MRSA in Residential Treatment Facility

weetziebat · Feb 27, 2005

I work in a group home for MR/DD clients, and we were having similar questions. Everywhere we turned the information seemed contradictory. Hospital staff are wearing gloves, gowns and masks but telling us it is not really needed and they are going to change policies.

In the end, we stress excellent handwashing, following universal precautions and using a disinfectant spray to clean surfaces with. As long as the product says it kills HIV and/or TB, it will kill MRSA.

stevierae · Feb 27, 2005

I work at a residential treatment facility for kids with mental illness. Kids live in dorm-like setting for 6-12 months. About 6 months ago we had a "cutter" with a MRSA infection in one of her wounds. She has since been discharged. Then a couple weeks ago we have another "cutter" with MRSA to a deep antecubital wound. Client refused PO antibiotics so we had to transport her to ER for Clindamycin 600mg IM q12hours. She finished the IM course and will be going for another culture Monday.
How is MRSA delt with in residential care settings such as mine? There have been no precautions except lots of hand washing...but I'm concerned about furniture, surfaces, etc.

I am curious---was Clindamycin the appropriate antibiotic treatment for this child? I alsways thought that the antibiotic SOC for MRSA (more appropriately called ORSA, or Oxacillin resistant, since Methcillin has not been available in the U.S. for a long, LONG time) was Vancomycin. I don't think I have ever seen anything else used.

I know at my gym they were reporting MRSA infections being introduced into open wounds from OTHER people's Staph aureus being left behind on surfaces such as the circuit training equipment--particularly the pad on the arm curl machine, where one's elbows and forearms rest.

I hope that they (the staff) disinfect the equipment at intervals with a bleach solution. However, I have never seen them do it---hence, most people are just careful to lay down a clean towel, always--and, of course, showering well with plenty of plain old regular--not antibacterial--soap and water afterwards.

I partially blame all the antibacterial soaps hyped to consumers for everyday hygiene for getting us into the whole antibiotic resistant bacterial infection problem in the first place---that and overdependence on antibiotics when not needed (such as for colds and flu) has resulted in an entire population being unable to resist bacteria we could formerly resist.

melissa_rn · Feb 27, 2005

I am curious---was Clindamycin the appropriate antibiotic treatment for this child? I alsways thought that the antibiotic SOC for MRSA (more appropriately called ORSA, or Oxacillin resistant, since Methcillin has not been available in the U.S. for a long, LONG time) was Vancomycin. I don't think I have ever seen anything else used.
I know at my gym they were reporting MRSA infections being introduced into open wounds from OTHER people's Staph aureus being left behind on surfaces such as the circuit training equipment--particularly the pad on the arm curl machine, where one's elbows and forearms rest.
I hope that they (the staff) disinfect the equipment at intervals with a bleach solution. However, I have never seen them do it---hence, most people are just careful to lay down a clean towel, always--and, of course, showering well with plenty of plain old regular--not antibacterial--soap and water afterwards.
I partially blame all the antibacterial soaps hyped to consumers for everyday hygiene for getting us into the whole antibiotic resistant bacterial infection problem in the first place---that and overdependence on antibiotics when not needed (such as for colds and flu) has resulted in an entire population being unable to resist bacteria we could formerly resist.

Yes, Clindamycin was on the list of "sensitivities" --as was Bactrim which I was surprised to see. After she finished her course of IM clindamycin, they gave her a script for oral Cipro, which I KNOW she will refuse.

CapeCodMermaid, RN · Feb 28, 2005

Same problem...different setting. Alzheimer's unit in a LTC facility. Our patient came back from the hospital with MRSA in his hip incision. Nurse practitioner ordered IV Vanco through a PICC line. I tried to tell her that 1)this guy would pull out the PICC, and 2) the culture and sensitivity said it was susceptible to PO Bactrim. She wouldn't listen. The guy got less than 1/2 a dose of vanco before he pulled the line out...ended up on the PO Bactrim. ...the repeat culture???negative!

weetziebat · Feb 28, 2005

I hope that they (the staff) disinfect the equipment at intervals with a bleach solution. However, I have never seen them do it---hence, most people are just careful to lay down a clean towel, always--and, of course, showering well with plenty of plain old regular--not antibacterial--soap and water afterwards.

Just need to watch the bleach. Sorry my brain is a sieve at the moment, and can't remember details, but recently Clorox management issued a bulletin saying that their bleach does not kill MRSA. So all bleaches are not created equally. This was big news to us as we'd been using a diluted bleach solution to clean surfaces. Oops!

Antikigirl, ASN, RN · Mar 2, 2005

I am going to say what I told all my freaking out CNA's about a patient that just was tested positive for MRSA on wound...UNIVERSAL PRECAUTIONS! Assume all wounds/fluids are MRSA positive, Hep positive, HIV positive! This should always be considered as part of your routine no matter what patient!

Now with the MRSA, I wrote on her MAR's for my caregivers to use extreme caution, using their gloves and very dilligent hand washing. Linens/clothing are to be separated into a different area for our laundry staff so they know to handle with more awareness, and housekeeping also know this for when they change her bed linens and towels. No mask needed in this case unless one feels like they should (the MRSA seems to be just in the wound). Gowns if you wish, and may come in handy if the patient has a really messy incontenent episode and you will be leaning over where your clothing may hit the area and you didn't notice (happens!).

But the fear factor was there until I calmly reminded staff that this is a bacterial infection that is just stronger than others. It just doesn't die with the typical treatments...and they all understood that when I said...how many of us have had PCN or Amoxicillin time and time again...well, go figure a bacteria may get use to it and we will need to use something a bit stronger! Once they looked at it like that...I said...'so we just want to kill it where it is and not transport it somewhere else! So take steps to ensure those bacteria stay there so we can kill it...kinda like leaving a spider stuck in the shower till someone can bring the bigger shoe to smoosh it (LOL!), and do whatever we can to keep it from escaping or biting you by using barriers and not allowing things for it to crawl on! Don't fear the thing, just be aware of it!".

That really seemed to help people come back to planet earth and realize that freaking out or fear isn't our friend when it comes to bloodborne paths., but understanding it and remembering what to do is our best defense!!!!!!

expatnurse · Mar 2, 2005

I work at a residential treatment facility for kids with mental illness. Kids live in dorm-like setting for 6-12 months. About 6 months ago we had a "cutter" with a MRSA infection in one of her wounds. She has since been discharged. Then a couple weeks ago we have another "cutter" with MRSA to a deep antecubital wound. Client refused PO antibiotics so we had to transport her to ER for Clindamycin 600mg IM q12hours. She finished the IM course and will be going for another culture Monday.
How is MRSA delt with in residential care settings such as mine? There have been no precautions except lots of hand washing...but I'm concerned about furniture, surfaces, etc.

I find it very intersting to read how you all are dealing with MRSA. I would like to know if they ever screen staff if MRSA starts to get out of control? Do they pay you for time off work and put you somewhere else to work while you are getting treatment? In the UK they have had cases of MRSA in the community with one person 28 years old dying from it. The whole story can be found on http://www.bbc.co.uk health section. I am currently working a paper on this topic any information would be heplful thanks have to go to work now. The joy of night shifts.

Antikigirl, ASN, RN · Mar 2, 2005

Sheesh..in my facility you are lucky enough to get non latex gloves if you need them let alone testing for MRSA! No, my company won't even pay for CPR lessons for my caregivers that do all the direct care of my patients..and will be the first on scene in a situation!!!!!

I have never heard of a facility testing all staff or even parts of staff for MRSA unless there was very SERIOUS circumstances surrounding it...and I really think they would spend a lot of time trying to pin point certain people and not just test all staff...

CarVsTree · Mar 2, 2005

I find it very intersting to read how you all are dealing with MRSA. I would like to know if they ever screen staff if MRSA starts to get out of control? Do they pay you for time off work and put you somewhere else to work while you are getting treatment? In the UK they have had cases of MRSA in the community with one person 28 years old dying from it. The whole story can be found on http://www.bbc.co.uk health section. I am currently working a paper on this topic any information would be heplful thanks have to go to work now. The joy of night shifts.

I can't remember the exact statistic, but I read somewhare :rolleyes: that 70% of healthcare workers carry MRSA in their nares.

I know where I work, we just glove (always) and gown when necessary. Masks only if it is MRSA in sputum.

Bottom line, use standard precautions and common sense. MRSA is opportunistic. It needs an opening. Make sure all open wounds are properly covered. And wash, wash, wash your hands.

CoffeeRTC, BSN, RN · Mar 2, 2005

10 or so years ago as a nursing student taking Microbiology I sat in the front row...of course I was swabbed and tested for everything!! :lol2: Never worked in a hospital, heath care setting or anything near sick people....I was positive for MRSA in my nares...Never really been sick and work with MSRA, VRE, C Diff etc in the nursing home.

Universal precautions and proper disinfection!

LPN1974, LPN · Mar 2, 2005

I also work in a facility that takes care of MR/DD people.

We use alot of gloves, hand washing, and the staff in the homes use alot of bleach,

to clean surfaces and the bathroom floors. They mop and clean every night.

The aides are so "clean" conscious, they PREWASH the dishes after meals, in a pan of bleach, THEN they go in the dishwasher for another cleaning.

Sometimes the bleach is so strong it makes my eyes water as I go to the sink to get water for my med tray.

I would be willing to bet I work in the cleanest facility west of the Mississippi. lol

I certainly can't blame them for being so conscious of it, they have to work in there with these people, and then go home to their own families.

We also have these special kits to get blood off the floor if that happens.