MRSA in the ED

Lots of patients don't know their MRSA history and no one else knows they're at risk for it either. Caregivers don't figure it out until the patient has been hospitalized awhile. By that time it's too late.

It's been my opinion, for ages, that hospital staff who have direct patient care probably all have MRSA or will eventually. How would it be avoided? Same thing with tb--by the time we get a positive PPD from a patient, we've already been coughed on, breathed on, etc. Since most staff people don't have positive PPDs on yearly testing, though, it must not be that infective.

So, what do we do about this? Gown, glove, and mask everyone who comes into the ER until he/she is cleared? Always gown, glove, hair cover, and mask ourselves? Always change protective garments between patients? What about when a patient first arrives and is being triaged? What about before staff has come into their little cubicle for assessment? germs flying everywhere!

It's sooooo complicated!

Our institution has found a way to isolate MRSA pts in the ED. Patients are flagged from previous health history before they come into the ED. (doctors offices, tests, previous visits...) However, is a curtain really a good barrier? Also what about all the ones we don't have a history on that come in with their first abcess. Also what about family members? Not the family that come in with a MRSA pt but ones you have seen with someone else that has MRSA! All I know is gowning up for every pt everytime seems over the top.

It's silly.

I have worked in a number of ER's with varying degrees of MRSA precautions. None have appeared to me to be even remotely effective.

Your question only adresses admitted pt's with known MRSA. How about all those with yet to be diagnosed MRSA, or those we send bak into the community?

Hospitals are really gross places teeming with pathogenic micro-organisms, and ER's are probably the worst place in the hospital. If you actually wanted to get sick, I can think of no better place to go.

I also work ambulance. A lot of the time we don't find out pt has MRSA or other infectious hx until just before we get to the ED (when I have a moment to read all of the nursing home hx sheet) if then. I always tell the ED if I know, but I pretty much just assume the patient has something that I don't want.

What about the MRSA patients who decide to leave their isolation rooms upstairs and go for a walk in the hall? Or the ones who are discharged or leave AMA and walk out pushing the elevator buttons etc. What about the taxi they get into?

I'm beginning to think that if we want to prevent the spread of these diseases we'd need a locked ward for all MRSA, all VRE, all C Diff etc patients. Eventually it will just be easier to have a locked ward for patients who don't have any of these infections.

As an ICU nurse, I will tell you why it matters for you to be gowned bringing the pt up. No, we don't think it will do anything for you, it's for us and our other very compromised pt's. You being gowned is a large visual clue that all the ICU staff going into that room better be gowned too.

I have to say my ER is good at bringing up pt's that have known contact isolation in gowns. The OR are the ones that bring up pt's with known problems without gowns and then tells us after 5-6 ICU nurses have been all over the new admission.