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.

[kids]

So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?

Yes, I would and have, I even *gasp* lived with someone with MRSA in their sputum and slept in the same bed. As long as the person is not coughing uncovered and is washing their hands there is no risk to people around them.

There are people walking around everywhere with MRSA, your coworkers, your children's schoolmates and likely even your doctor.

[rn/writer, RN]

So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?

Yes. As long as there is no active coughing, or he is good about covering a cough.

While I applaud your zeal and enthusiasm, I'm a little bothered by the fact that I haven't seen any mention of regard for this resident as a man. HE is not MRSA. HE is a person and you are coming into his home. Isolating him and treating him as if he is some kind of menace for carrying an organism that a good portion of the population harbors seems to exceed diligence and cross the line into disgust.

Look at what the CDC has to say. Read the policy and procedure for your facility. Speak with someone from infection control. But never lose sight of the fact that this is a human being you are talking about.

If he needs reminders about covering a cough or washing his hands, please, learn how to do this without being insulting or giving him the impression that you think he's unfit to have contact with other people.

When HIV and AIDS were new and beyond scary, some folks thought that infected patients--including babies and children--should be treated like lepers and made to live in separate colonies. Thank goodness, the panic and hysteria eventually died down and wiser heads prevailed. Unfortunately, a lot of hearts were broken on the way to universal precautions.

I hope you can find a way to temper your vigilance with wisdom and respect.

[subee, MSN, CRNA]

Masks make us feel better but they don't do much unless it's tight fitting with a seal.

[KelRN215, BSN, RN]

So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?

How, pray tell, would I know that the person sitting across the table from me has MRSA? I don't swab people that I invite to my home for dinner. There are undoubtedly children with MRSA out there in schools, so your child very likely is sitting with these kids at the lunch table. I assumed that I likely was colonized with MRSA after working in the hospital for years but I was negative when I was tested in the hospital 2 years ago. Who knows, though, I could have it now... I've been exposed to it plenty of times since then. And, if I found out I had it, I wouldn't isolate myself from others at the dinner table and I wouldn't wear a mask. How is one supposed to eat dinner wearing a mask, btw?

[CrunchRN, ADN, RN]

Poor man. It would be cruel to isolate him like that.

[Sun0408, ASN, RN]

All of you have done a fantastic job at trying to educate the OP on MRSA, sadly the information has fallen on deaf ears. So sad for the her residents and future pts.

Sadly in the this case, knowledge does not change behavior.

[MunoRN, RN]

The following is from an article from MRSA Topic » MRSA

"Furthermore, asymptomatic (ie. non-infected) MRSA carriers can easily pass this bacteria on to others through direct contact or even just by living in the same environment. This is especially scary because while your immune system may do just fine dealing with 1,000,000 MRSA bacteria per square inch in your nose, your 80-year old grandmother, 6-month old infant, or cancer-fighting spouse may not be so lucky. This is exactly the reason why initiatives are popping up all over aiming to have all patients screened for MRSA prior to admittance into hospitals. There are simply too many immunocompromised patients, too much movement, and too great a risk within those walls to allow free passage of bacteria living silently on unaware carriers."

There are many immunocompromised patients in nursing homes. Do you not mind getting the bug from someone who has MRSA colonized, just because the pt is not having an active infection? I don't think so.

On the plus side, you can find tons of information on the internet; on the negative side, a lot of it is crap.

The "article" you cite is from a company called MRSAid, which sells an unproven "cure" for MRSA colonization. Given their vested interest in encouraging the development of an extreme form of MRSA Common Wisdom, I'd hardly consider them a reliable source.

[MunoRN, RN]

I'm still not clear if the patient you're referring to is colonized with MRSA or if they have an active infection. The evidence does not support the use of isolation precautions in colonized patients, the rate that these patient spread MRSA does not change whether Isolation or just Standard precautions are used. What does change are the patient's outcomes and standard of care. Patients on isolation have worse outcomes which has been correlated to an "altered" standard of care.

So basically, initiated isolation precautions on a patient who is only colonized is unlikely to provide any benefit whatsoever, but is likely to harm the patient.

[BlueDevil,DNP, DNP, RN]

So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?

Sure. Why not??

[amoLucia]

I'm still not clear if the patient you're referring to is colonized with MRSA or if they have an active infection. The evidence does not support the use of isolation precautions in colonized patients, the rate that these patient spread MRSA does not change whether Isolation or just Standard precautions are used. What does change are the patient's outcomes and standard of care. Patients on isolation have worse outcomes which has been correlated to an "altered" standard of care.

So basically, initiated isolation precautions on a patient who is only colonized is unlikely to provide any benefit whatsoever, but is likely to harm the patient.

Interesting about pt outcomes with isolation. but not totally surprising.

[KelRN215, BSN, RN]

On the plus side, you can find tons of information on the internet; on the negative side, a lot of it is crap.

The "article" you cite is from a company called MRSAid, which sells an unproven "cure" for MRSA colonization. Given their vested interest in encouraging the development of an extreme form of MRSA Common Wisdom, I'd hardly consider them a reliable source.

Critical thinking for the win! :)

[BlueDevil,DNP, DNP, RN]

ROTFLOL.

Manufactured drama, or a complete lack of understanding of MRSA, or both.