MRSA and C-Diff

[EJSRN, BSN, RN]

:up:For some reason I just cannot grasp a couple of things about MRSA and C-Diff. I fully understand the infections and treatment but.... When testing for MRSA you do a nasal swab to see if the bacteria have colonized. I just dont quite understand what that entails and if isolation is required if they are NOT colonized. With a hx of MRSA when is it safe to say they are MRSA free? C-diff is a little confusing too. When results come back they say negative for toxin but positive for antigen or vice versa. What exactly does this mean? When can the Patient come off of isolation? When can antibiotic therapy be discontinued? If anyone could clarify these for me i would greatly appreciate it!!! Thanks, ejsrn:up:

[Gabe's GirlLVN]

I've never seen a nasal swab for MRSA where I work. We culture the wound. Interesting

[StrwbryblndRN]

At our hospital we do a nasal swab aka MRSA screen for all pt's with a hx of MRSA or certain criteria. Such as resident of a LTC, prisoners etc.

If there is a hx of MRSA then they are automatically put on isolation precautions on top of the nasal screening. Regardless of the hx. For example if someone came up MRSA+ from a wound on there foot from one year ago and they no longer have an open sore they are still put on precautions.

For c-diff we just isolate when test comes back positive. Or even perform precautions even before the results to be safe when there is a strong indication to be +.

[vadee]

i was doing some reading on the CDC website regarding MRSA or MDRO (Methicillin Drug Resistant Organisms) and there are no current recommendation on when a patient should be taken off of precaution.

All I got from the CDC website is that MRSA is considered standard unless there are drainage/pus or positive colonization, it is then considered contact precaution. It also becomes contact precautions when the patient is in an acute care settings, long term care settings, and dialysis settings.

As far as the room recommendations, private room should be assigned if available...and if not, you would want to cohort.

Mask is not recommended during routine care...use mask in burn wound care and when performing splash-generating procedures such as in during open tracheostomy care.

You can read more on the CDC MDRO website..You can scroll to the bottom two pages and read more about it.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We do MRSA screening per nasal swab on all LTC, prisoners, or those with hx. Our policy states that isolation is removed after 2 separate negative swabs. C-diff is removed after neg culture.

[GeminiTwinRN, BSN]

All patients being transferred out of a Unit bed (CCU, ICU, SICU, etc) are swabbed prior to leaving with an MRSA nasal swab.

[EJSRN, BSN, RN]

So if the Nares swab comes back positive the MRSA is active and antibiotic therapy is required?

[Mommy_of_3_in_AL..RN]

In SICU and CCU we do an MRSA nasal culture on all patients upon admission. That protocol was just implemented a couple weeks ago. All patients are on isolation precautions until the results come back, which generally only takes a couple hours. If they are negative, they are taken off precautions, positive they stay on. USuallly they are transferred to the floor still on precautions, so i am not sure about taking them off. Cdiff, i am not really sure. We dont get many of them. If there is suspicion, they are placed on precautions until the culture comes back.

[loriangel14, RN]

We do MRSA swabs, nares,rectum and all wounds for new admits. If positive they have to have three neg swabs, five days apart before they come out of isolation.Results take about 2 days as we are a small hospital with no lab.