MRSA/gowns and gloves

[BABY--RN]

HI Guys,

WE have had our second serious outbreak of MRSA(meaning more that one patient at at time) and our unit is in an uproar! The staff have all been swabbed twice and the babies are being swabbed once a week. I have two questions that I really need some input about. First--Our manager has reccommended that we start wearing gowns and gloves when performing routine care for all of our patients, esp. during bottle feeding. Is this reaally necc? I just feel like this is to cold--some of the only touch some of our patients get comes from the nursing staff during routine care.

Second--When MRSA is among you---Do you allow a MRSA assignment to care for a routine stable feeder grower with no PIV or Central line access or not? I know there is literature out there, All the "good books" are at the hospital and I am on vacation, just wanted to here what you had to say as I was searching the net.

Thanks for your time!

[rnin02]

I'm not in the NICU, but in our well-baby nursery we are supposed to gown up whenever we hold or feed a baby. Gloves aren't needed. I'm sure our NICU has the same requirements.

[SteveNNP, MSN, NP]

We wear gowns when holding a baby for feeds, gloves when mixing MBM, but otherwise, not during routine care. We wear gowns/gloves when caring for a MRSA cohort. We adjust acuity so that all isolation kids are cared for by the same nurse/es, no "clean" babies in an isolation assignment. Even if we have 1 MRSA feeder-grower, that baby has that nurse all to himself. Isolation assignment nurses don't go on deliveries, "help" with clean babies or even answer "routine" alarms on clean babies. The rest of us understand this, and it's worked well for us. (You do get REALLY bored if you only have 1 stable iso baby)

[dawngloves, BSN, RN]

We wear gloves whenever touching a baby. Taking a temp or feeding or changing a diaper, whenever. And we still have pts that get MSRA from time to time.

[BittyBabyGrower, MSN, RN]

When we have an outbreak, we wear gowns and gloves for all contact. When we had a REALLY big breakout, even the clean kids were subjected to the same treatment. Clean and dirty are never mixed. All the kids got swabbed, we got swabbed, all the kids got Bactroban, all kids over 1500gms got Bactistat bathes once a week.

We had several patients a few weeks ago that had MRSA, in different rooms...and all those moms had artificial nails. Since we aren't to wear them because of infection potential, we are thinking of telling mom's that have them that they either have to remove them or wear gloves for their babies stay. These were otherwise okay gainer and growers, not the usual kind that get MRSA.

[lovemyjob]

We used to swab babies every monday and we had tons of kids on iso. Now, we only put a baby on iso if they have and MRSA infection. Many many of us (parents, visitors, etc) have MRSA living on their skin as part of our normal flora.

When we have a few kids with MRSA we will not necesarily put themj with the same nurse. But we do make a border around their bedpace with umbilical tape and place a isolation cart on the outside of the bedsapce and require gloves and gown for pt care and fopr touching anything inside the space. The isolation(s) assignment usually does not have a vent and is not with admission. But, they can help with any other kids, vents and admits.

[BittyBabyGrower, MSN, RN]

Yes we all may have MRSA on us, but we aren't immunocompromised.

[lovemyjob]

If that were the case, we would not let 75 year old grandmas in to see their grand-babies, especially if they have been in a rehab center or temporary nursing home. So, swabbing all kids on a weekly basis and quarantining them would only make sense if you had all visitors wear gloves and gowns so that no one could bring it in to the unit.

I guess I just have a more laxed view of MRSA. I fully appreciate the devastation of a MRSA infection, I guess I just dont see the sense in swabbing kids routinely. Our Neos dont agree with it either. I see treating all kids with MRSA on the skin does nothing more than create a super-super bug. When MRSA becomes reistant to bacitracin, then what will we use? OR, to use another example, some units use nystatin oral swabs when on ABX to prevent candidas. When we start seeing resistant strains, what will we use for true candidas oral infection?

Those would be devastating to one who is imunocompromised.

[crazyaaa]

Shall we also stop giving babies cuddle ,just to prevent MRSA?Babies r patients,but they are babies...

Is there anything else we can do???

[RedWeasel, RN]

Well I just saw a doc go into an adult pts room with MRSA without washing hands in or out, no gloving up and touching the pt with bare hands. We are to always wear gloves into a MRSA room and gown for extended contact (ie with sheets, fluids etc., transfers)AT LEAST. It infuriates me to know we take care to not pass it around and they feel they can just traipse in there and take it out with them. I will be calling the infection control doc in the AM. THEY NEED to follow the dang rules. I will NOT be blamed for passing it around. We as nurses always get the blame. "Oh the nurse didn't wash her hands etc." Heck what about the family member sitting on the floor handling the remote. THEY never wash their hands or are required to. This is ridiculous there needs to be continuity. They never ask if they should wear gloves etc. but instead take it out of the room onto the elevator and walla out into the community. But it is us nurses who don't wash their hands. Yes I tell them what they should do, wash glove etc but not everyone does so they get mixed signals. The CDC needs to get on this and require stricter compliance with visitors. It is our turf and we don't want spores kicked up in our faces. I mean who wants a fan in a CDIFF room? ANYWAY i am tired and cranky sorry.

[everthesame, LPN, LVN]

Within a year after implementing the gown and mask rule and receiving constant hand hygiene education we saw a statistically significant reduction in our MRSA infections. I agree with one of the earlier posters in that we are missing out on therapeutic touch. I was pulled to our newborn nursery the other night and it seemed so weird to actually touch the baby. It was really nice for a change.

[LilPeanut, MSN, RN, NP]

We also gown and glove for MRSA pts., and glove for all pt. contact.

We have seen a huge reduction in MRSA, but I also am sad for not getting the therapeutic touch aspect.

We don't necessarily treat for colonization, but we do isolate. Swabs are done every tuesday, and upon admission. We also have different housekeeping staff for isolation rooms, and we've gotten a new "environmental tech" who helps us with regular wipedowns of everything.