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Discussion

MRSA screening in OB?

My unit is in a small community hospital. We have a combined OB unit (L & D, postpartum, nursery all together).

There are generally 2 nurses and 1 aide on 2nd and 3rd shifts. Maybe 1 more nurse on 1st shift.

Administration is now asking us to perform nasal swabs on ALL inpatients upon admission (this is hospital-wide). It generally takes at least 24 hours to get results. When a swab comes back positive for MRSA, even if the patient has never had symptoms and has no sores, they are automatically put in Contact Isolation, which also means that their baby is considered "contaminated/potentially infected" and cannot go to the nursery. Since we do not have an official "isolation" nursery, that means she basically has no choice but to keep her baby all day and night until discharge. -Even though the baby has usually spent time in the nursery in the 24 hrs prior to the positive result! I mean, the patient's stay is half over before we even get the results! :angryfire

Most of us nurses are furious with this. The patient is given a nice little information letter about what MRSA is and how proper handwashing and universal precautions are sufficient to prevent the spread, at the time that we take the nasal swab, and then when it's positive, all these other things happen. There's a nice big STOP sign on their door announcing to all the world that the patient in this room is in ISOLATION. :imbar

Now, they can still have all the visitors they want. We are to encourage them to wear gloves when in contact with the patient or baby, but if they choose not to, we can't help that.

It just all seems so ridiculous! We have not had an issue with MRSA in our hospital other than the norm.

This apparently all stems from Medicaid refusing to pay for post MRSA care unless it can be proven that the patient had the infection before they were admitted to the hospital. Now to make sure they are getting paid, this is what is happening.

At the same time, they are not going to swab any staff members because, "We probably would have a large percentage come back positive." And, "Probably most of the visitors that come in, carry the infection as well."

EXCUSE ME?? So, why are we isolating patients and babies??:eek:

After all that, I am aware that Staph is a serious thing and that we need to do what we can to minimize the threat to our patients, but I just don't see that we are really doing that.

Anyone else out there doing anything like this?

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Yes, unfortunately. We have the same gripes. If isolation is not done properly and strictly, what is the point? Management won't budge, as it is hospital protocol. I don't feel badly though about 24 hour rooming in, that's really best practice in most cases anyway :)

Just out of curiosity, what happens if the patient refuses to submit to a nasal swab?

  • Experts

We have (fortunately) not started doing that yet, and I hope nobody gets any bright ideas. CA-MRSA (community acquired) is a whole different ball of wax than hospital MRSA. Most of us walking around probably have MRSA, whether we work in a hospital or not.

This is a touchy subject for me. While I understand the need to protect, I don't understand a) why they are culturing patients but not staff; and b) why they don't isolate everyone BEFORE results get back. I just don't think the apocalypse is coming to the world in the form of MRSA.

  • Author

I also think 24 hour rooming in is a good thing. IF the mother wants to. I do feel badly telling a mom who hasn't slept in 2 days due to labor, fussy baby, etc. that even though she has to go home tomorrow, I can't take her baby for even an hour so she can get some sleep. After all, if she gets an itemized bill from the hospital, it will show a charge of around $600 per day for "nursery". I know that is nursing care included, but as a patient, I would bristle at that charge if the nurses refused to take my baby to the nursery. (And that is how it appears, that "the nurses refused").

Patients can sign a form declining to receive the MRSA swab. I am going to start outlining what the results will be if the swab is positive (isolation, no nursery use, etc.) so that at least patients will be forewarned and can choose to refuse.

I, too, agree that MRSA is not going to be properly contained this way. If I discharge a "positive" mom and baby at 2 pm, she and her baby can return at 2:01 pm to visit another mom and baby and she can hold that other baby and do whatever she wants, as a visitor, and that is fine. :banghead:

At this current time we are not swabbing all patients. We only swab those that have a history of testing positive in the past. They have to have 2 negative cultures before they are considered MRSA negative. If they have a positive history (and no negative cultures) they have to be put into contact isolation. We have a special policy on OB for these mothers and babies.

We haven't started doing this yet, but the OB supervisor did mention something about it the other night when we were working together. We had a newborn C/S baby born with a very bad looking rash, swabbed him and it came back as MRSA, but was decided the swab was contaminated I guess and the Dr. swore the baby just had baby acne.

What do you do if you have a mom that is not stable enough to care for her own baby (ie fresh c/s, on mag etc.) Do they have to have a sig other there to care for the baby.

I'm happy we aren't doing this... yet.... I hope we don't lol... I can understand how frustrating it must be

We also screen all OB patients but the mother is not required to keep the baby in her room constantly- we keep a separate crib outside the room that is used to take the baby to the nursery and the nurse/aide in the nursery wheres PPE when holding or feeding the baby. I have rarely heard of patients refusing to be swabbed.

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