Isolation

[busy-bee]

What are some of your policies for MRSA in the urine? Naturally a foley cath is present, but should or should not a patient be isolated?

Shingles...what about those. If they are covered, under clothing/dressing and not draining, what are your policies. If they are on the face, and the patient touches them frequently...then isolation?

Can we review this again? Thanks.

[nyapa, RN]

We isolate both, and use universal precautions, ie gowns, gloves etc.

[Conrad283, BSN, RN]

Both get isolated, sometimes get cohorted w/same infection. I don't think for shingles though, they get a private room.

[EmmaG, RN]

I posted this somewhere before, can't remember... but anywho, all the guidelines are here.

http://www.cdc.gov/ncidod/dhqp/gl_isolation.html

Click on 'complete document', then go to Appendix A; concise chart listing the type of precautions and duration for pretty much everything you could possibly encounter. Also with comments on the side specific to each.

I printed this chart off and carry it with me on my clipboard. Great reference.

[Conrad283, BSN, RN]

I posted this somewhere before, can't remember... but anywho, all the guidelines are here.

http://www.cdc.gov/ncidod/dhqp/gl_isolation.html

Click on 'complete document', then go to Appendix A; concise chart listing the type of precautions and duration for pretty much everything you could possibly encounter. Also with comments on the side specific to each.

I printed this chart off and carry it with me on my clipboard. Great reference.

Excellent website. I think I'll do the same. Thanks

[EmmaG, RN]

control interventions. the various types of interventions used to control or eradicate mdros may be grouped into seven categories. these include administrative support, judicious use of antimicrobials, surveillance (routine and enhanced), standard and contact precautions, environmental measures, education and decolonization.

1. administrative support. in several reports, administrative support and involvement were important for the successful control of the target mdro (3, 152, 182-185), and authorities in infection control have strongly recommended such support(2, 106, 107, 186). there are several examples of mdro control interventions that require administrative commitment of fiscal and human resources. one is the use of asc(8, 38, 68, 107, 114, 151, 152, 167, 168, 183, 184, 187-192). other interventions that require administrative support include: 1) implementing system changes to ensure prompt and effective communications e.g., computer alerts to identify patients previously known to be colonized/infected with mdros(184, 189, 193, 194); 2), providing the necessary number and appropriate placement of hand washing sinks and alcohol-containing hand rub dispensers in the facility(106, 195); 3) maintaining staffing levels appropriate to the intensity of care required(152, 196-202); and 4) enforcing adherence to recommended infection control practices (e.g., hand hygiene, standard and contact precautions) for mdro control. other measures that have been associated with a positive impact on prevention efforts, that require administrative support, are direct observation with feedback to hcp on adherence to recommended precautions and keeping hcp informed about changes in transmission rates(3, 152, 182, 203-205).

http://0-www.cdc.gov.mill1.sjlibrary.org/ncidod/dhqp/pdf/ar/mdroguideline2006.pdf

in depth report. long, but an interesting read.

[swee2000]

At my hospital, both scenarios require the patient be placed in isolation. For shingles, I'm not 100% sure on this(my unit rarely sees these cases), but I believe the isolation precautions just call for gown & gloves. Same thing with MRSA; however, if the MRSA is located in the patient's sputum, then a mask is required when having any direct contact with the patient.

As for as patients w/MRSA in their urine, I can't say that I've seen about or heard of my hospital having a policy that states these patients must automatically have a foley placed just because of the MRSA. I also did not see anything in the CDC's guidelines regarding this. Am I missing something? Does anyone else work somewhere that has this type of policy?

[GingerSue]

just looking at my pediatric textbook, it says that for children with zoster or varicella, in a hospital setting, should be placed in strict isolation

and that airborne and contact precautions should be in effect for children with zoster infections

[nrsang97, BSN, RN]

Shingles are contact precautions with being in a private room. MRSA is private room with contact precautions and mask if MRSA is in sputum.