Isolation of NH pts in Acute Care

rjflyn, ASN, RN · Apr 28, 2004

I am the Infection Control nurse at our hospital. We have a physican that wants to place all NH pts in contact Isolation, when admitted, and for us to do a nasal, rectal, urine and wound (when applicable) Culture, to test for MRSA. Isolation can be stopped if cultures are negative.Does anyone presently do this and if so, would you be willing to share a policy with me.
Greatful for help in Kansas!

Its not to odd. I worked at a hospital in North Carolina and a few years back they started putting any patient admitted from LTC or an outside hospital on the same contact precautions. Apparently there was some study at the time that said as high as 3 out of every 4 pt from a nursing home was colonized with MRSA. We were doing swabs of the axilla, groin and nares, when things came back negative they were moved out of contact isolation, anyone positive had it noted on there chart and would always be adimited as such.

Rj

zambezi, BSN, RN · Apr 28, 2004

We don't routinely do this at my hospital for LTC patients. Any patients that get admitted to critical care do get an MRSA nasal swab upon admit though. I like the nasal swab because it is pretty noninvasive... IF we get a patient transferred from another hospital and they have been there >3 days or have been in a hospital within the last 60 days we do do a rectal VRE swab (on any unit/floor).

Tweety, BSN, RN · Apr 28, 2004

We are currently doing that. We've found several patients with MRSA nares, or other infections that way, so I'm thinking it's a good idea, as nursing homes are a high risk environment and many of the patients are immunocompromised due to age.

Basically we swab the nares, get a sputum if products, get a urine if the patient had the foley in the nursing home, and collect stool only for diarrhea. We don't routinely swab the rectum.

Do to bed crunches we are allowed to cohabitate nursing home patients that are admitted close to the same time until the cultures come back.

It usually takes three days.

We do not isolation persons in an assisted living facility.

This winter it was a huge hardship placing nursing home patients (the county I live in Florida has tons of nursing homes).

This and other isolation policies we've come up with has decreased the infection rate according to snippets in our newsletters.

Good luck. :)

Dinith88 · Apr 29, 2004

...IF we get a patient transferred from another hospital and they have been there >3 days or have been in a hospital within the last 60 days we do do a rectal VRE swab (on any unit/floor).

Wow...i hope if i'm a patient i never get transferred there! I wonder if your hospital's admissions have gone down since this policy was initiated...

"...i've just got this bad headache and....hey..whats that Q-tip for?..and why are you smiling?? ...AHHGGGHHHH!!!"

Thats a wierd policy...i wonder if more places are doing this than not???