MRSA legislation in Maine

Mammy1111 · Aug 23, 2009

"Contact Precautions" do mean just that. Unfortunately, MRSA is invisible and intangible. Conatct with a MRSA patient's environment will contaminate clothing, instruments, doc's ties, pens, charts, blood pressure cuffs, bathroom fixtures, and especially healthcare givers' hands. Thus the necessity of gloves and gowns in a MRSA patients room. Masks are also necessary when MRSA droplet transmission is possible.

lamazeteacher · Aug 23, 2009

"contact precautions" do mean just that. unfortunately, mrsa is invisible and intangible. conatct with a mrsa patient's environment will contaminate clothing, instruments, doc's ties, pens, charts, blood pressure cuffs, bathroom fixtures, and especially healthcare givers' hands. thus the necessity of gloves and gowns in a mrsa patients room. masks are also necessary when mrsa droplet transmission is possible.

here are the cdc's recommendations. this is the bottom line on the subject, and must be followed, lest dire jcaho fines and discredit will occur. read the disposable blood pressure cuff requirement!

it sounds like your infection control committee (the docs on it), need to grab their colleagues by their neckties, (unless it's a bowtie), and the patient isn't known to sneeze or cough, if mrsa has been cultured from the respiratory tree. they should discuss the necessity/possibility of running cultures on the docs! :yeah: so write that in a report to your infection cintrol nurse, regarding your observations of docs' neckties on possibly contaminated articles. you'll need to name names and dates of the occurrences.

guideline for isolation precautions: preventing transmissionof infectious agents in healthcare settings 2007 , should control the spread of mrsa in most instances. additional measures for prevent the spread of mrsa are described in management of multidrug-resistant organisms in healthcare settings, 2006 pdf (234kb/74 pages)

standard precautions

for more detail see standard precautions

1) hand hygiene perform hand hygiene after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. perform hand hygiene immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. when hands are visibly soiled with blood or other body fluids, wash hands with soap and water. it may be necessary to perform hand hygiene between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

2) gloving wear gloves (clean nonsterile gloves are adequate) when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur. remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination. do not wear the same pair of gloves for the care of more than one patient. do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens.

3) mouth, nose, eye protection use ppe to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.

4) gowning wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated.

5) appropriate device handling of patient care equipment and instruments/devices handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single-use items are properly discarded. clean and disinfect surfaces that are likely to be contaminated with pathogens, including those that are in close proximity to the patient (e.g., bed rails, over bed tables) and frequently-touched surfaces in the patient care environment (e.g., door knobs, surfaces in and surrounding toilets in patients' rooms) on a more frequent schedule compared to that for other surfaces (e.g., horizontal surfaces in waiting rooms).

6) appropriate handling of laundry handle, transport, and process used linen to avoid contamination of air, surfaces and persons. contact precautions

for more detail see contact precautionscontact precautions should be followed for some patients. to determine if a patient needs to be placed on contact precautions see page 37 of management of multidrug-resistant organisms in healthcare settings, 2006 pdf (234kb/74 pages)

in addition to standard precautions, contact precautions consist of:

1) patient placementin patient placement in hospitals and ltcfs, when single-patient rooms are available, assign priority for these rooms to patients with known or suspected mrsa colonization or infection. give highest priority to those patients who have conditions that may facilitate transmission, e.g., uncontained secretions or excretions. when single-patient rooms are not available, cohort patients with the same mrsa in the same room or patient-care area. when cohorting patients with the same mrsa is not possible, place mrsa patients in rooms with patients who are at low risk for acquisition of mrsa and associated adverse outcomes from infection and are likely to have short lengths of stay. in general, in all types of healthcare facilities it is best to place patients requiring contact precautions in a single patient room. to assist with decision making about patient placement in various types of healthcare facilities see page 84 of preventing transmission of infectious agents in healthcare settings 2007.

2) gloving wear gloves whenever touching the patient's intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails). don gloves upon entry into the room or cubicle.

3) gowningdon gown upon entry into the room or cubicle. remove gown and observe hand hygiene before leaving the patient-care environment. after gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in possible transfer of microorganism to other patients or environmental surfaces.

4) patient transport in acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes. when transport or movement in any healthcare setting is necessary, ensure that infected or colonized areas of the patient's body are contained and covered. remove and dispose of contaminated ppe and perform hand hygiene prior to transporting patients on contact precautions. don clean ppe to handle the patient at the transport destination.

5) patient-care equipment and instuments/devicesin acute care hospitals and long-term care and other residential settings, use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patient-dedicated use of such equipment. if common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient. in home care settings limit the amount of non-disposable patient-care equipment brought into the home of patients on contact precautions. whenever possible, leave patient-care equipment in the home until discharge from home care services. if noncritical patient-care equipment (e.g., stethoscope) cannot remain in the home, clean and disinfect items before taking them from the home using a low- to intermediate-level disinfectant. alternatively, place contaminated reusable items in a plastic bag for transport.

6) environmental measures ensure that rooms of patients on contact precautions are prioritized for frequent cleaning and disinfection (e.g., at least daily) with a focus on frequently-touched surfaces (e.g., bed rails, overbed table, bedside commode, lavatory surfaces in patient bathrooms, doorknobs) and equipment in the immediate vicinity of the patient.

7) discontinuation of contact precautions no recommendation can be made regarding when to discontinue contact precautions.control of mrsa outbreaks

information regarding the control of mrsa outbreaks see management of multidrug-resistant organisms in healthcare settings, 2006 pdf (234kb/74 pages)

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date last modified: october 10, 2007

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division of healthcare quality promotion (dhqp)

national center for preparedness, detection, and control of infectious diseases

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management of multidrug-resistant organisms in healthcare settings, 2006
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hand hygiene in healthcare settings - 2002
isolation precaution 2007

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Mammy1111 · Aug 23, 2009

My opinion on the CDC recommendations is that all of the necessary componants of MRSA prevention (and possibly other ESO prevention) are in there, but in the wrong order.

The CDC has never mandated any of their steps for prevention. EVER! Hospitals still hold the final say on what they will or will not do. So, if they choose not to isolate patients because it is not fiscally beneficial, or there is an emergency of their own definition, or just plain because....they can and they will. Vulnerable patients are put at risk, and they do not know. These blatant violations of patient safety are avoidable and preventable. Because I have taken a stand in my state for the prevention of MRSA, I have heard the stories about how loved ones or patients themselves have been roomed in the same room with somebody who had MRSA.

MRSA has been minimized and in some cased dropped to ZERO in hospitals that have enacted Active Detection and Isolation. These steps are High Risk or Universal Screening, Isolation/cohorting patients, contact or "transmission based" precautions, and decolonization of MRSA colonization. All of the VA hospitals in the US use this method of preveniton and have dropped their rates by 70% in just two years. I have not heard of that kind of success in hospitals who swear they are using the CDC recommendations.

CDC has all the componants that ADI has (as recommended in the 2003 SHEA recommendations), but they don't even recommend MRSA screening until the 3rd tier of MRSA prevention recommendations. CDC screening is only recommended AFTER an outbreak...not to PREVENT and outbreak. In their first tier of recommendations, CDC says all infected and colonized patients must be isolated. Yet, screening isn't addressed until far into the recommendations (3rd tier). So, is there some mark or scarlet letter or other secret way to help us determine which patients are colonized on admission? I dont' think so. Only screening will tell us that. Colonized patients can contaminate an environment too, just as a full fledged infected patient can.

CDC in it's current order, has been an ineffective tool in controling MRSA. We all know there is no such thing as 100% CDC compliance. Couple that with an ineffective prevention policy and what do you have? More MRSA cases and outbreaks all the time.

Until CDC changes and mandates are made, we will have MRSA outbreaks. Maine now has high risk screening mandated. HR screening is very important in MRSA prevention, but it is not the end all cure all. If Maine hospitals continue to house MRSA patients with uninfected patients, or if they fail to improve on precaution compliance, and if they don't start doing terminal cleaning after MRSA patients are discharged, their numbers will remain at alarming rates. Then they will tell me that HR screening doesn't work. With HR screening AND compliance with Isolation and precautions, we have the potential to drop the MRSA rates in Maine like lead.

lamazeteacher · Aug 23, 2009

".......The CDC has never mandated any of their steps for prevention. EVER! Hospitals still hold the final say on what they will or will not do. So, if they choose not to isolate patients because it is not fiscally beneficial, or there is an emergency of their own definition, or just plain because....they can and they will......" quote from mammy's post

Well it seems the answer to my several times posed question, "where are you getting these ideas?" has been answered - they're your own!

Since you have provided evidence in your posts that you have never attended education courses for Infection Control nurses, you don't realize the power the CDC has, and the great minds that collaberate to present policies that are generally accepted as the last word on surveillance, and procedures to prevent transmission of communicable diseases.

After taking the accreditation courses that Infection Control nurses do, their word is law regarding the local control of infectious diseases. They can close specific units where microorganisms are spreading, or the whole hospital, carrying out the dictates of that august organization.

Please bite off what you have the authority and ability to chew, mammy.

Mammy1111 · Aug 24, 2009

I have made a project of educating myself by doing research and contacting experts, advocates, lawmakers and vicitms. I have bitten off a great deal for sure, but it isn't anything I can't handle. The ever rising numbers of preventable MRSA infections in our hospitals are evidence that CDC recommendations, in their current order, are not working. Yes, CDC is powerful, but there is a whole population of epidemiologists and consumer advocates that are questioning their sincerity in reducing MRSA. There are two bills in the US Senate and House to mandate Active Detection and Isolation, just as I have done in Maine. I am not alone in this quest and I gleen information and education from many advocates (medical professionals and lay activists) of ADI in this country...

I watched my own father die of preventable hospital acquired MRSA pneumonia in his small town hospital. He contracted it while hospitalized for a minor fracture. He had no invasive procedures done. It took that hospital only 12 days to give him his death sentence. Until you have sat by a loved ones bedside day after day watching them disappear from your life becasue of inadequate CDC recommendations and lousy MRSA prevention, you have no right to judge me or what I do. It was the most difficult time in my life. Dozens of thousands of other families and their loved ones have gone throught exactly the same thing.Over 100,000 have been infected and many of them are permanently disabled. There was nothing I could do for my father...absolutely nothing except love and support him and my mother and help give him nursing care.

I work very hard on the Maine Quality Forum in the MDRO metrics groups to make a positive change in Maine hospitals. With the law that my representatives and I got passed in Maine (unanimously in the Health and Human Services Committee hearings), and the strict compliance of hospitals with CDC recommendations for MRSA, we will drop the MRSA rate in Maine. The 2007 APIC study showed Maine to be the 4th highest incidence of MRSA in the US.

You should prepare yourself CIC nurse, because there is a momentum in this country to change hospitals' approach to MRSA prevention and I will promote it every opportunity that I have. CDC and hospitals do not have the complete say...consumers are really riled up. Always remember who you answer to about your nursing care...not a certification board...you answer to your patients.

http://www.safepatientproject.org/2009/07/kathy_day.html

PS..I work with many IC nurses in the MQF Meetings and I have a great deal of respect for them. I believe we have a mutual respect for our experiences and knowledge. None of them have made the comments that you have.

Elsarap · Mar 23, 2010

I want to know why some facilities require gloves, gown, cap, and booties, while some others

only require gloves.

We have started a strict MRSA surveillance where I work. All patients admitted to the critical care units are placed in glove precautions. Any patient admitted to the ICU is screened for MRSA using a nasal swab and if the screen comes back positive they are placed in contact precautions and receive a daily bath using a special cleansing agent and bactroban to the nares.

Mammy1111 · Mar 23, 2010

Your question is exactly the problem. Until ALL hospitals adapt a single effective and standard approact to MRSa prevention, MRSA will prevail. My belief is that ADI is the method that will drastically reduce MRSA. That along with decolonization and mandatory reporting of all MRSA for ALL states are the three most important standardized things that hospitals in the US can do to stop MRSA.

MRSA precaution recommendations are all over the place. Nobody knows exactly what they are supposed to do. Just watch the VA hospitals in our country. All of their staff knows what to do becasue they have adapted ADI, and decolonizatoin and their rates have dropped over 70% nationwide.