NHS Trust eliminates MRSA

Trauma Columnist · May 10, 2008

Thanks for the very interesting article. What exactly are they doing differently? Here in the US, our Medicare/Medicaid system (for people that are old, disabled/poor) will no longer pay the hospital for care of MRSA or VRE infections contracted while in the hospital. THis has resulted in every single pt who comes into the hospital being screened for MRSA/VRE.

Silverdragon102, BSN · May 10, 2008

From what I can gather they are making a clinical decision on whether to insert a cannula and if one is required it is prescribed by a doctor and monitored regularly. Saying that when I nursed patients with a cannula I would inspect them a couple times every shift anyway. What I did see was a habit of inserting when one was not always required so nice to see a step away from that.

I know some hospitals screen for MRSA on admission but not sure if all hospitals do that now. I know when I had a operation done privately 3 years ago I was swabbed a week before the op for MRSA

allnurses Guide · May 11, 2008

Sounds good, I would like to see what other measures they use as well and what the protocols are for those patients who are infected.

LiverpoolJane · May 11, 2008

Really interesting, on our ward we have now decided to swab every patient on admission as we are a high risk ward. Two years ago I convinced the Consultants and our Microbiology leads to let us use silver dressings for all our CVC exit sites. Thankfully the agreed as I was able to convince them it was cost effective. We reduced our MRSAs form 8 to 2 in 12 months, none of them were from a CVC exit site. We were getting the blame for the MRSA detected in patients that had come to us from ITU and now the ITU has started using our pathway.

We have started using disposable BP cuffs for our infected patients - MRSA, CDT, VRE etc. We also use stethescope diaphragm covers and are looking at a few other things we are putting in place in the next few weeks - very simple things not higfh tech expensive things.

We have tightened up on our periferal line insertion policy - it is now a strictly asceptic technique, the clinician inserting must fill in a profoma stating in was inserted as per policy. Failure to follow this policy can lead to disciplinary action.

I'm quite excited about the coming months, to see if all our efforts will propve affective. After reading a NY Times article I am tempted to order a load of disposable BP cuffs for each and every patient but I haven't had my budget statement in - if we are underspent I may just go ahead.

Diary/Dairy, RN · May 11, 2008

Does Cannula mean IV??

Silverdragon102, BSN · May 11, 2008

Really interesting, on our ward we have now decided to swab every patient on admission as we are a high risk ward. Two years ago I convinced the Consultants and our Microbiology leads to let us use silver dressings for all our CVC exit sites. Thankfully the agreed as I was able to convince them it was cost effective. We reduced our MRSAs form 8 to 2 in 12 months, none of them were from a CVC exit site. We were getting the blame for the MRSA detected in patients that had come to us from ITU and now the ITU has started using our pathway.
We have started using disposable BP cuffs for our infected patients - MRSA, CDT, VRE etc. We also use stethescope diaphragm covers and are looking at a few other things we are putting in place in the next few weeks - very simple things not higfh tech expensive things.
We have tightened up on our periferal line insertion policy - it is now a strictly asceptic technique, the clinician inserting must fill in a profoma stating in was inserted as per policy. Failure to follow this policy can lead to disciplinary action.
I'm quite excited about the coming months, to see if all our efforts will propve affective. After reading a NY Times article I am tempted to order a load of disposable BP cuffs for each and every patient but I haven't had my budget statement in - if we are underspent I may just go ahead.

Some very good ideas there and like you said simple non expensive things. Nice one :up:

Silverdragon102, BSN · May 11, 2008

Does Cannula mean IV??

For this article yes it means IV access

LiverpoolJane · May 11, 2008

Does Cannula mean IV??

Yes, the term cannula would usually refer to a periferal IV (venflon) then there is the CVC - central venous cannula (central line- internal jugular, femoral, sub clavian)

RGN1 · May 11, 2008

Nearly all our patients have venflons because they are either surgical cases having anasthaesia/PCA/other IV meds or medical patients requiring IV antibiotics/anti-emetics. We don't have MRSA because we are a private hospital with single rooms. We barrier nurse & swab any patient coming from another hospital/nursing home & we pre-screen anyone else thought to be at risk e.g coming in for debridement of infected wounds.

I've been there 2.5 years & to date we have not had a single case of MRSA caught in our hospital. We've had a couple already admitted from elsewhere that tested positive on our screening but they have stayed as isolated & not spread to others on the ward. Same with C-Diff.

We use silver dressings on our cannulae & they are removed asap (usually by me or another colleague whose hot on getting them out as soon as poss!)

Due to the volume of IV access needed it would not be practical for our doctors to have to prescribe venflons everytime but it is important to have good IV access care.

I always write the date on the dressing of any venflon I insert or see the docs insert, it's an easy way to check they've not been in too long.

sofaraway04 · May 14, 2008

We have a similar system where I work, although venflons aren't prescribed by the doctors. Patients only have them if there is a clinical need and on the insertion sheet you ahve to put reason fro insertion. as soon as they are not needed any more they are taken out, eg. once IV antibiotics are switched to oral.

each venflon is checked once daily (at least) and it's an allocated nurse's job that day to 'do the VIP'

every venflon is changed after 72hours, even if the VIP score is 0 and it's looks fine.

the whole hospital is autited weekly and our ward usually scores 100% compliance.

the most annoying thing is when patients are admitted to the ward and there no record of when the venflon was put in, it's not written on the dressing and the patient can't remmeber.

kiuff · Jul 14, 2008

I wanted to ask a simple question. How cases of MRSA septicaemia have there been proven to be due to peripheral iv cannulas? I am not talking about central lines.

I think people should look at these so call infection measures closely. The fundamental problem is that wards are over crowded and patients from nursing homes are more than likely to have MRSA before they come to hospital.

I do aggree that an IV cannula should be kept in as little as possible.

However I do think our so called infection control measures have little if any evidence behind them.

You can insert an IV cannula under aseptic conditions but you should also be handling them using the same aseptic techniques.

Moreover now the way venflon dressings are being put on also coming under scrutiny. The hospital I work in has now introduced a bare below the elbows policy. No watches on my non-dominant hand because it is an infection risk. Level of evidence? Level D ie it makes sense from a theoretical point of view but not proven by a RCT.