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MRSA & IVAB - Vancomycin

Nurses   (3,522 Views 14 Comments)
by AussieKylie AussieKylie (Member)

8,745 Profile Views; 410 Posts

Hi there

I am wondering if other nurse see this situation in their units.

We swab patients on the ward for MRSA when they first arrive on unit or get transfered from other units to my ward.

Once confirmed that they are positive for MRSA, then Vancomycin IVAB is set up.

The question i pose is: Does anyone see a result prior to patients discharge after their long stay in the unit when and if they get clear of the MRSA bug ???? I cant work this one out, otherwise they just go back into community with the bug??? That to me is not controlling the problem.

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CarVsTree has 4 years experience and specializes in Trauma ICU, MICU/SICU.

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I've never heard of this practice. Many ppl are colonized with MRSA, including the majority of healthcare workers. I doubt that a round or two of Vanco would make a colonized pt. uncolonized. A MRSA infection is altogether different. That should be treated.

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WoWChick is a BSN, RN and specializes in Medical Surgical.

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We, along with three other floors swab folks as soon as they get in the room. Most of the time I send the swab down to lab with a chart sticker before lab can print a sticker off and send it up to me.

If positive we place on contact isolation and we treat with IV antibiotics and usually a topical antibiotic to the nares daily.

If they have a history of MRSA they automatically get placed on isolation.

At a staff meeting I suggested staff be swabbed. I think my manager is part politician because you've never seen someone change subjects so fast. "thats not an option. Now the next thing I want to talk about is..."

If they swabbed the staff...there would be a HUGE staffing crisis.

We should start a survey..."Who has MRSA...vote yes or no."

lol

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CarVsTree has 4 years experience and specializes in Trauma ICU, MICU/SICU.

1,078 Posts; 7,398 Profile Views

Where is the evidence for this practice? The CDC recommends NOT treating MRSA colonization, only infection. Treating colonization will only increase resistance to drugs that are currently effective (such as Vanco). Also increases risk to contract C. Difficile.

Step 9. Know when to say "no" to vanco

- Vanco should be used to treat known infections, not for routine prophylaxis

- Treat staphylococcal infection, not contaminants or colonization

- Consider other antimicrobials in treating MRSA

Step 10. Treat infection, not contamination or colonization

- Use proper antisepsis for drawing blood cultures

- Get at least one peripheral vein blood culture, if possible

- Avoid culturing vascular catheter tips

- Treat bacteremia, not the catheter tip

http://www.cdc.gov/drugresistance/healthcare/surgery/12steps_surgery.htm

http://mqa.dhs.state.tx.us/QMWeb/MRSA.htm

Again I ask, why are your facilities treating patients for an infection they do not have?

I'm going to request that the mod move this to Gen Nursing to get more opinions. :)

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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

8 Followers; 142 Articles; 9,659 Posts; 248,350 Profile Views

Done!;)

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lsyorke is a RN and specializes in Med-Surg, Wound Care.

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We only treat those with an "active" MRSA infection. Treating a colonized patient is not good medicine.

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WoWChick is a BSN, RN and specializes in Medical Surgical.

21 Posts; 1,427 Profile Views

I'll have to check our policy on colonized patients. I know they are placed on contact isolation, regardless.

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jmgrn65 has 16 years experience as a RN and specializes in cardiac/critical care/ informatics.

1,344 Posts; 12,072 Profile Views

we only put active MRSA in isolation, not hx of, as it can be cured. VRE hx gets isolation because that is much harder to cure.

I agree with op that tx mrsa that is not active infection is bad medicine. Where is evidenced based practice?

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Ive generally only seen people treated with AB's if they have MRSA in a wound, not just for colonisation... The only time I've seen colonisation treatment is prophylactically prior to surgery and even then, it is only topically. All patients transferred who are tested positive for infection are definitely isolated. I agree with standard Vanc therapy causing more harm than good unless for an infection that is already underway...

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lsyorke is a RN and specializes in Med-Surg, Wound Care.

710 Posts; 6,831 Profile Views

Why do people randomly culture patients on admission?

Not a good practice if there's evidence of active infection. This is what creates more antibiotic resistance. Our ICU's do this, but it's more for knowledge for preventing tranfer to other patients than for treatment of a non active infection.

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