3 More friday. I had No idea the world was begging for nurses outside of patient care. Guess what.... that door has been shut and locked . I will enter College again and finish another program before returning to patient care!!!
  14. by   btraveler
    I am a critical care RN and several months ago ended up with MRSA. It started out like a zit on the back of my neck and then it got infected and the MD called in a boil. I ended up having an I & D on it and it came back positive for MRSA-my doctor stated that 90% of all skin infections are staph infections. So I was treated with bactroban in the nares x 5 days and clindamycin. Several months later I got another skin leasion on my abdomen-I was really frustrated....all along I thought I got it from work, but it turns out I got from the gym I worked out in.

    I talked with an infection disease nurse and she stated once you have MRSA it's very common to get it again. She also stated that when someone is under alot of stress, there immune systems are almost as low as what an AIDS pt's immune system is....THAT'S CRAZY AND VERY SCARY!

    I too was a carrier of it and using the bactroban cleared me of it. The hospital would not let me return to work until I tested negative: skin and nares.

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