pt with MRSA in sputum ambulating in hallway with no mask

[unsaint77]

I am a new grad working at a longterm care TCU. I found one patient with MRSA in sputum walking in the hallway without mask. He even eats at the same table with other patients. I asked the supervisor about it and she told me if I was concerned I should call the MD to get a proper order.

My question is...

1) Is it really up to an MD whether to confine the pt to the room or have the pt wear a mask in the hallway?

2) Could there possibly be a facility policy that allows this pt to sit with other patients at the same table for meals?

Thanks.

[blondy2061h, MSN, RN]

MRSA requires contact precautions, which does not require a mask. I would want any actively coughing patient to be wearing a mask around other patients, though.

[amoLucia]

This is freq a problem also with wounds and incontinent residents with infectious processes. Check your Infection Control manual so you'll have some info to present to your IC Nurse (who may also be your ADON or Staff Devel. Nurse). Also know what the most recent cultures are. MDs need to follow facility P&P. And State surveyors just LOVE to see the situation you so wisely question.

[sauconyrunner]

It is not up to the MD to give a proper order. This is basically an infection control issue. Best thing to do may be to look up exactly what the CDC says and try to get your facility to follow it.

You do need to look at when the pt was diagnosed with MRSA in the Sputum and the treatment done for this.

[unsaint77]

Thank you for replies which were pretty much as I expected. I have no problem calling MDs but I don't see why they don't just say "use your facility P&P and stop wasting my time." Next time, I am going to escort the patient back to the room and have him eat meals in the room. If my supervisor gives me hard time, she just going to have to write me up. I bet she won't.

I guess this kind of crap goes on in many facilities. This is the same supervisor who works 16 hours straight without any overtime pay. "Oh a great nurse, what a devoted dedicated nurse, never complaint," I can hear people say. In reality, that kind of nurses are the ones that make it tough for the rest of the nurses and jeopardizes patient safety.

[sapphire18]

In my experience, in LTC facilities, pts on contact precautions still get to eat in the common dining room. Realistically, you can't lock someone away in their room 24/7 in a long term living situation.

Also, in every facility I've worked at, 3 negative cultures= off contact precautions.

[unsaint77]

sapphire18, your experience probably was against the facility protocol, which happens everyday. As a nurse I think it is reasonable to have the pt eat meals in his room and walk in the hall way with mask on. I should not risk infecting other elderly residents for that one patient's emotional well being.

[Esme12, ASN, BSN, RN]

There are people that walk around with MRSA everywhere. Many nurses if cultured would be positive. If the MRSA is in his sputum then as long as he isn't coughing and there is meticulous hand washing he is fine. MRSA is not an airborne organism.

The CDC provides information about Health Care-Associated infections. I have provided you links.

CDC - Long-Term Care Settings - HAI

CDC - Prevention Tools - HAI

[CompleteUnknown]

Is the resident infected or colonised? As others have said, many people, including many facility staff, are colonised.

If colonised, there's no need for a mask or for exclusion from the dining room or other common areas.

If there's an active infection and the resident can cover their mouth with a tissue when coughing, most guidelines say there is no need for exclusion or for a mask.

It's the same with MRSA in wounds. As long as the wound is covered and any drainage is contained in the dressing, there's no need for exclusion.

You wouldn't make a resident wear a mask because they might cough up sputum and deposit it somewhere, and you wouldn't exclude a resident with MRSA in a wound because the dressing might fall off.

[Scarlette Wings]

The MRSA in his sputum does not tell me if he has a cough and is symptomatic or getting better and not coughing at all. Is it from a respiratory infection or is just colonized? You can educate Pts on the need for hand hygiene and use precautions leaving their room but you cannot hold them against their will. Isolation is definitely Contact but often Droplet can be added when the lungs are involved with resp symptoms.

[SuesquatchRN, BSN, RN]

What do you think the guy's going to do, spit on people? He should cover his mouth if he coughs. Geeze Louise.

[unsaint77]

1) Thank you for all your thoughts.

2) I would not let my elderly mother sit in the same table with that patient just because that pt "might" cough. In fact I would be upset if the facility let the patient walk down the hall without mask on, again, just because the pt "might" cough.

3) I wish someone would actually tell me any existing protocol regarding pt with MRSA in sputum.