MRSA protocol

[untamable07]

I have a question, once an infant in NICU has tested positive for MRSA are they tested again after antibiotics are finished to see if it's cleared up or once they have it are they kept on contact isolation. Also, if the infant was negative when they arrived in the NICU where could they have gotten it from now that they're testing positive?

[BittyBabyGrower, MSN, RN]

Once positive and then negative...you stay on precautions until you leave. The same kids stay in the same room, no moving in and no moving out until they are dc'd.

Where they get it from.....non washed hands and surface contact is the number one means of transmission. Beginning on OCT, Medicare/Medicaid will no longer reimburse units for hospital acquired MRSA.

[TiffyRN, BSN, PhD]

One of the really nice things about the unit where I work is that you can pick any answer and at some point in time in our unit it would be the correct response. We change our MRSA policies pretty much every time we have a new case. Some stay in isolation for the rest of the hospitalization even with negative cultures. Some get to come out when their cultures come back negative.

Mostly parents are required to gown and glove, some get a dispensation from above and don't have to anymore, just the nurses. some babies are treated with antibiotics, some get special scrubs, some get ointments (that actually makes sense because it depends on the infection). Usually infected isolated infants are kept in a separate room but when space gets tight they keep the MRSA group on one end of a room and put down this special magical bacteria killing & shielding tape (commonly known as masking tape) and keep one nurse with the MRSA assignment. Of course when the mood strikes, a nurse will be assigned to a mixed assignment where some kids are positive and some are negative.

The absolute best story I have about our inconsistency is when we had an order from an MD that a mom could do kangaroo care with her infant underneath her isolation gown! What! What's the point of even wearing a gown if you're just going to stick the potentially infected baby under it? We all laughed at that one.

We did get them to stop with the policy that if you have an isolation assignment you have to stick with it for as many days in a row you are working. Apparently our showering skills are not up to snuff and we need at least 2 showers before we can take a non-isolation group. Unless you are a charge nurse or delivery nurse, then you can go in the isolation room, take the isolation assignment then admit a new kid, whatever. Yea, that made no sense and now you only have to stay with an isolation assignment until the end of the shift then you can change the next day if you want. I generally like isolation assignments myself.

[untamable07]

This case is very frustrating due to the fact we know it was hospital aquired because the prior tests were negative!!! Why can't nurses just WASH THEIR HANDS PROPERLY!!!!!!!

[dawngloves, BSN, RN]

This case is very frustrating due to the fact we know it was hospital aquired because the prior tests were negative!!! Why can't nurses just WASH THEIR HANDS PROPERLY!!!!!!!

It could have been the doctors, x ray tech or even the family that gave the baby MRSA.

[elizabells, BSN, RN]

It could have been the doctors, x ray tech or even the family that gave the baby MRSA.

We had a huge MRSA outbreak last year, and they cultured every one of the staff. Only 5 of over 150 nurses tested positive. Far more likely that one of the folks who goes from baby to baby to baby (XRay, MD, Resp Therapy) was the vector. We have also had cases of family transmission.

But everything is the nurse's fault, of course.

[TiffyRN, BSN, PhD]

Yes, hospitals do have a bad history with spreading MRSA. Keep in mind that there is more and more in the community. We have had many infants in the past couple of years that had parents or grandparents diagnosed with MRSA after the baby admitted. We still allow visitation as long as they gown/glove. But what if these people either didn't know or didn't know how important this information is. So far I don't thinkwe've proven any post-natal transmission, yet . . .

[BittyBabyGrower, MSN, RN]

Sorry, but it usually isn't the nurses....we do 3 audits per day and most of the offenders are the docs. They go bedspace to bedspace, don't hand sanitize after touching stuff at the bedsides, leave the rooms without sanitizing, etc. They are the ones that are most careless in heeding the gown and glove signs, esp other services such as surgery. Not saying that nurses are blameless, but when we get audited by ID, the docs are usually the ones that cause us to fail.

We have also had kids be positive because someone in their family works on an adult floor and doesn't have the sense God gave a goose to make sure to change their scrubs to regular clothes before they visit. Or moms with the fake nails...another big horder of MRSA. This is why we culture every kid upon admission.

For more info on the non-reimbursement from medicare/medicaid on nosocomial infections, just do a google and put in reimbursement for hospital aquired infections. Load of info.

[RainDreamer, BSN, RN]

This case is very frustrating due to the fact we know it was hospital aquired because the prior tests were negative!!! Why can't nurses just WASH THEIR HANDS PROPERLY!!!!!!!

What case are you talking about? And how exactly do you know for certain that it was the fault of the nurses?

[preemieRNkate, RN]

When we spot someone in scrubs we are on them before they can touch a thing. We ask them where they are coming from in scrubs. If they came from working on a "dirty floor," we make them gown and glove, and tell them that they should not visit after work without showering and changing clothes, or they should come before work. Most of the time, people are cooperative and understand why we are making them do all that.