MRSA and Isolation

mary78910 · Aug 13, 2008

So as a new grad i have a few questions on this. A patient comes in with mrsa+ nasal swab, should they be in isolation????

Is it ok to put a mrsa+ nares with a non mrsa patient.

What about taking a dinamap from one patient to the next without cleaning it, even if you know they are mrsa+ or cdiff+.

and here is the big one,

when you switch a patient rooms, we take the whole bed, then they take the clean bed and supplies and just put it in the other room, without it being cleaned, why because the bed and table are clean. That drives me nuts, what about the floors. This patient they can be switching can be mrsa+ or have cdiff and then two hours later they'll put a fresh post op in the dirty room, but it has a clean bed. Is this normal. DO they do this everywhere. :banghead:

nerdtonurse?, BSN, RN · Aug 14, 2008

I can't find it right off the bat, but a hospital in Texas did a study on their rooms after a MRSA pt left. They found MRSA on walls, floors, phone books and the Gideon Bible in the room. Now, either MRSA is airborne, in which case we are all exposed and can just take the iso stuff down, or it's endemic in the environment and we can just take the iso stuff down.

I think we'd serve our pts better if we just made sure the docs WASH THEIR HANDS BEFORE TOUCHING THE PATIENT. I had a guy + for everything but pregnancy (MRSA, VRE, c diff, shingles, and we were all thinking he had to have HIV to be so immunocompromised at his age) and I practically had to smack the doc in the face with the gloves to get him to put them on.

nerdtonurse?, BSN, RN · Aug 14, 2008

What we do:

+ or waiting for a test result --- iso. And they have to be negative twice to get the iso stuff taken down.

Single room, or if it's a double, no roommate. Seems like we could at least put the positives together....

achot chavi · Aug 14, 2008

I work in a PICU that will put a MRSA + patient who is on contact isolation in the same room with other patients. So if the others weren't positive before, they will be before they leave. Plus, we culture for MRSA but don't implement contact isolation measures until the result is back. So why bother. Ridiculous.

Hope they have a legal team!!! re you even allowed to tell the roommate that he has to be careful etc? Do they hand signs on the door etc.?

achot chavi · Aug 14, 2008

I can't find it right off the bat, but a hospital in Texas did a study on their rooms after a MRSA pt left. They found MRSA on walls, floors, phone books and the Gideon Bible in the room. Now, either MRSA is airborne, in which case we are all exposed and can just take the iso stuff down, or it's endemic in the environment and we can just take the iso stuff down.
I think we'd serve our pts better if we just made sure the docs WASH THEIR HANDS BEFORE TOUCHING THE PATIENT. I had a guy + for everything but pregnancy (MRSA, VRE, c diff, shingles, and we were all thinking he had to have HIV to be so immunocompromised at his age) and I practically had to smack the doc in the face with the gloves to get him to put them on.

I'm curious where the Texas MRSA+ patient was infected with the MRSA? was this a pulmonary unit? According to the textbook- if the MRSA is in the urine - unless they squrted the stuff how did it find its way to the PHONEBOOK? (or walls for that matter)

Re HANDWASHING- well DUH- I'd report him to my supervisor if he refuses to follow Universal Precautions- do you have to wipe his nose for him too?

tgirl84 · Aug 14, 2008

my hospital started paying these nobodies (i say nobodies because these individuals have no medical training or background) to observe the nurses to watch if we are "foaming in and foaming out, followed by hand hygiene (washing with soap and water)". of course the anti-bacterial foam that the hospital provides for the nurses is the cheapest, most horrible available form on the market. there are a few nurses that are absolutely refusing to use it because by the end of the day their hands are hamburger meat. well, yesterday at work i opened my email and i had received an email from the new manager who stated that she will be "initiating disciplinary action against those who are not foaming in and out". on top of that, there is going to be a "wall of shame" and a "wall of fame". shame= nurses who are not foaming in and out, fame= foaming in and out, per protocol.

does anybody else find this as horrible as i do...?

achot chavi · Aug 14, 2008

yes....

... but I also empathize with your supervisor- do you think she has nothing better to do than this? do you think that having a wall of shame endears her to the staff and makes her look good? Perhaps she feels that she isn;t getting through to the staff and drastic measures need to be taken,

She is just trying to protect her staff and the facilities reputation. If we all cared about cross infection and preventing nosocomials- she wouldn't need to do this.

On my unit a new patient brought with her a terrible eye infection- I begged my staff to take every precaution. The doctor pooh- poohed my instructions. He ended up with a doozy of an infection along with the 2 aides who disregarded the facilities instructions and the rest of us thank g-d stayed clean.

Regarding the crappy soap that makes your hands look llike hamburger meat- may I suggest you keep good hand lotion next to the sink- we all chip in and we try to wheedle samples from the pharmaceutical reps.

At night wash your hands and with wet hands slather vaseline on them and cover with cotton gloves- by the morning you will thank me.

iluvivt, BSN, RN · Aug 15, 2008

No active infection in last 6 months or current issues and they can go without all the precautions, That is our policy