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.

[brainkandy87]

I want to nasal swab the OP and isolate them when they swab positive for MRSA.

[unsaint77]

OMG Why is that a harmless question posted can irate so many people? Did I ever say anything about isolating this pt? You don't even know about this pt's coughing spells. Please think about why you guys assumed that I wanted to isolate this pt. Why did you assume that this pt had no problem covering mouth? People just love to pounce on others in the same industry because it gives them a false sense of pride. Nurses are one of the worst I realize. BTW, many of you so knowledgeable about MRSA yet none of you ever quoted what CDC said. Hmmm. So, I guess those of you, who were quick to criticize me, know more than the CDC and the MD who ordered the culture?

[BlueDevil,DNP, DNP, RN]

I am not irated (sic), lol. I am amused. You are being awfully (over) reactionary about this and no one understands why.

[dirtyhippiegirl, BSN, RN]

Aw, I kind of get why. I work on a burn unit. Ever had to deal with a trach'd pt with copious amounts of sputum which grows MRSA?

[BlueDevil,DNP, DNP, RN]

I have probably worked with literally thousands of patients with MRSA in various wounds and orifices. I am colonized with MRSA. I still don't see the reason for the chicken little routine in the OP. :shrug:

[PetsToPeople]

OMG Why is that a harmless question posted can irate so many people? Did I ever say anything about isolating this pt? You don't even know about this pt's coughing spells. Please think about why you guys assumed that I wanted to isolate this pt. Why did you assume that this pt had no problem covering mouth? People just love to pounce on others in the same industry because it gives them a false sense of pride. Nurses are one of the worst I realize. BTW, many of you so knowledgeable about MRSA yet none of you ever quoted what CDC said. Hmmm. So, I guess those of you, who were quick to criticize me, know more than the CDC and the MD who ordered the culture?

You said yourself that if you found the pt in the hallway w/o a mask you would take him to his room...nursing programs have specific vocabulary for that and it's called "isolation" and "restraint".

No, we don't know if the pt is coughing or is able to cover his mouth because you failed to give adequate information and failed to respond the the multitude of questions asking for specific info.

And one poster gave you 2 links to the CDC site with the info you were asking for.

If you have this many issues simply posting on a website, such as failure to give a proper report, failure to have a working knowledge of your facilities policies, failure to comprehend or utilize the report/information given to you by fellow nurses, failure to educate yourself in areas of knowledge that you are finding yourself to be lax, failure to take constructive critisism, etc., I can't even imagine how you function on the floor. There were many posters on here who gave you polite, non-judgemental advice, but you ignored those and only focused on the negative ones. But then again, because the friendly advice did not simply agree with you, you felt those were negative as well.

[BlueDevil,DNP, DNP, RN]

And further, no one was nasty or irate. Just incredulous that you would get so worked up about something that is just not all that significant to those of us that understand it.

[rn/writer, RN]

Did I ever say anything about isolating this pt?

Yes, actually, you did.

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.

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.

Confining him to his room, even if it's just for meals, IS isolating him. And making him eat in his room could be viewed as punitive and a violation of his dignity as fellow residents pick up on the fact that he's not allowed to eat with anyone else. This is especially true if these measures are viewed as an end in themselves and no other actions are taken to accommodate him or find ways to get him healthier.

You don't even know about this pt's coughing spells.

We don't know because you didn't tell us. That's kind of a big piece of information to leave out when you're asking for our opinions on how to treat this individual. Even so, why not try to get to the root of his coughing and get an order for a cough suppressant or an appropriate antibiotic or something else that will address the cause (which may have nothing to do with MRSA) and not just the symptoms?

People just love to pounce on others in the same industry because it gives them a false sense of pride. Nurses are one of the worst I realize

You were given a lot of good information. And you were also given some constructive encouragement to remember that you can get in a lot of trouble for treating a resident improperly and using isolation incorrectly. Members also shared some balancing perspective about the reality of MRSA in much of the population, many of whom don't even know they have it. You yourself could have it and not be aware.

*********

Including questions in your opening post implies a willingness to hear other people's opinions. Disagree with the responses, if necessary, but please don't accuse posters of pouncing on you simply because they gave honest answers to your inquiry.

[Horseshoe, 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?

YES. Unless he plans on licking an open wound, I'm perfectly okay with it.

[Esme12, ASN, BSN, RN]

[h=4]

omg why is that a harmless question posted can irate so many people? did i ever say anything about isolating this pt? you don't even know about this pt's coughing spells. please think about why you guys assumed that i wanted to isolate this pt. why did you assume that this pt had no problem covering mouth? people just love to pounce on others in the same industry because it gives them a false sense of pride. nurses are one of the worst i realize. btw, many of you so knowledgeable about mrsa yet none of you ever quoted what cdc said. hmmm. so, i guess those of you, who were quick to criticize me, know more than the cdc and the md who ordered the culture?

actually, no unsaint77...........i gave you 2 cdc references in post #14.

"the cdc provides information about health care-associated infections. i have provided you links.

cdc - long-term care settings - hai

cdc - prevention tools - hai "

and you did say you would isolate him........and i quote........post #4

"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 responded with....and i quote........

making a patient go back to and stay in their room, without an order and just cause, is a form of restraint and can be considered assaultive. that, can get you fired and put your license in jeopardy.

i applaud your dedication and enthusiasm but......i would choose

your battles wisely.

from the cdc website....

group activities...

it is extremely important to maintain the patients' ability to socialize and have access to rehabilitation opportunities. infected or colonized patients should be permitted to participate in group meals and activities if draining wounds are covered, bodily fluids are contained, and the patients observe good hygienic practices.

cdc - precautions to prevent the spread of mrsa in healthcare settings | mrsa infections (third reference)

so, i guess if you are quick to criticize you need to be sure the resources haven't been made available to you. we assumed this patient wasn't hacking, snorting and spitting down the hallway because you did not infer that in your post. no one has a false sense of pride on this post.....i have seen nothing but informative advice that is standard of practice. hypersensitivity i am seeing.......i am feeling that you are sensitive about your practice as you are a new grad. no one said you were wrong but they did feel you were a bit over zealous.

making a patient to eat alone is isolating them and treating them punitively for an illness and can be considered a form of restraint as you are "restraining"/isolating him to his room without an order and might be a violation of standards of practice. which can be considered assaultive. your supervisor should have handled your question differently ..........however, your complete rejection and mockery of the information that has been given here can be considered aggressive and confrontational.

there are many very smart people here even thought we are "anonymous" and we only seek to educate and help other grow in their chosen profession. :hug:

you asked a question....it was answered. peace:paw:

[BlueDevil,DNP, DNP, RN]

I skipped over that sweet little gem about making the poor guy eat alone in his room! That is abuse. Now it that were my grandfather, I'd be at the BON raising cane until the OPs license was revoked!

In short, the people who don't want to eat with him need to eat alone in their rooms, not him. Jeeze.

[CoffeeRTC, BSN, RN]

I've been colonized with MRSA in my nares since 1995 or 96. Sitting in the front row in my micro class in nursing school I was the guinnea pig. I've never been isolated before.