MRSA Swabs

Depends on location.

Nares I just wash my hands and treat them as I would any other patient, considering I tested postive for MRSA in my nares. (Did the bactroban treatment as well due to having surgery).

Wounds/Urine/Blood I will generally gown up if I come in contact with sheets/bed/patient but it really depends if theres open wounds, drainage, urine, fecal matter, etc. Depends on the situation.

I"d hate to know, we've always joked and said if the hospital wants to get serious with mrsa then they'd swab us too.

But it does make you wonder, the other day we got an admission from the ER and he was mrsa+ nares. They hadn't taken any contact precautions on him other than gloves and I'd bet they cross-contaminated. Also, we had a patient that was isolated for mrsa in a wound.....that was on a foot which was subsequently amputated. I've asked why we need to continue to isolate that patient when they obviously don't even have the body part that was cultured positive. Just makes us laugh about how we'd probably never make good administrators!!

I take the precautions very seriously and I think all my co-workers do too. ESPECIALLY c.diff. That's what I'm more worried about getting.

We have alot of MRSA where I work right now too. Sometimes we have hald the floor on isolation and the other half consisting of fresh-post op orthos and a few neutropenic pts from chemo, etc. It's so hard to divide up the assignments! Sometimes one RN ends up with all isolation pts and is gowning up and down so many times they are literally sweating and exhausted by the end of shift!

My personal pet peeve though... when we have a pt for 2 days with diarrhea and THEN they determine it's C-dif!!?? or the other day we had a little one there for 2 days coughing all over us, when all of a sudden they say she's isolation for RSV.. a little late thanks! Alot of the girls have newborns at home and would have liked to know that they were taking care of that as well as other pts were were going in and out of their rooms...

Personally, i gown up when giving personal care. Reason, like said, a lot of our pt. test positive for mRSA, C-DIFF after being in the unit for several days. Some hospitals actually have the pt "testing out" of mrsa. Their cultures have to be negative for a certain period of time. Interesting!

Where I work, we also test for MRSA in nares on admission and then every 7 days after. We also have to wear isolation gowns and gloves even if we go in the room to hang a med and not touch the patient. These patients do not have open wounds, but just MRSA in the nares. It is so hard to explain to family members that they have to gown up and put gloves on when they don't see a wound. Practically everyone that gets admitted is MRSA + in the nares. The nurses do their best to adhere to the contact precautions, but the doctors, well that's another story. I have seen them go in the room and not wear gown or gloves and then use their stethescope and not clean it. Seems to me, it is all just a waste of time if you can't get everyone to comply.

there is a HUGE variance in practice as far as MRSA isolation goes in acute care facilities. I wanna know the bottom line, what does the CDC recommend for hospitals? I've tried to look it up but couldn't find it. I wanna know what best practice is!

Z

We tend to isolate wounds until we know what is growing and we isolate anyone who had a history of MRSA until we can rule it out. We do nasal swabs. We also isolate Cdiff or any history of Cdiff until we can rule in out. They have to have three negative stools before they can come off isolation.

I know one hospital that does routine screening swabs for MRSA on everyone that gets admitted. I know another hospital that assumes everyone has MRSA. You might want to take a look at the policy and procedure manual for that facility and see what they are required to do. We don't charge extra for isolation in our hospital so that would not be a deciding factor for us.

there is a HUGE variance in practice as far as MRSA isolation goes in acute care facilities. I wanna know the bottom line, what does the CDC recommend for hospitals? I've tried to look it up but couldn't find it. I wanna know what best practice is!

Z

Isn't trying to find info on the CDC site a nightmare!? We culture EVERY patient on admission, on transfer, on discharge and even when they die. No one gets out without being cultured at least twice!!! As for the doctors, I work in a teaching hospital and I feel that it is my responsibility to inform them to follow policy. All of us in the ICU where I work take it very seriously.

We swab our babies on admit for MRSA and if they are positive for the nares, they go on contact isolation. PAIN IN THE BUTT for something I probably already have!