MRSA

[LetsFixNursing]

I've been a nurse a long time but haven't ever quite gotten a full understanding of MRSA colonization vs active infection. When I report off sometimes I'm asked which I it ot where is the infection, ie: wound, urine etc. Why does this matter when the pt I'd on contact precautions regardless of if it is colonized or not. How does that affect the care of the patient from a nursing point of view?

[THELIVINGWORST, ASN, RN]

Would the site of infection not affect the treatment?

For instance MRSA of the nares might be treated with muprocin.

[hppygr8ful, ASN, RN, EMT-I]

Sounds like homework to me - I wish the op would just say so.

Colonization means that the organism is present but not causing active infection. Since MRSA escaped from the clinical setting it is estimated that approximately 10% of the total population is currently colonized. In one country (Norway I Think) the government outlawed the use tetracycline in livestock feed and the numbers for MRSA colonization went down after about 10 years. I always thought the use of ATB in livestock feed was to make a safer product but it turns out it certain animals grow faster and reach market size faster.

Hppy

[Studentnurse365]

I'm a new nurse and thought about this the other day. Why do we swab everyone's nares for Mrsa then put them on iso when it comes back positive? It isn't an active infection, it is just colonized in the nares. Most health care workers probably have mrsa colonization on their skin. So why the precautions if it is just colonized? I get that it can lead to an active infection, but why abx and precautions b4 the infection?

[NurseBeata]

I believe the reason why patients are put on precs before infection is to protect other more vulnerable patients with open wounds. I work on a general surgical floor where patients often have open incisions, fistulas, and other large wounds.

On a larger scale, visitors who enter contact precaution rooms are advised to wear PPE to prevent carrying antibiotic resistant microbes back to vulnerable populations- like children, the elderly, and the immunocompromised.

[klone, MSN, RN]

m a new nurse and thought about this the other day. Why do we swab everyone's nares for Mrsa then put them on iso when it comes back positive?

You do? I don't believe that's standard of care. As far as I know, the only time someone should be cultured for MRSA is if they have an active infection/wound. The only time nares should be swabbed if there is a wound inside the nose, or to CLEAR a person with a MRSA designation (bilateral nares, armpits, groin).

[SassyTachyRN]

You do? I don't believe that's standard of care. As far as I know, the only time someone should be cultured for MRSA is if they have an active infection/wound. The only time nares should be swabbed if there is a wound inside the nose, or to CLEAR a person with a MRSA designation (bilateral nares, armpits, groin).

My hospital swabs everyone on admission to the floor, ICU patients are swabbed every 4 days. If your swab comes back positive for Mrsa then you are placed on contact precautions. Your patient account is then flagged with MRSA and every admission MRSA will then appear next to your name and you'll automatically be put on contact each subsequent admission. Same if you test positive for VRE, you'll be flagged and always be placed on precautions. Some docs will treat nares with abx cream for a positive MRSA and some won't do anything at all.

[Studentnurse365]

My hospital swabs everyone on admission to the floor, ICU patients are swabbed every 4 days. If your swab comes back positive for Mrsa then you are placed on contact precautions. Your patient account is then flagged with MRSA and every admission MRSA will then appear next to your name and you'll automatically be put on contact each subsequent admission. Same if you test positive for VRE, you'll be flagged and always be placed on precautions. Some docs will treat nares with abx cream for a positive MRSA and some won't do anything at all.

That's what we do too but we don't treat the nares with anything. Almost everyone comes back positive for Mrsa in the nares.

[chiromed0]

Yeah we swab a lot of vulnerable populations too. Precautions are to curb the spread to more immunocompromised patients. Most patients colonization is never treated b/c they are heading right back to the same environment but I think there should be some treatment vs just precautions for colonization. Honestly, I don't see that many MRSA infections but they do roll through every so often. I get a little confused on the issue too as with C-Diff. With C-diff you have a known sucessful treatment option but so few choose it, so few providers offer it, and so few know about it. Why it is not common practice is beyond me if C-diff is such a problem.