MRSA, and proper precautions

[CNA2dayRNtomorrow]

While on a Dr. visit with a client, I learned that not only did that client have MRSA, but that it was active. The open areas on the skin which I had been told were from banging against furniture were actually caused by the MRSA. The client did not cover these open wounds at any time, not even with clothing. I called the agency who employed me, and was told by the RN on the case that universal precautions were to be practiced at all times, so I had no worries. When I informed her that in all my years working on med-surge units and in geriatrics, contact precautions were always used with MRSA, she became hostile. I was also extremely upset to learn that not only was my agency previously aware of the MRSA, the client had just finished wound care services with the hospital a week before I started. I feel that I should have been informed, not only for my own safety, but my children's as well. These clients ride in our personal vehicles, and there is no way I would have let the client in my car without the wound being covered. I also would have changed and bagged my clothing before picking up my children from daycare. Aside from my own worries, I feel that I could have given my client better care, because had I known what it was, I wouldn't have believed that it was just from recurring accidents with the furniture, and I could have contacted the nurse in charge of the case sooner. Is this something I will have to contend with alot in in-home care? Am I wrong for being furious that this information was not shared with me?

[Jolie, BSN]

Precautions to Prevent the Spread of MRSA in Healthcare Settings

Please pay particular attention to the section on Contact Precautions:

Contact Precautions CDC recommends contact precautions when the facility (based on national or local regulations) deems MRSA to be of special clinical and epidemiologic significance. The components of contact precautions may be adapted for use in non-hospital healthcare facilities, especially if the patient has draining wounds or difficulty controlling body fluids.

These contact precautions should be followed for some patients. To determine if a patient needs to be placed on Contact Precautions see page 38 of Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 PDF [234KB/74 pages]

CDC - Precautions to Prevent the Spread of MRSA in Healthcare Settings | MRSA Infections

[mindyfromcali]

I'm really sorry that has happened to you. I'd be pretty upset too, especially if I had kids and their safety to be responsible for.

[funtimes]

Doesnt sound like a good situation, but if you worked med/surg, you know that although they do put patients with MRSA on contact precautions, that is only after they discover they have MRSA. How many patients do we take care of that have it but it hasnt been confirmed. Its not unusual for a patient to be put on contact precautions for MRSA or C diff AFTER theyve already been up on the floor a day or two with no extra precautions.

Ive had patients coughing continually, including right in my face, only to find out a day or two later the patient is now on droplet precautions because MRSA was found in their sputum. Its basically an occupational hazard. I tend to assume someone with an open wound or who has a productive cough might have MRSA until proven otherwise, and any patient with loose frequent stools has C diff.

I cringe to think of what the results would be if I ever had a nasal swab for MRSA because of all the patients Ive taken care of both before and after they tested positive and were put on contact precautions. I just assume I have it myself now and try to take appropriate precautions.