MRSA in L&D

[mfshirk]

Hi,

I work in a new hospital, we have grown to approx 60 deliveries a month. In the last 2 months we have had 3 pts with MRSA, 1 with an active lesion and 2 w/ histories of MRSA during their pregnancy. All three have been handled differently. Our infection control guru says that we only need to use universal precautions and even over-rode MD orders for nasal cultures and MRSA precautions. This is unsettling to me. The guests go in and out of the room, the nurse is assigned another pt, the baby is able to be in the nsy with other babies. Is this safe? What do you do?

Thanks!

[TiffyRN, BSN, PhD]

This high number of MRSA patients you've seen is probably due to the reported increased incidence of MRSA in the community. We've had several infants that came from moms with MRSA and we've always isolated the infant until they had one set clear cultures (usually nose, umbilicus, sometimes blood and rectal). But I work NICU, not L&D. I do know that of all the infants that came to us for mom having a wound or nasal positive culture, none of the infants have come up positive. All the moms who had chorio with MRSA have had infants that tested positive and stayed that way until discharge. Of course, until a few nights ago all those infants were infants that needed to come to NICU for some reason. I don't think our L&D and mom/baby unit allows these babies to stay in the nursery because we had such an infant a few nights ago. Allegedly this infant was admitted to our unit only because his mom was too ill to have infant in the room with her (was in adult ICU?). So they admitted this infant to our unit to stay in the isolation room and supposedly he/she would be going home with family the next day as he/she was considered a well term infant.

I believe this is going to become a real issue in our hospital in a few years as MRSA becomes more common in our community. We already have significant conflicts of opinions on how to isolate these infants between the infection control department and the Neonatologists.

[mfshirk]

Tiffany,

Thanks for the reply. It is so frustrating to have such inconsistencies between the OB's, peds, neos, and infection control. None of our babies have been isolated OR cultured. How's that? I've tried researching it on the web and find that there are an increased number of community acquired MRSA cases but I haven't found solid instruction/suggestions on what to do about it. Harumph!

[SmilingBluEyes]

I think we are just beginning to grapple with the huge problem and increasing frequency of MRSA in the hospital and, more frighteningly, in the community. How do we stop visitors/patients from bringing it to our units???? (we all know OB is a spectator sport after all). It's really scary if you ask me.