MRSA and Infection Control in LTC...??

[WannaBeNrse]

Hi,

I just started a new job at a LTC that is affiliated with a local hospital. To my surprise, there are a lot of patients with known MRSA, and not just in their nares. According to the CDC, when someone is colonized or infected with mrsa other than in the nares, the person needs to be on contact isolation. Yet in this LTC, there is no such thing, and I am a little concerned about this.The policy is that the site that is infected needs to be covered. So for one resident who has mrsa present on his scalp, this means, he is wearing a baseball cap... this does not seem like real infection control to me. There is also no designated equipment for the mrsa patients, so unless you have a conscientious aide who remembers to wipe everything with a saniwipe all the time, chances are mrsa has free reign.... is this normal? is mrsa just a part of LTC that we have to live with? How worried are you about possibly contracting it with this lack of precautions? At the nursing home where I worked before, I only knew of one resident who had mrsa.... but I was told that they probably just weren't testing for it, so the numbers may have been higher. What are the stats for LTC mrsa....does anyone know?

Thanks!! :)

[travel50]

If it is colonized anywhere, we do not isolate. Everyone must use universal precautions anyway. We have had no spread of infections. In the hospital, they do isolate, but not in LTC...not where I am anyway. Probably some others will write in that they do.

[evilolive, BSN, RN]

We recently had a resident return from the hospital with MRSA in her bronchioles. When I learned that the prior shift didn't implement precautions I immediately went to my Policy/Procedure manual. According to my company's policy, here's what we would do:

1) Private room if available

2) If private room unavailable, cohort with other residents with MRSA

3) If unable to cohort, place in room with a roommate at a low risk for infection (ex. not immune compromised, no open areas or wounds, etc).

It's tough when you really don't have the ability to switch rooms around on whim. I don't think we've had too much spread of this type of infection. That norovirus this past winter on the other hand....

[achot chavi]

what she said :yeahthat:

[Nascar nurse, ASN, RN]

If it is colonized anywhere, we do not isolate. Everyone must use universal precautions anyway. We have had no spread of infections. In the hospital, they do isolate, but not in LTC...not where I am anyway. Probably some others will write in that they do.

We do not isolate for colonized infections either. Why would you if not an active disease process? I realize things are much different in a hospital, but I would guess that if we forever isolated everyone who had ever had MRSA in a matter of just a few years.. everyone would be in isolation FOREVER! No what a mess that would be (if it even made sense?).

Now we have local hospitals doing nares swabs for MRSA on all of our residents admitted to them and several do come back positive. We take them out of isolation as soon as treatment is complete and they have no signs of infection, ie: colonized. The most interesting part of this is that no one cultures the staff (hospital or LTC) and just how many of us seasoned nurses to you think would culture positive for MRSA of the nares - lots if not most of us!

[MichelleB34]

The hospital I work at has a LTC facility on one of the floors. To my knowledge they don't isolated for MRSA. However one has to remember that the nursing home is the residents' home. So the approach to their care is a little different than it is in the hospital. The hospital has changed the policy in regards to isolating MRSA patients in the acute care setting. If the patient tests positive for MRSA prior to hospitalization and the following routine is followed we don't have to isolate the patient. A patient has to use bactroban to the nares for 3 or 5 days (I can't remember the exact number) and has to shower with a specific medicated scrub for 2 days prior to hospitalization. Then they continue the bactroban to the nares for the first 2 days of hospitalization. We have had these patients a few times on OB for csections. I know I am getting a little bit off the original post but does anyone else have a similar policy?

[BoopetteRN]

I am the inservice director and infection control nurse at a 304 bed facility. We use contact isolation for MRSA unless it is in the sputum then droplet. We try to isolate the infection, not the resident, in other words if the area is covered they can mingle, but if not they have to stay in their rooms. I do the orientation for all new staff and everyone has to watch a video on MRSA. I tell them to use universal precaution, it needs to be second nature because in reality we probably have more infections than we are aware of. Unless the resident becomes symptomatic or goes to the hospital we do not test. Always remember to use universal precautions but also be aware of what your clothing has touched. My biggest pet peave is seeing staff going to the grocery store and other places in their uniforms, or hugging and carrying small children with the same uniform they worked in when they are caring for residents who have MRSA infections. I just hope they follow my advice and use the proper precautions.