MRSA isolation

[chenoaspirit]

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.

[casperx875x]

Come work a day on my floor. Nearly every patient is on contact precautions for MRSA, with every other one being on precautions for MRSA/VRE as well, some CDiff, too. I'm used to the gowns by now and almost feel naked without one on. And yes, they are HOT. :)

[beachbum3]

I have a question:

My feeling on the subject is that unless someone is MRSA + in the sputum the gown is somewhat of overkill. In other words for a pt with say, MRSA to a wound, well, unless I'm touching the wound or its draining like crazy, I wouldn't contract it.. so I'd be perfectly safe to go into a room and take a blood pressure (the pt I'm thinking of had a small lower leg wound that the culture came back +) or check an IV pump, answer a call light etc. Unless I came in direct contact with the wound, or wound drainage I wouldn't be at risk. Am I correct?

[RNfaster]

BeachBum3, a nursing manager explained it to me this way: do you know that the patient didn't scratch their wound and then touch the bedrail or something? She said it was best to err on the safer side (and wear a gown) when dealing with patients on contact precautions. Someone could touch the bedrail with their clothing and carry MRSA to another bedrail --and another patient.

The possibility is low, depending on the patient and the wound, etc., but I think she made sense. I also think it's best to establish a clear protocol, as without one people will most certainly take the shortcuts, even when the risk is too high and/or they are unaware of the risks.

I think folks are right that the gowns generate a lot of waste (time, product), but that they do likely stop some infections.

I think that some other posters have made some interesting points about isolation of all unknown cases (until proven clear). I do think studies on that would be useful.

[ilstu99]

I have a question:

My feeling on the subject is that unless someone is MRSA + in the sputum the gown is somewhat of overkill. In other words for a pt with say, MRSA to a wound, well, unless I'm touching the wound or its draining like crazy, I wouldn't contract it.. so I'd be perfectly safe to go into a room and take a blood pressure (the pt I'm thinking of had a small lower leg wound that the culture came back +) or check an IV pump, answer a call light etc. Unless I came in direct contact with the wound, or wound drainage I wouldn't be at risk. Am I correct?

You just never know. The safest choice is to err on the side of caution, and to set a good example. What if you know how careful you are, but the next person doesn't....but they decide that your idea is the right one? Now they're bringing it back to the desk, other patients, equipment, etc.

[psalm, RN]

Here's a related question: How many of your facilities require the visitor of a Contact Isolation pt. to gown & glove, since they will be leaning, touching, sometimes on the bed, moving equipment, sometimes using the pt. bathroom (even when instructed not to)? How many actually wash their hands before they leave the room to go home?

Why or why not is it enforced?

[RN1982]

Sorry but I am against having to mandatory nasal swabbing of nurses. What are they going to do to a nurse when their swab comes back positive for MRSA? Fire them? That will ruin a lot of nurses' careers.

[RN1982]

I don't understand the purpose of wearing a gown if the patient has MRSA in the nares. I also have a question, I had a patient with Acinebacter in her wound which has a wound vac dressing on. Nurses in my ICU do not touch the wound vac dressings, that is the responsibility of the surgeons, so is it necessary to wear a gown in this case?

[RNfaster]

I have worked at a facility that required visitors to gown and glove. At that facility, the sink healthcare workers washed in after leaving a contact room was in the middle of the nursing station. There was a patient-only sink in the room as well as a healthcare worker sink in the room, but you'd have to take the PPE off to use it. --So while that hospital was great at enforcing their policies for workers, and better than most for visitors, the lack of sinks for visitor washing was a problem relative to C-Diff. (That hospital required healthcare workers to wash hands (not sanitize) after all contact rooms.)

Another hospital I worked at (mentioned in an earlier post) didn't enforce anything, and most healthcare workers there didn't use PPE or adequate sanitizing much less handwashing, nor did visitors as they weren't educated.

My current hospital is more like the first. They enforce the use of PPE with staff and visitors, but they have the sinks inside the rooms and in the middle of the nursing station.

[RNfaster]

I don't understand the purpose of wearing a gown if the patient has MRSA in the nares. I also have a question, I had a patient with Acinebacter in her wound which has a wound vac dressing on. Nurses in my ICU do not touch the wound vac dressings, that is the responsibility of the surgeons, so is it necessary to wear a gown in this case?

Michigan RN - see my earlier post. --If a patient has MRSA in the nares or a wound, what if they touched it and then touched their bedrails or something. Say you go it without PPE, and you are helping them reposition in bed. While you are doing that you brush against the bedrails and pick up some MRSA on your scrubs. Then you go to another patient and do the same thing, depositing the MRSA on that patient's bedrails.

I have seen some studies that say MRSA can persist in the environment for months.

I think it is better to be safe than sorry. It is better for the patient and for the hospital's bottom line and reputation. It's also better for us as it is easier to care for patients without MRSA.

I worked on a hospital unit that did not enforce use of PPE. I don't know for certain, but I think it likely that some of the MRSA cases that emerged were due to that lack of enforcement.

Would you rather someone wear PPE or not take the time if they were caring for isolation patients AND YOUR LOVED ONES?

[chenoaspirit, ASN, RN]

today we had an employee as a patient who tested positive in the nares. She was sent home with Bactroban for her nose and an order to wash/soak in a mixture of bleach and water. He said that while we are trying to stop spreading it, we should also treat it while they are in the hospital. If not, they get discharged into the public and the "precautions' were for nothing. It makes sense.

[miko014]

today we had an employee as a patient who tested positive in the nares. She was sent home with Bactroban for her nose and an order to wash/soak in a mixture of bleach and water. He said that while we are trying to stop spreading it, we should also treat it while they are in the hospital. If not, they get discharged into the public and the "precautions' were for nothing. It makes sense.

Lol okay there's your answer! A bleach/water nasal soak station in every nurses's station! I'm sorry chenoaspirit (I'm not trying to be mean!) but that just made me crack up! Soak your nose in bleach heeheehee! ...maybe I'm tired and should go to bed now... :chuckle

[chenoaspirit, ASN, RN]

Well, i dont recall saying to put bleach/water in the nose. I was referring to the skin. :icon_roll I mean, come on!