MRSA isolation

mpccrn, BSN, RN · Sep 6, 2008

seems silly to gown and glove to answer a light or reset a pump when laundry is mixed with unisolated laundry, food trays are put in the general population etc.... :smokin:

iluvivt, BSN, RN · Sep 6, 2008

No active infection in 6 mos we do not isolate anymore. That all I know but now I am curious.....I work for a big hospital system so they must have good resources!!!!

nerdtonurse?, BSN, RN · Sep 6, 2008

Here's the places I'd like to see them test:

The phonebook in the room after an ambulatory pt leaves (MRSA can live for 11-14 days on a surface)

The "menu" section of the pt care book

the twisty thing for the blinds in the room

The toilet paper holder -- the inside parts you bump when you reach up for paper

I mean, I've seen our room cleaners, and some are great and some are "a lick and a promise" (and I do report those when I happen to see it, but good lord, who has time to go watch them clean a room every time?).

Kevin RN08 · Sep 6, 2008

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

Take 15% away from your current staff, your staff of 10 is now 8.5. And this is just patient care staff, add to that administration and ancillary staff.

Would it be the right thing to do? Yes. Will it happen? I think so, sooner or later.

Virgo_RN, BSN, RN · Sep 6, 2008

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.

I was referring to the attitude that it's pointless to take precautions on the assumption that one is already infected anyway. Obviously, from the studies that I posted, the odds are that I am NOT infected. So why just assume that I am and throw caution to the wind?

Contact precautions generally mean that if one can reasonably anticipate contact with the patient. their body fluids, or environmental surfaces, one should wear a gown to protect their clothing. Obviously, one does not anticipate any of those things when running in just to reset an alarming pump or to deliver a meal tray (if the patient is able to sit up and eat without any assistance). Maybe every facility does not do so, but mine does allow us to use a little bit of judgment and common sense in that area.

Is it necessary to isolate every single patient that has a history of MRSA, even if they do not have an active infection? I don't know the answer to that. But I have seen the suffering that MRSA infection causes, and the inconvenience of my having to wear a yellow paper gown every once in a while is nothing compared to the inconvenience of being septic with MRSA. :nurse:

imanedrn · Sep 6, 2008

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.

I work on the THE infectious disease unit at my hospital, so I feel your pain! Thank gawd we have 1 shared room (for 2 patients), otherwise, 1 nurse could get stuck with all 6 of her patients being isolations! The worst, then is having 4 out of 6 being isolations.

We get MRSA (and history of also!) & C dif which are considered "contact isolation" = gown & gloves. We also get VRE & acintobacter which are "special" contact iso = gown, gloves, masks, hair cover, and booties. Imagine doing this for FOUR patients who are incontinent, lazy, wound care, etc, and you can only imagine how frustrated we get.

Nurses who float to our unit ALWAYS tell us how much more difficult it is than their home unit -- even though we have the SAME ratios. It just isn't fair! But that's my rant...

And, yes, we still have to keep them on contact isolation until their history of MRSA shows up negative -- TWO times, by the way! The funny this is, like in your case, if it was a healed wound YEARS ago, we swab their NARES for MRSA.

???#$(&@$%(@$&%!!! :confused: :banghead: It's so frustrating and befuddling...

P.S. I was going into a contact room the other day at the same time that 2 docs were. I overheard them talking about how they were putting on the PPE because they didn't want to get written up by our I.D. specialist, but that it's essentially pointless. You have more chance of getting infected from an NON isolation patient, than from one who IS whether you wear the PPE or not. He also pointed out that there have been NO significant studies which show that wearing this "PPE" reduces the risk of transmission to healthcare personnel. Awesome...

P.P.S. Our hospital is now doing this thing where the charge nurse will "silently" monitor how many of the staff our washing their hands EVERY time before entering a patient room. I asked her why they're doing this since policy states (it's also CDC guidelines!) that we should use alcohol hand-rub when hands are NOT visibly soiled and only soap and water when hands ARE visibly soiled because the constant hand-washing actually increases chance of infection because hands are more likely to become dry and cracked = open wounds. Awesome x2...

imanedrn · Sep 6, 2008

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.

Ours is a 3-ft rule. I laughed hysterically inside when I heard that! Since the pumps are usually within 1-ft of the patient, guess what? All PPE's on me! Guess I better make sure the pumps are 3-ft away from now on... :chuckle

mpccrn, BSN, RN · Sep 6, 2008

our ID nurse specialist actually measured the soap dispensers to see how much staff washed our hands........childish to say the least! undercover.....like we were too stupid to figure it out. needless to say, her study results were "skewed".....but it was fun (covertly) ....you figure it out....lol :smokin:

miko014 · Sep 6, 2008

I was referring to the attitude that it's pointless to take precautions on the assumption that one is already infected anyway. Obviously, from the studies that I posted, the odds are that I am NOT infected. So why just assume that I am and throw caution to the wind?
Contact precautions generally mean that if one can reasonably anticipate contact with the patient. their body fluids, or environmental surfaces, one should wear a gown to protect their clothing. Obviously, one does not anticipate any of those things when running in just to reset an alarming pump or to deliver a meal tray (if the patient is able to sit up and eat without any assistance). Maybe every facility does not do so, but mine does allow us to use a little bit of judgment and common sense in that area.
Is it necessary to isolate every single patient that has a history of MRSA, even if they do not have an active infection? I don't know the answer to that. But I have seen the suffering that MRSA infection causes, and the inconvenience of my having to wear a yellow paper gown every once in a while is nothing compared to the inconvenience of being septic with MRSA.

I don't think the attitude is that we should all just assume that we are already colonized, so it doesn't matter. I hope that's not what you got from my earlier post. My point was the debate of universal precautions vs. isolation. I certainly want to protect myself, my patients, my family, pt's family, etc, from nasty bugs. But I just think that's kind of overkill to isolate people who don't have an active infection. Do I use gowns on pts who are not on isolation sometimes? Heck yeah! If I'm doing messy trach care (or something else equally gross :-)), you bet I'll get a gown and/or mask, face shield, etc, even if the pt isn't on isolation. I just think it's silly to go so overboard when universal precautions and handwashing should do the trick. And your gowns are yellow paper? I'm jealous. Ours are blue plastic, and they give me a rash if I wear them too long. Guess who won't be able to stay at the bedside if everyone has to be on contact isolation........

RNfaster · Sep 6, 2008

"Approximately 32% (89.4 million persons) and 0.8% (2.3 millions persons) of the U.S. population is colonized with S. aureus and MRSA respectively."

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_surveillanceFS.html

We have white gowns and yellow gowns. I understand why the hospital requires us to wear them all the time (if you go into the room, the pt may ask for something that requires contact --best to be prepared). Sure it's a hassle. But, I like it better than when I was at another hospital and workers did not wear them 95% of the time (in rooms where patients had an active MRSA/C-Diff infection). At that hospital, one nurse told me that there was no need to wear a gown as she (and other healthcare workers) were probably already colonized with MRSA. These workers would lean against the bedrails (no gown) and care for the patients who were supposed to be on contact precautions. Then they'd care for other patients... Nice.

icyounurse, BSN, RN · Sep 7, 2008

I was referring to the attitude that it's pointless to take precautions on the assumption that one is already infected anyway. Obviously, from the studies that I posted, the odds are that I am NOT infected. So why just assume that I am and throw caution to the wind?
Contact precautions generally mean that if one can reasonably anticipate contact with the patient. their body fluids, or environmental surfaces, one should wear a gown to protect their clothing. Obviously, one does not anticipate any of those things when running in just to reset an alarming pump or to deliver a meal tray (if the patient is able to sit up and eat without any assistance). Maybe every facility does not do so, but mine does allow us to use a little bit of judgment and common sense in that area.
Is it necessary to isolate every single patient that has a history of MRSA, even if they do not have an active infection? I don't know the answer to that. But I have seen the suffering that MRSA infection causes, and the inconvenience of my having to wear a yellow paper gown every once in a while is nothing compared to the inconvenience of being septic with MRSA.

I feel like you misunderstood what I was trying to say if you think that I meant just because some health care workers were infected that no precautions should be taken. I certainly think that if a patient has an ACTIVE infection or a probable one nurses should take proper precautions. I was simply trying to illustrate how common these infections are. And pointing out that many staff could have a "history" of MRSA..........I dont agree with instituting precautions on someone with a history who is no longer actively infected. That was my point. Or wearing total protective gear (unless we are talking airborne, I am talking simple contact) to go program a pump. And yes many facilities require this. I just havent seen it scientifically demonstrated that in these circumstances it actually reduces transmission. I dont think it does.

miko014 · Sep 7, 2008

These workers would lean against the bedrails (no gown) and care for the patients who were supposed to be on contact precautions. Then they'd care for other patients... Nice.

That's gross. I try not to lean on the bedrails even if they aren't on isolation.

I guess that just illustrates my point that if we use universal precautions appropriately, there is no need to use contact isolation on a person with a history but no current active infection.