MRSA Isolation

[KEN44]

I am a new CNA at a rehab hospital. I am noticing a trend within the hospital of the staff not using the standard precautions with patients in isolation. There is one man with MRSA and the physical therapist does not use gloves, a gown or mask. The Patient walks around the halls without a mask. Everyone looks at me like I am crazy when I gown up and I am hesitant to put on a mask for fear of overdoing it and offending the patient. They also treat me as if I am crazy when I question why no one is talking precautions and that I show that it worrys me. I am worried I will contract MRSA from not only the staff but the patient. Am I being overly paranoid about it? I knew nothing about MRSA before this new job. Please help me understand. The nurses I ask act as if it is no big deal and everyone has it. I am seriously thinking of switching careers again because I do not want to contract a disease. I have always wanted to be a nurse but have a little boy at home and his health is my number one concern. I don't know what to do.

[asun21ta]

I understand. We had patients that had MRSA. If the MRSA is in a wound or something, they are not going to infect the whole community just by walking around. However, they are extremely contagious and they need to be isolated especially when they are bathing, changing dressings, sneezing, coughing (depending on where the MRSA is) they need to be to isolated. Many mediacl facilities isolate the patients because of how easily it spreads and for liability purposes. Here is a list of common things associated with the spread of MRSA

• Close skin-to-skin contact
  
• Openings in the skin, like cuts or abrasions
  
• Contaminated items and surfaces
  
• Crowded living conditions, like in hospitals or prisons
  
• Poor hygiene
  

Truth of the matter is MRSA exists everywhere. You would be surprised to know that is in more places than you think. You and I could have MRSA and not even know it! Just use the precautions as outlined at your facility.

[fuzzywuzzy, CNA]

You should ask for an inservice packet on isolation precautions at your facility so you better understand how MRSA is contracted and what your facility's policies are. It'll probably win you brownie points too! lol.

You only have to wear a mask if you're coming within 3 feet of someone who has MRSA in the lungs- droplet precautions. If it's in a wound or something, nobody needs to wear a mask, and the patient certainly doesn't need one to go out in the hall. If it's in the urine, you don't have to gown up just to hand them a meal tray.

I also wouldn't worry so much to the point where you're thinking about switching careers so you don't catch it. It's true, a lot of people do have it. You say you work in rehab- well lets say a patient has MRSA in the sputum and they have to wear a mask in the hall and all that. Then they're discharged. Do you think that when they go home they wear a mask to the grocery store, to visit friends, to church? Chances are, they don't. And all the people who are colonized or actively infected with it certainly don't either. Switching careers isn't going to protect you.

[JDZ344]

You should ask somebody at your facility what the procedure is for dealing with MRSA. There should be a policy for how to isolate them.

[eveningsky339, LPN]

We do use standard precautions in MRSA rooms, but in all frankness, most of my co-workers have MRSA. For some health care workers, gowning and gloving is a mere formality.

[juliaann]

I agree with most of the above. If you've worked in direct patient care for more than a few months, chances are high that you have MRSA.

While we need to do our best to prevent the spread from one patient to another, and precautions do need to be followed - they're often not.

You need to be responsible for what you do (so go on and gown and glove - you're doing your job!), and if you're concerned about your co-workers, mention it to management. It sounds like there needs to be some re-training.

Unless the MRSA is in the patient's sputum, they and their caretakers do not need to wear a mask. You, however, can wear a mask whenever you want to. It definitely doesn't hurt. It's just a little wasteful of supplies to use in interactions with patients/residents where it is not indicated.

You WILL come in contact with communicable diseases in any healthcare field, and you'll need to make sure you're comfortable with that so it doesn't interfere with your care or how you treat a patient. A girl who became a CNA at the same time as me was fired on the spot only a week into our orientation because she refused to take a patient that was on airborne precautions for TB, citing that she had a child at home and was concerned about getting or transmitting TB to her child. *Everyone* has to be willing to take isolation patients, and be willing to give them the degree of care they deserve. If your fears or concerns for family will get in your way, you might want to reevaluate a career in healthcare.

[juliaann]

As an amendment to my previous comment (I apologize for a second comment, I can't edit my last one anymore), I'd like to add this link:

http://tahilla.typepad.com/mrsawatch/2008/12/highly-resistant-bacteria-common-in-er-workers.html

It was pointed out on the general nursing forum that my statement, "If you've worked in direct patient care for more than a few months, chances are high that you have MRSA," was rash and not well-thought out. I apologize for my hyperbole and for maybe giving people the wrong impression. I'm definitely not trying to scare anyone; rather I'm just trying to paint the picture that working in healthcare comes with risks. We do everything we can to manage those risks, but they're still there.

The link shows that the incidence of MRSA in healthcare workers is significantly higher than that in the general public, but not "high" depending on your definition of high - 4%-15%. But according to that site, only about 1% of the general public has it. So, there you have it.

I apologize if I mislead anyone.