MRSA isolation

Nurses General Nursing

Published

Specializes in Med/Surg, Home Health.

At our facility, we have to use disposable gowns with every patient who has or had MRSA. Even if a patient had MRSA years ago in a wound that is now healed, just having a history of it. We go thru so many gowns, they are hot to wear, and it takes so much of my time to put one on, take it off and throw it away, put one on, take it off and throw it away, etc. I know MRSA is a problem, but if they dont actively have it, does that make sense to you? If they are taken downstairs for a diagnostic test, they are exposing everyone anyway because they are not gowned. We use the same BP cuff on everyone that is not in isolation, which is stupid because anyone can have undiagnosed MRSA. Even if we take a food tray into their room, we have to put on a gown. Imagine trying to put on a gown while holding a tray.

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Specializes in Cardiac Telemetry, ED.

Once a person has had an active MRSA infection, they are considered to be colonized, hence contact precautions, even for "old" MRSA. By coming into contact with a colonized individual and not taking contact precautions, you potentially become a vehicle to spread MRSA to vulnerable individuals.

If the patient leaves the room for a diagnostic, it is one of your responsibilities as the nurse to communicate their isolation status so that contact precautions can be taken by other persons coming into contact with that patient.

I set the tray down on a surface while I gown up, then pick up the tray.

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Specializes in MICU, SICU, PACU, Travel nursing.

I know it may not be a popular opinion per say, but I think using those gowns all the time on people who just have a history of MRSA is overkill. I think its a waste of resources and time. I suck it up and do it anyway because its policy, but come on- everybody in the hospital including me is probably colonized with something or has been at some point and if you are not coming into direct contact with the patient or body fluids I think that good hand washing is a way more effective means of reducing transmission of these bugs. I still have not seen any research that using a gown EVERY time you enter a room, even to program a pump or something like that, adds any extra protection from washing your hands. So I am also skeptical about MRSA precautions on someone with a "history" who is currently negative.

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Specializes in Cardiac Telemetry, ED.

I feel that's similar to not using a condom because STIs are so common, you've probably got something anyway. Why take the risk? Unless you've had a nasal swab done, you don't know whether or not you are colonized, so why assume that you are?

Also, they're finding that the MRSA bacteria can live on fomites for a very long time.

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Any pt admitted to our ICU is automatically put on contact isolation until they get 3 negative nasal swabs. Then they can come off of precautions. If they have a positive swab, they stay on isolation forever. Great, ain't it? They don't do it on the ER pts or regular floor pts, just ICU. But here's the thing. I probably have it. So do most of us. And guess what, EVERYONE is colonized with staph! It's a fact, we all have it on our bodies. MRSA is an opportunistic infection. It waits around till the immune system is depressed, or else until it gets a great portal of entry (a bug bite, a surgical incision, etc.), then it goes to town. Sure, precautions for people who are oozing green stuff, or coughing up a lot of MRSA positive sputum make sense, because you never know what they are going to touch in the room. But if they are just colonized, but not infected and not being treated for that, then universal precautions should be enough, IMHO. MRSA is not necessarily a nosocomial infection anymore. You can get it at the grocery store! Make sure you wash your apples, by the way! Healthcare just got a lot less affordable. Why don't they just invent a full body glove. We could step into it and zip it up to cover every possible surface and orafice on our bodies each time we go into a pt room. Or better yet, lets wear a biohazard suit with a respirator on it for every patient!

Don't get me wrong, I am all for protecting myself and other pts. I just think that thi is going a little bit too far. And I don't think it's because the hospitals are worried about us, or even the pts. It's because MRSA infections are one of the things medicare will no longer pay for starting in October. I know it's MRSA s/p open heart, but I don't know whether it includes all MRSA infections.

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Specializes in Cardiac Telemetry, ED.

I'd like to see the statistics on MRSA prevalence in health care workers. Yes, we all have Staph Aureus, but we don't all have MRSA.

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I'd like to see the statistics on MRSA prevalence in health care workers. Yes, we all have Staph Aureus, but we don't all have MRSA.

They can't do that. If you swab say 100 nurses, and "a bunch of them" (not going to guess a number) turn out to be colonized, then what?

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Specializes in Cardiac Telemetry, ED.

"They" have done it.

http://infectious-diseases.jwatch.org/cgi/content/full/2008/625/1

What is the prevalence of MRSA carriage among healthcare workers, whose risk for MRSA exposure is elevated? Now, researchers have explored this issue in two investigations involving emergency departments.

Suffoletto and colleagues conducted a prospective convenience-sample survey from October through December 2006 among emergency department healthcare workers in five Pittsburgh teaching hospitals. Individuals with a known recent S. aureus infection, or a hospitalization within the previous year, were excluded. Among the 255 participants, 81 (31.8%) had nasal colonization with S. aureus, including 11 (4.3%) with MRSA. All MRSA-colonized workers were nurses, nursing assistants, or patient-care technicians.

Bisaga and colleagues conducted a similar study from May through September 2006 at a tertiary care community teaching hospital near Chicago, using a PCR assay for MRSA. Nasal MRSA colonization was found in 16 of 105 participants (15.2%), with no statistically significant difference in prevalence among nurses, physicians, and technicians.

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They can't do that. If you swab say 100 nurses, and "a bunch of them" (not going to guess a number) turn out to be colonized, then what?

I agree. If "they" wanted to reduced MRSA in hospitals then "they" would nasal swab each employee for MRSA yearly when they did the PPD. Why is that not happening?

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Specializes in MICU, SICU, PACU, Travel nursing.
I agree. If "they" wanted to reduced MRSA in hospitals then "they" would nasal swab each employee for MRSA yearly when they did the PPD. Why is that not happening?

Easy. Because then there would be no nurses to take care of anyone:)

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Specializes in MICU, SICU, PACU, Travel nursing.
I feel that's similar to not using a condom because STIs are so common, you've probably got something anyway. Why take the risk? Unless you've had a nasal swab done, you don't know whether or not you are colonized, so why assume that you are?

Also, they're finding that the MRSA bacteria can live on fomites for a very long time.

If you dont directly contact the patient, wear gloves, don't touch your clothes or face/hair ect. plus use good hand washing technique then I am not convinced you are taking much of a risk.I dont think its comparable to unsafe sex:chuckle. Universal Precautions should be in place for EVERY patient and they are often adequate.

Alot of times we have a patient for a while before they come back positive with anything. Do you think we should just wear gowns 24 hours a day with every single patient that comes through the door just in case??

And I am sure many health care workers are colonized and also many in the community. As a previous poster stated it is an opportunistic bacteria that doesn't always affect those with adequate immune function.

Heck, maybe we should wear plastic gowns to Walmart too. That place is crawling with disease. :chuckle

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In my institution as long as you are not touching the patient (aka checking IV pump delivering food, etc...) you do not have to be gowned going into a MDRO precaution room. It all depends on your hospital's infection control protocols what you have to do. But when we bring patients with MDRO precautions to tests or other rooms they are wearing a gown themselves as per our hospital protocol. You should take any concerns up with your hospital/institutions infection control committee.

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