Mrsa.....

[TeresaB930, BSN, RN]

I asked a co-worker if she had a blood pressure cuff I could borrow tonite at work. She had me follow her to a room with contact precautions, and provided the cuff for me. I questioned whether or not I could use the cuff on another patient, she stated that the patient has MRSA in his urine, and it didn't come in contact with that, so it will be ok.

My gut continued to question this, so I took the cuff and wiped it down thoroughly with alcohol pads before using it on my patient. Can anyone clarify this for me?? If a patient has MRSA, no matter what kind, shouldn't they have their own equipment designated to that room?

Thanks!!

[GingerSue]

MRSA mode of transmission is "contact; person to person, contact with contaminated surfaces"

Location of MRSA is skin and nasal secretions

The organism can remain viable for days on environmental surfaces and clothing.

[fronkey bean]

Teresa, I don't think wiping something w/ an alcohol pad will kill MRSA. I'm pretty sure it has to be cleaned thoroughly with a bacterialcidal solution (cavicide, etc.) or a bleach solution.

[clemmm78, RN]

MRSA pts are supposed to have their own equipment as it's person-to-person transfer. If we followed that nurse's thinking, then we wouldn't have to take isolation precautions when caring for a pt with MRSA unless they were being toileted.

[MoopleRN]

At my facility if a patient is on contact isolation, regardless of cause, the only thing that can leave the room are meal trays. Equipment for VS are left in room and NOT to be used for anyone else until cleaned per protocol. If you look up your facility's cg for contact iso, you'll probably get a more detailed answer.

[Sylv]

At my facility if a patient is on contact isolation, regardless of cause, the only thing that can leave the room are meal trays. Equipment for VS are left in room and NOT to be used for anyone else until cleaned per protocol. If you look up your facility's cg for contact iso, you'll probably get a more detailed answer.

I wonder about that, the meal trays leaving the room. If it lives on environmental services for days, then it must be on the tray, the flatware, etc. Of course, they will all be washed shortly in hot water, but what about the workers who handle the trays, that are not wearing gloves? Isn't there a potential for spreading it around there? Also, the cart that the dirty trays are put in and then later clean ones are placed in, how are the carts cleaned between meals? If the trays aren't picked up before the cart leaves, they are left in a dirty utility room. Another chance for spread. Doesn't make a lot of sense to me, I guess I must be missing something.

[MadisonsMomRN, BSN, RN]

No matter where the MRSA is... in our facility we use disposable bp cuffs, thermometers, etc.

Better safe than sorry!

[TeresaB930, BSN, RN]

At my facility if a patient is on contact isolation, regardless of cause, the only thing that can leave the room are meal trays. Equipment for VS are left in room and NOT to be used for anyone else until cleaned per protocol. If you look up your facility's cg for contact iso, you'll probably get a more detailed answer.

This is what I thought from previous patients with this bug. I should have stood my ground. I pray I didn't infect my patient with it.

Thank you all for your help!!

[CVICURN2003]

No matter where the MRSA is... in our facility we use disposable bp cuffs, thermometers, etc.

Better safe than sorry!

I cannot hear through the disposable stethescopes. I always take MY stethescope in the room. But, I leave it in there and when it is removed carefully clean with our santiwipes (we use to wipe down equipment in isolation rooms or even from one patient to another and at the end of my shift). We frequently have dialysis machines and Xray machines that are wiped down with those after a contact isolation patient is in there. We are doing MRSA nasal swabs on everyone admitted to the hospital, when tx to different dept (yes it is a pain in the butt). So, we have TONS of people on contact isolation for positive nasal swabs. We do sometimes have to put a "real" BP cuff on someone to get a manual pressure. WE take dopplers and glucomanders into the rooms. All are cleaned throughouly with the wipes before contact with another patient. Community acquired MRSA is rampant in my community.

[MoopleRN]

I wonder about that, the meal trays leaving the room. If it lives on environmental services for days, then it must be on the tray, the flatware, etc. Of course, they will all be washed shortly in hot water, but what about the workers who handle the trays, that are not wearing gloves? Isn't there a potential for spreading it around there? Also, the cart that the dirty trays are put in and then later clean ones are placed in, how are the carts cleaned between meals? If the trays aren't picked up before the cart leaves, they are left in a dirty utility room. Another chance for spread. Doesn't make a lot of sense to me, I guess I must be missing something.

Good questions and I agree with your critical thinking. Trays are removed by gowned/gloved personnel (may be nursing or dietary) and are placed in a separately contained area of the meal cart. If the cart leaves before the isolation tray is picked up, it's picked up with contact iso protocol and carried directly to the kitchen. I don't know why they don't just use disposable trays/utensils.

[crissrn27, RN]

I have always heard MRSA in the urine can not be passed on from a bp cuff. That is if it is only in the urine. Actually, I always heard a person with MRSA in the urine doesn't even have to be on contact precautions if they have a foley (ie, a contained source of infection). This from several infection control nurses I have talked to about this very thing. Of course we go overboard in the hospital, for good reason, I think. Don't want to spread it around, and better safe than sorry.

So, if this is true, and this pt had MRSA in the urine only, no need to worry. If he has it elsewhere and they just haven't cultured the site yet, then maybe it could be a worry. But probably everything is fine. Just learn from it and move on.

Any infection control nurses out there that know for sure about the MRSA in the urine thing?

[Mabel 29]

If a patient with MRSA in the urine uses a bedpan or is incontinent, the linens and clothing would become infected as well. At that point, using a community bp cuff would be a bad idea.

At the facility that I work at (LTC) we currently have a patient with this exact situation. The only precaution being taken is the use of gloves while doing care. Trays are in and out, linens and equipment are in and out constantly. Dirty linens are sent to laundry with other dirty linens.