MRSA question

Surgical Hrt RN · May 1, 2005

I knew that S.aureus was everywhere, on our bodies, etc. but I had no idea that MRSA was everywhere and on us all the time.... are you sure that's right b/c it was my impression that this resistant strain caused terrible infections in anyone who became infected with it. I had a poor lady come down with it the other day and we not only used universal precautions but also isolation precautions as well. Can't be as common as your suggesting....

It is as common as the previous poster is suggesting! My healthy, 15 year old 6ft tall, 180 lb son just had community acquired MRSA! He was hospitalized, placed in isolation, and had a 10 day run of Zyvox. He had fallen while skateboarding, and opened up an area on his knee. About a week after that he fell and opened the same area. Unfortunatley, I was not home when this second fall happened and he cleaned the area himself. About a day or 2 after the second injury he developed what looked like and ingrown hair on his knee. Then this "ingrown hair" started spreading to other parts of his body. I took him to the ER for what resembled a huge boil on his opposite leg. They lanced it and cultured it and gave him IV Clindamycin. The very next day he had a another "boil" surface on his belly. This was a Sunday, on Monday morning I took him to his pediatrician. The doc took one look at it and said it was community acquired MRSA! I freaked out! I thought maybe I brought it home and gave it to him. The doc assured me that was not the case. He cultured the boils and they came back positive for MRSA. He spent 2 days in the hospital. The doc said that this is becoming more and more prevalent. He said that he has seen half a dozen cases within the last six months.

My sister took her son to the doc...we have different docs.....and her son's doc told her the same thing. He doesn't know what is going on, but if you see any areas that look like boils to bring your child in right away. It is almost always MRSA. So, now, we do not use any bar soap at home, since the bacteria can live on that surface. We spray the bathtub down with bleach after each use and each one of my kids has a travel size bottle of Purell hand sanitizer that they carry in their book bags at school. It is more common and is coming from gyms, lockerooms, wrestling mats, etc... The ID Doc said frequent handwashing is the single most important way of preventing this.

Bird2 · May 1, 2005

We follow the CDC guidelines that recommend not to perform routine cultures to test for MRO's. I work in a Long Term Care facility and we isolate the bug not the resident. Usually if the resident has positive cultures for MRSa but is not symptomatic the ID Doctors will label them as colonized. To clear them of the MRSa label we will reculture 72 hours after the antibiotic therapy is completed. Since colonization of MRSa is in the nares we culture the orginal site such as the urine and the nares twice at least 48 hours apart. If they still show MRSa the ID Doctors usually do not continue with antibiotic. We only put them in isolation if they are symptomatic. We also keep them listed on a MRO log incase they become symptomatic or we need to change ther room. We try to not place a colonized resident in a room with someone that has a foley, GT, or is immunocompromised.

sbic56, BSN, RN · May 2, 2005

Here's a good, current article. I find it amazing that cases aren't really tracked. No way of telling how common this is. If only we had known that all those anibiotics we used were actually going to make us sicker.

http://msnbc.msn.com/id/6132747/

meownsmile, BSN, RN · May 2, 2005

I think this week i have seen my first case of neg cultures come back on a patient that previously had been positive. She was cultured 2x's 48 hours apart and hadnt been on an antibiotic for almost 2 weeks prior to the first cultures. Amazing, we finally got one out of isolation!!!!

JJRN · May 2, 2005

.

CoffeeRTC, BSN, RN · May 2, 2005

Years ago when in school I sat in the front of my Micro class. Of course I was swabed for everything as the ginnea pig. I was + for MRSA in the nares. Never once been in a clinical setting yet.

sbic56, BSN, RN · May 2, 2005

Is someone who has used alot of antibiotics more apt to swab positive for MRSA over SA? I wonder if MRSA has evolved to the point of overtaking staph as a primary resident of the nose and that is why we are finding it so frequently? Any info or ideas on that?

Mandylpn · May 2, 2005

Where I work in LTC we have many residents with MRSA, they do not do nasal swabs on us. shouldn't they be doing this? they have antibacterial soap in their rooms, but is this and gloving enough? I mean if you can get it in your nose shouldn't you be wearing a mask also? :uhoh21:

germain · May 2, 2005

sbic is correct. i recently read an article that said you could lower
your "bacterial load" by soaking for 30 min in a bath with 1/2 cup
of bleach. there are other tx i have heard, but don't recall specifics.

Really? I always thought that if you always killed all the bacteria, good and bad, colonized on your skin, you increased the populations of bad bacteria, or could, by killing your normal skin flora that keep the bad guys in check. Then all thats left are the bacteria tougher than average- like if all the good people move out of the neighborhood, then whats left? THats how it was explained by my high school biology teacher 100 years ago.

bobnurse · May 2, 2005

MRSA is everywhere.......Its now running wild with kids due to frequent injuries....Also becoming more common in the gyms..............

It once was a hospital problem now gowing in the communities........

it seems costly to swab everyone for MRSA......Especially when many ID docs will only treat if they are symptomatic..

MRSA is becoming pretty common........Its the VRE and VRSA that im worried about....

madwife2002, BSN, RN · May 3, 2005

I see you are in UK. I have not heard of precautions such as you describe used in the US, but maybe someone here can clarify on that. About what percentage of those you test upon admission test positive for colonization? Do you keep those who colonize positive isolated from the rest of the patient population? If so, do you lift precautions after treatment and the second swabbing?

you are supposed to keep patients isolated in side room, but not always possible. We dont lift precautions until we have had 3 negative swabs all done days aparts. Sorry cant give percentage at the moment but will see if I can get that on return to work off til thurs. :)

sbic56, BSN, RN · May 3, 2005

you are supposed to keep patients isolated in side room, but not always possible. We dont lift precautions until we have had 3 negative swabs all done days aparts. Sorry cant give percentage at the moment but will see if I can get that on return to work off til thurs. :)

Now that's diligence! I look for ward to learning how many test positive initially. 'Alot' and 'it's everywhere' while probably vaguely so, doesn't mean much; I think this is something that should be known! This is what our CDC should be tracking, but I don't have a lot of faith in our gov't program, anyway.