MRSA Precautions-Isolation or standard?

[Not new new]

Once upon a time, in a job long ago, we put EVERYONE with a mrsa dx on contact precautions.

It seems there are now varying ideas as to who needs to be on them vs who doesn't.

Wondering what other facilities to in regards to Mrsa, say in nares, or Mrsa in urine for a continent Pt?

[MessyMomma]

At my place of employment, all patients with MRSA--whether active or history, any source--are placed on contact precautions. There is no retest or follow-up culturing to exclude from/discontinue from isolation.

[BloomNurseRN, ASN, BSN, RN]

At the facility I completed my clinical rotations in any patient that tested positive for MRSA (nares or otherwise) was placed on contact precautions. Retests were done though and if they had repeat negative results, the precautions were removed.

[nurseprnRN, BSN, RN]

When in doubt over any such issue, the CDC is your friend.

This is 225 pp, but it's all there:

http://www.cdc.gov/hicpac/pdf/isolat...lation2007.pdf

This has subsections you can click on:

CDC - 2007 Isolation Precautions:Part 3 - HICPAC

This is their glossary of terms:

CDC - 2007 Isolation Precautions:Glossary - HICPAC

These are the definitions of isolation categories:

Isolation precautions: MedlinePlus Medical Encyclopedia

[Not new new]

Thank you! this is both confusing, and helpful at the same time :) It seems there is some gray area, depending on if it is contained or not? Still pondering...

[Morainey, BSN, RN]

I was just talking about this with one of my coworkers at my per diem job. He was asking me if my FT job considered MRSA patients "once positive, always positive" and if a patient who had had a history of MRSA infection and was treated, discharged, and later readmitted (for another dx) to the hospital was automatically put on precautions. I guess some places are doing this now?

FWIW we do a MRSA screening on admission and if they have any positive responses (HCW, coming from a nursing/group home, etc) they are swabbed per protocol but we don't automatically put them on precautions.

[Nurse Kyles, BSN, RN]

It is once positive always positive at my facility. MRSA patients are placed on isolation. Our lab will not even run a nasal swab on a patient that was positive on a previous admission. Some providers have been setting up follow screening post discharge. If the patient has three cleared nasal swabs, then they don't have to be on precautions any more. The swabs have to be a

certain number if days apart, but I'm not

sure how many days exactly. The only problem is that when people actually do get cleared, we seldom know about it at the hospital.

[Not new new]

I am a LTC nurse and wondering if there is a difference between LTC and Hospitals when it comes to this.It seems that in maintaining a "home like" environment it is a bit less strict? I am still trying to figure out why it would be less strict than the hospital setting I guess.

I mean, I get that if a pt is continent, and has MRSA UTI, how the staff cares for them would be the same no matter what, but I just don't feel completely settled with that.

Any other LTC nurses that can weigh in?

[CapeCodMermaid, RN]

In my LTC facility, our precautions are based on the CDC recommendations mixed with common sense. MRSA in the nares is contact precautions-private room not necessary. VRE in rectum is treated the same way. If someone is MRSA positive in their sputum, they need a private room. CDIFF always requires a private room or cohorting.

We treat MRSA nares with bactroban for 10 days. Thank goodness we haven't started swabbing the staff! Most of us probably have something.

[Esme12, ASN, BSN, RN]

The simple answer is yes.....go to the CDC page...CDC - Long-Term Care Settings - HAI

[MassED, BSN, RN]

we place EVERYONE who has ever been swabbed +for any kind of infection (DRO) on precautions. It is so stupid. I can see for admission purposes, but for the ER, who cares? If it's not active, it's no different than going to your local supermarket and having contact with the patient's cart.

[MassED, BSN, RN]

When in doubt over any such issue, the CDC is your friend.

This is 225 pp, but it's all there:

http://www.cdc.gov/hicpac/pdf/isolat...lation2007.pdf

This has subsections you can click on:

CDC - 2007 Isolation Precautions:Part 3 - HICPAC

This is their glossary of terms:

CDC - 2007 Isolation Precautions:Glossary - HICPAC

These are the definitions of isolation categories:

Isolation precautions: MedlinePlus Medical Encyclopedia

This brings the question, what about visitors and families entering precaution rooms? They don't gown up/glove up, and yet they move all in and out and potentially transmit infection. This should be addressed as the reason for proliferation in drug resistant organisms, at least in the healthcare setting. Nevermind the rooming of admitted patients!