MRSA again- Are You Kidding Me???

[WannaBeNrse]

Hi,

I posted recently about mrsa and lack of infection control in LTC, but it gets even better, and I really don't know what to do.

Last night, I cared for a resident (hs cares). After I left the room, I saw the sign on the door: Contact Precautions. I had not seen the sign before because the door was open, and there was no PPE outside the door. So anyway, I talked to the RN and asked her why contact precautions. She told me that resident has MRSA in her sputum. So I asked her, shouldn't she be on droplet precautions then? The RN said No, because she really hasn't been coughing all that much lately. EXCUSE ME??? So I just hope and pray that she won't have a coughing fit while I am doing her cares?? But okay, I guess I am not the one doing the care plan, so I asked the RN if she could at least show me where the gowns for contact precautions are, as there were none outside this resident's door. And her advice was, well, if you're concernded, you can just wear a resident night gown over your uniform. EXCUSE ME AGAIN???

I really don't know what to do here. I have to care for this resident for the rest of the weekend, and she is a nice lady, I don't want to give her any less attention. But I do not feel safe.

This facility is expecting state surveyors any day now. Tell me if I am wrong, but there is no way that these practices are in accordance with state and cdc regulations, are they....?

[Fish Feng]

am sorry to hear that---

i think nursing is quite a difficult job

we should pay all attention to comfort the clients ,

but at the same time keep us safe !

have one more eye pls

[ohmeowzer RN, RN]

well the pt's MRSA could be colonized ( not infectous anymore and you have to meet critera for this). which means the pt does meet the critera not to be in droplet precaution the hospital i use to work in had critera to take the pt out of droplet. the droplet includes.... 1. no fever for 24 hours 2. not coughing 3. on antibotics such as iv vancomycin for 24 hours. i always took people out of droplet when they were able to reach this critera. they are not infectous so why keep them in isolation...?? so the RN did the right thing if the critera of the hospital was followed. remember.. just because you hear the word MRSA does not always mean infectious. but if you feel safer wearing a mask then do so.

[litbitblack, ASN, RN]

last i heard mrsa in sputum was not droplet. only tb. Use contact and a regular mask. and wash wash wash those hands

[CapeCodMermaid, RN]

I think you've got it backwards. MRSA in sputum is droplet....TB is respiratory. The bacteria linger in the air if someone with TB coughs hence the need for negative pressure rooms with ventilation. MRSA is droplet...the 3 foot rule applies. If someone has MRSA in their sputum and you stay 3 or more feet away from them, your chances of acquiring MRSA are small. And just because someone is colonized doesn't mean YOU can't contract the disease from them. It only means they are no longer sick themselves. Check the CDC web site.

[ohmeowzer RN, RN]

i'm not a infectous diease nurse thats for sure. but i know what the protocols were for the hospital i worked for were. i went by the protocols of the hospital and took people out of isolation . i was in charge there for years and went by the recommedations of our infection control nurse. well i can't say noone ever caught it.. here's a good story ... one nurse had a sore on her hand.. she touched a pt who had MRSA on a wound WITHOUT gloves ,, and she got it.. she got mrsa in her bones and she still is suffering with it... she was only 30 and now can't walk and her hands look like they have arthritis... so yes you are right , you can still catch it ,, please wear gloves and wash your hands.... this was 6 years ago and the nurse still can't work... sad huh ?? thank you cape cod good reminder.. i forgot all about that nurse..

[icyounurse, BSN, RN]

Umm, if there is no isolation equipment available- why even bother with "precautions"?? Wear a resident gown, really??

Granted I do think that sometimes precautions arent necessary as the previous poster stated when they have been on Vanc and are on them for previous colonizations that arent active, but if they place someone on precautions with no supplies.......that just seems kinda pointless. Most places I have worked its the opposite problem-its an act of congress to get them taken away, only infection control can remove the precautions once they have been ordered and thats only after 3 negative cultures at least 3 days apart....meanwhile no one really worries about the massive supplies being wasted.

[AnnieNHRN]

What amazed me is how different every facility's rules are! Some places you have to r/o MRSA by doing nares/axilla/groincultures. Other places just the nares. Some say 2 neg. cultures at least 1 week after ending ABx, other say 3 days apart! Some places a nurse can take a pt off precautions, others only the IC RN can. Some hospitals allow pt's with different sites of infection to room together, other don't. I thought the CDC would have universal guidelines for this? Why are all these infection control nurses making up different rules? So confusing! Sigh.

It's laughable when a colonized pt is on strict isolation in our hospital and then goes back to his NH where he then gets to eat and mingle with everyone else. It makes me feel like all the hours I spend in my sweaty isolation gown were for nothing.

I know precautions are important, don't get me wrong. Just wish we were all following the same plan.

[flightnurse2b, LPN]

here's a good website with information re: MRSA in LTC.

http://www.edcp.org/guidelines/mrsa.cfm

at my hospital, we consider any kind of MRSA located within bodily fluids a droplet precaution--ESPECIALLY respiratory MRSA and MRSA in the sputum. we also go by the 3 foot rule. if you are going to be within three feet of the patient, you must gown, mask and glove.

not only does it protect other patients, it protects YOU. just because the patient is colonized, doesn't mean you can't contract MRSA or pass it to another patient.

this RN you spoke to needs some serious ID education. i would ask higher up the chain.

[CapeCodMermaid, RN]

Let's remember we're talking about long term care. We have different rules than hospitals. Y'all can tie people down to the bed and give 'em IM Haldol against their will---we can't. While we don't go around encouraging people who live in a facility to comingle their bodily fluids,neither do we shut them in a room with the door closed. How have times changed? When I was much younger I worked in a skilled facility at which we had to wear caps. We had a patient with MRSA & VRE ib his sputum and needed to be suctioned. I told the DON that none of us would go in his room without gloves,gowns masks, goggles, and foot covers since there was a chance of being contaminated with the small droplets while we were suctioning. She reluctantly agreed and then tried to write me up one day when I came out of the room without my cap. She told me I was out of uniform. I suggested being out of uniform was far superior than wearing a cap loaded with bacteria.

We should take reasonable precautions without punishing or isolating the person with the disease.

[nina4nursing]

I too have previously taken care of a MRSA patient in a nursing home.

Was not even told he had contracted MRSA until I was already in his room

with another aide. As we took away the sheet to provide care, I saw his leg

was extensively bandaged. So I asked him what was wrong and if he minded

my asking him. He said no that he had just gotten back (from being at a very

well known hospital in our area) about 10 days ago and that they had to cut his

leg open and scrape some of it out. Next thing you know the words MRSA came

right straight out of his lips. Mind you as soon as he said "scrape something out"

MRSA was already in my head. We talked with out head nurse. She also claimed

it was not that big of a deal. My concerns to her was we were using a lift to move

the individual. The lift sling was then used on other patients in other rooms. And like

one of the above posters, he also was allowed to freely leave his room and go to the

dining room to play bingo!

[CapeCodMermaid, RN]

If his wound was covered so were you. MRSA in a wound is contact precautions. Did you touch the wound? If not, you are safe. I wouldn't use the same sling.