MRSA precautions in the ER?

cmyer3368 · Apr 19, 2011

It isn't great on the floors sometimes either... I can be taking care of someone for a day or two and THEN get notified they need to be on contact precautions for active MRSA or something else not as fun.

steelcityrn, RN · Apr 19, 2011

Thats one benefit from electronical records. This would come up immediately for the staff to address.

emtb2rn, BSN, RN, EMT-B · Apr 19, 2011

Welllll, OP, you're talking about your ER, not every ER.

If a pt comes into my ER and is known to have mrsa/vre, the computer system automatically pops up a warning (which appears every time you open their chart), a contact precaution sign goes up on the door, an isolation sticker goes onto the face sheet and their isolation status is on the computerized report sheet which travels with the pt when they leave the ER for the floor. Isolation status is part of verbal report too.

With respect to bp cuffs, we use disposable one that go with pt to floor. Our housekeeping staff cleans pulse ox's & monitor leads bewtween pts. I personally clean all vs equipment between pts even if housekeeping has done so. That's my ER, can't speak for anybody else.

Esme12, ASN, BSN, RN · Apr 19, 2011

Technically.....if you are using universal precautions and gowning IF heavy soiling is present.......you are protected. I would use a patient gown if someone was heavily unkemt or soiled and leave it by the room. I always wore a lab jacket, my shoes never left the hospital......and I stripped the minute I got home, showered, and the uniform immediately to the washer........for 32 years.....

nursej22, MSN, RN · Apr 19, 2011

There is scant evidence that contact precautions are any more effective than standard precautions in decreasing the spread of drug-resistant organisms. And some experts feel they may do more harm than good.

http://journals.lww.com/ajnonline/Fulltext/2011/03000/Emerging_Infections__The_Contact_Precautions.30.aspx?WT.mc_id=HPxADx20100319xMP

The VA recently demonstrated a 60% decrease in MRSA infections using a "bundle" that included nasal swabs, contact precautions, emphasis on hand hygiene and a "hospital culture of accountability". My guess is the last 2 had the most impact.

I wonder why we swab patients but not the staff? Too expensive to treat us all as carriers?

psu_213, BSN, RN · Apr 19, 2011

The ER is a scary place for infection control.

You mean the ED at your hospital, right??

In ours, a "flag" comes up on the pt electronic chart as soon as they are checked in. A sign goes on their door and gloved/gown are placed at the door. The individuals I see most often not following isolation procedures are the residents/attendings (non-ED) who just march in to the rooms to assess their patient.

Here is the other problem....before coming to the ED this person with MRSA or VRE, etc. was in the grocery store touching the produce and, well, breathing. Now they come to the hospital and we make a big deal about it. Plus, the pt may not have a resistant organism, but a visitor might, and we don't screen them (not saying we should). Point is, there is a lot outside our influence when it comes to infection control.

bjaeram · Apr 19, 2011

We don't do a very good job in our ER either. Our system does flag them but all it means is they have had it at some point in their life. For some reason it doesn't fall off. So they may have had it after surgery 3 years ago and it seems silly to isolate all of these patients.

That being said our room turnover is sloppy at best. It's usually a two minute clean up. Strip and spray the cart, empty the kick bucket and if you are lucky spray the bedside table. The bp cuffs and leads are not routinely cleaned unless visibly soiled. Horrible I know but we don't have the staff or time to do it better. Our techs, not housekeeping clean the rooms in between transports and hundreds of other duties. We are busy so the room needs to be occupied again. Often they are wheeling the next patient back from triage before the room is even cleaned so they sit in a wheelchair and watch. Terrible I agree but unless we can hire a dedicated room cleaner or two I don't see it changing.

psu_213, BSN, RN · Apr 19, 2011

One other thing...If a known isolation pt was in a particular room, housekeeping comes and cleans the room, throws away BP cuffs (and anything else disposable), etc, etc. For a non-iso room a tech or RN will wipe down the stretcher and all other surfaces with chlorox. Housekeeping would be down for any major cleanup (for example, blood, diarrhea, etc. on the floors/walls/etc.)

This begs the question, however, what if the pt in the room was + for MRSA, VRE, C diff, etc and we just do the "normal" clean? Of course that then opens up a very large can of worms re: isolation procedures and who gets tested for all pt's in any other unit of the hospital.

P_RN, ADN, RN · Apr 19, 2011

Treat ALL as if there may be "something" Now you don't have to put on space suits, but wear gloves, masks'goggles if ooey gooey stuff appears and wash those hands every few minutes. There you have Universal precautions. No one will be offended.

KyPinkRN · Apr 20, 2011

wash your hands, wash your hands, wash your hands... and when your done with that wash them again! Also as others have posted be sure to wiped down stretchers and equipment between patients. Remember, if you are healthy you are not likely to have problems with this sort of infection... it's our patients that are at greatest risk when cross contamination happens.

WildcatFanRN, BSN, RN · Apr 20, 2011

I had an mrsa infection in the past and I'd be pretty annoyed if I was put in contact isolation everytime I came to the hospital unless it was for an active infection. Having had it in the past does not mean "carrier" or "active". I hate having patients in contact precautions when that's not even the reason they are admitted. No open wounds, or oozing areas, yet they are in contact precautions because of a "history".