MRSA colonization and staff

Mammy1111 · Jan 29, 2009

The fact that nurses are constantly exposed to MRSA is quite frightening. I used to do TB testing of employees in an employee health setting. Out of around 5,000 tb tests I did in a 2 year period, I got 2 new positives. MRSA cultures would be at least productive. If nurses test positive, they should be treated with bactroban, the same as when we find a presurgical patient who is positive on screening. They should also wear a mask and do scrupulous handwashing and gloving to protect their patients. In especially critical areas..cancer patients, cardiac surgery units etc, they should not be doing patient care. The logistics of mrsa screening of employees is daunting, but in order to control MRSAs spread, screening is the first step.

MRsa in healthy people can be transient too, so periodic testing would be necessary. Screening is the first step for controlling MRSA, both in hospital admissions and in healthcare workers.

I don't work in a hospital anymore. But, I will tell you that if I ever enter one as a patient. I will be asking a lot of questions. I will refuse to be in a room with anybody with any kind of infection...unless I have the same infection. I will watch my nurses like a hawk. There used to be a sense of confidence that our hospitals and caretakers would make us better. My father just died of HA MRSA pneumonia after rehabilitation from a minor ankle fracture. His hospital made him sicker and he died on Jan 9.

accessqueen · Feb 6, 2009

If you read the studies where they did decolonization of MRSA, a high percentage were recolonized within 3 months. If you routinely swabbled every hospital emplyee, you'd have to do it constantly. Then you'd have to treat them every time. It has been shown that then MRSA becomes quickly resistant to the treatment. Between testing, treating, and not allowing people to work, you'd just have a huge mess on your hands. It has NOT been proven that poeple with nasal colonization are spreading the MRSA.

elizabells, BSN, RN · Feb 7, 2009

Interesting, how did the handle the positives? Did they allow them to continue to work while being treated?

Nope. They were off for two weeks, paid. I do know of one woman who was actually infected while working, and the strain was identified as originating with a particular patient. She had multiple abcesses that had to be I&E'ed, and it took her a really long time to clear. Our ID people told her if she didn't clear she wouldn't be able to come back to work and probably wouldn't be able to work anywhere, ever again.

Mammy1111 · Feb 7, 2009

I just spoke about my state legislative proposal for MRSA prevention in Maine at an AARP meeting. One woman said her daughter has MRSA and she had to quit nursing because of it. It is not unheard of. Care givers are at a huge risk of infection. It only makes me want to get this legislation passed even more...to know good mandates make for a safer work environment for nurses and a safer healthcare facility for patients.

fulzgold · Feb 10, 2009

I currently work in LTC. Family members will insist on an ATB and put pressure on the nurses to call the Dr. We have one male patient who is colonized with Proteus. He is always asymptomatic and it is difficult to get him to drink enough fluid. His wife visits daily and stares at his foley all day and wants an ATB every time she sees mucous in the tube or thinks it smells when the CNAs empty the bag. I have told this woman a million times, "everybody's pee stinks, Proteus is part of the normal body flora, if you gather your own pee in a container and leave it sit for a few hours you will see things in it, if you keep using ATBs every 30 days you'll grow a supercootie." No one listens to me. Even the CNAs will come to the nurses and say "So and so has a UTI, his urine really stinks". or " So an so is confused, He's got a UTI". I have seen the doctor use IV gentamicin and IV Zosyn on the same residents as often as every 60 days because of this. The same doctor will even fax notes saying "Stop asking me, I'm not treating if he is asymtomatic and we can not clear this up". I think he just gets tired of it and throws his hands up.

Mammy1111 · Feb 10, 2009

Prudent use of antibiotics is an integral part of a good MRSA prevention policy. I have it in my Maine Proposal.

Unnecessary antibiotic treatment just because the patient or family wants it has to stop or we won't have any medicines left that will work on anything. Staph and other microorganisms have morphed into "superbugs" because of over use and unncessary use of antibiotics.

I don't work at the bedside anymore. So, I don't pretend to know all about all LTC or acute care. Is there some sort of deodorizer liquid or tablet you can use in the vessel you dump the urine bag into? Also, how often do you change the tubing? These things just come to mind as a possible solutions to the "doctor" wife of that patient. Maybe if the pee smelled like a nice perfume, she would settle down.

If a patients urine doesn't culture positive for anything active, then antibiotics are not necessary. If antibiotics are given repeatedly when unnecessary, you (or the doctor) are setting your patient up for a drug resistant organism that could kill him.

Lacie, BSN, RN · Jun 29, 2009

I work in chronic dialysis and when I see a significant increase in cvc infections related to mrsa or staph then I recommend we culture the staff nares It usually occurs when we have new staff come in. Last time we found 2 of our staff out of 8 had were active carriers including the secretary. A few weeks of bactroban in the nares and they cleared up and the cvc infections subsided. Even with the use of mask it still spread It could have just be conincidence but I dont like taking chances. It's a simple test and no uncomfortable nor invasive.