Question about MRSA in long term care facility

unknown99, BSN, RN · Dec 27, 2003

:confused:

What was the residents sent to the hospital for? Chances are that they had the MRSA prior to going to the hospital, and that is part of the reason they were ill. Was it respiratory? Was it wound? Was it urinary? By all means, if respiratory, the resident should only be out of the room if he has a mask, and only if being taken to another area for a very good reason. If wound, then as long as the wound is not "oozing" and is covered, the client should be safe to come out of the rooms.

ktwlpn, LPN · Dec 27, 2003

Originally posted by nursecompassion
Recently, at my facility we have had a number of "R" sent to the hospital. Three of them came back positive with MRSA. (They did not have it before they left)

Well, at our facility if the "R" has MRSA and is on respiratory isolation they have their own room, usually on a certain hall of the building. Also, we have to wear a gown, gloves, and mask with direct "R" care.

For the past week one of the "R" has been allowed out of their room as long as they have a mask on. (none of their cultures have come back negative, yet)

This "R" is often spoiled (hate to use that word) or allowed privelages that other "R' are denied.

Anyone else see a problem here?!!!

It is safe as long as this person keeps their mask on-once the mask gets really wet it looses it's effectiveness.....I have read that probably over %70 of healthcare workers and LTC residents are colonized with MRSA-it only becomes a problem when your immune system becomes compromised..It seems to me that the problem really is the other residents being denied privledges...They all have equal rights in their home...

nursecompassion · Dec 28, 2003

The "r" in question went to the hospital due to pneumonia, also has brain cancer and did not respond to chemo, thus the "r' has begun to fill with fluid. Making r body weak and more suseptible.

The "r" came back with respiratory mrsa (in her sputum).

My view and the view of other aides is that the other r who had or have mrsa (respiratory)are not allowed out of their rooms, thus why should this r be allowed.

Especially when for almost a week all r on all halls were confined to their rooms due to the recent outbreak of flu and pneumonia in our facility. The halls were closed off and visitors has to see the nurses before entering.

Makes no sense what so ever.

This r who is not private pay always ends up with a room to self, due to the fact r's family whines or the r throws a fit.

This r has called roomates vulgar names and recently ran their wheelchair into the back of aide becaue the aide could not immediately assist them because she was with another r.

This aide is now on light duty, and has been moved to another hall.

The r does not cover their mouth/nose when coughing. In fact would cough right on you. The r is young and is very aware of own actions.

I guess our head staff makes special requests for certain r, because they don't want too lose the money, so they sacrifice the health of other r.

just venting, jules

ktwlpn, LPN · Dec 29, 2003

Originally posted by nursecompassion
The "r" in question went to the hospital due to pneumonia, also has brain cancer and did not respond to chemo, thus the "r' has begun to fill with fluid. Making r body weak and more suseptible.

The "r" came back with respiratory mrsa (in her sputum).

My view and the view of other aides is that the other r who had or have mrsa (respiratory)are not allowed out of their rooms, thus why should this r be allowed.

Especially when for almost a week all r on all halls were confined to their rooms due to the recent outbreak of flu and pneumonia in our facility. The halls were closed off and visitors has to see the nurses before entering.

Makes no sense what so ever.

This r who is not private pay always ends up with a room to self, due to the fact r's family whines or the r throws a fit.
This r has called roomates vulgar names and recently ran their wheelchair into the back of aide becaue the aide could not immediately assist them because she was with another r.
This aide is now on light duty, and has been moved to another hall.

The r does not cover their mouth/nose when coughing. In fact would cough right on you. The r is young and is very aware of own actions.

I guess our head staff makes special requests for certain r, because they don't want too lose the money, so they sacrifice the health of other r.

just venting, jules

Im ny experience in LTC none of us working onthe floor ever really knew who was private pay and who was not.They are all deserving of equal care...You can handle this 2 ways-you can follow your chaain of command and request some additional training in infectious diseases and infection control because of your concerns...If you do not get satisfaction then you can make an anonymous call to your state's board of health...You do not have to tell them you are an employee-leave them guessing or let them assume you are a family member concerned about the welfare of your loved one...They WILL investigate and if they do see a problem it WILL be fixed...Also-when a resident strikes an employee or another resident or is verbally abusing another resident this should be taken very seriously-the social service department should be involved and all of these behaviors should be well documented.......Don't forget-there may be much more involved here then you and the other aides realize-There are a lot of regulations in LTC regarding how you can set limits for residents.....You can't "time out" like you can your kids....

nursecompassion · Dec 29, 2003

I actually called the rn on duty and told her about my concerns, she said that she thought it was ok for the r to be in hallways with a mask. I told her that as far as i knew the DON said no.

and asked her how that would be okay if we were to wear gowns,gloves, masks and then turn around and allow the infected r to only wear a mask and coincide with other r.

Also, if nothing is taken care of it, i plan to call state again. There offices are closed on the weekends, so I have to wait untill tomorrow.

Our facility is one of the facility's that will accept the most violent r. With very little regard for other r or staff safety.

I remember my first wk there I met a r who spit, hit, bit and called us names. During the day she was medicated at daytime but not at noct no such thing. of course you do not want to overly med a pt, however they should have told her family,doc etc. about her behaviour. THey never did, so I started documenting it myself just for my own protection.

There is a lot that goes on at LTC facility and only stops when state is expected. For instance they will schedule more staff when state is due in. However once state leaves it is a different situation.

For instance on hall has 24 r, most of them are incont. and heavy lifts. 80% of the time they only schedule one aide at noct. That aide usually has 11 r to get up by am. They usually start before 4:30. Thank goodness I am not on that hall. The hall I am on has mostly alert r, however I have 8 r to get up two of which are hoyers, 5 are 2 assist.

lovey setting hugh?

THis is why once I am an rn I will not work at a LTC facility,at least not in ohio. I love the elderly but I would have to do something like home health if I stayed in that branch.

jules

ktwlpn, LPN · Dec 29, 2003

Originally posted by nursecompassion
I actually called the rn on duty and told her about my concerns, she said that she thought it was ok for the r to be in hallways with a mask. I told her that as far as i knew the DON said no.
and asked her how that would be okay if we were to wear gowns,gloves, masks and then turn around and allow the infected r to only wear a mask and coincide with other r.
Also, if nothing is taken care of it, i plan to call state again. There offices are closed on the weekends, so I have to wait untill tomorrow.
Our facility is one of the facility's that will accept the most violent r. With very little regard for other r or staff safety.
I remember my first wk there I met a r who spit, hit, bit and called us names. During the day she was medicated at daytime but not at noct no such thing. of course you do not want to overly med a pt, however they should have told her family,doc etc. about her behaviour. THey never did, so I started documenting it myself just for my own protection.
There is a lot that goes on at LTC facility and only stops when state is expected. For instance they will schedule more staff when state is due in. However once state leaves it is a different situation.
For instance on hall has 24 r, most of them are incont. and heavy lifts. 80% of the time they only schedule one aide at noct. That aide usually has 11 r to get up by am. They usually start before 4:30. Thank goodness I am not on that hall. The hall I am on has mostly alert r, however I have 8 r to get up two of which are hoyers, 5 are 2 assist.
lovey setting hugh?

THis is why once I am an rn I will not work at a LTC facility,at least not in ohio. I love the elderly but I would have to do something like home health if I stayed in that branch.

jules

Jules-you come work with me...We don't do that stuff...I believe it is against resident's rights to pull their butts out of bed that early-I'd report that without a second thought.I am sure that it is a regulation here in Pa-I'll see what I can find in your state...Staffing is tricky=the state counts RN's LPN and aides together...Nevermind that in LTC they all have different areas of responsibilty...However the ratios at my facility are way better....I have a 21 bed unit with a census of 15 right now...I always have 2 aides on day shift......Evenings has 2 for the first part of the shift-nocs is supposed to combine the staff from both units on that hall......We will accept anyone but have gotten rid of several that were dangerous to other residents and the staff...We can't handle real psych problems.....and thankfully our DON will protect us...Sounds like you have aproblem with leadership and communication,too...The nurse"thought" it was ok for that resident to be out and about like she was while others were not? Did she think to look into it? Are you ready to relocate?

nursecompassion · Dec 31, 2003

Thanks, but too far too drive!:)

I found out last night that that r culture came back negative, but they are still awaiting the results of the second one. Meanwhile the r was out in the hall without a mask, untill the nurse saw and the r put one on.

Yeah, at our nursing home we are allowed to start at 4:30. In order to get done you have too. Especially when one person has 8 r to get up. This is bathing, dressing, making their beds, etc. I am on a skilled unit the majority of the time however more than half of them cannot bathe theirselves. They always get partial/full baths if they are not a shower. They only get a shower twice a week unless requested otherwise. However, this morning both shower aides were pulled to the floor, thus no showers.

Kind of hypocritical hugh?

A good note:

I finally (I am a procrastinator, need to work on that) registered for winter qtr. However, I missed out on my one electives class the one was full, the other was canceled (it was online too.)

But, I am taking eng 101 and med term.

Good luck everyone! ( I know you're probably thinking; what the hell does that have to do with mrsa in ltc?):chuckle

ktwlpn, LPN · Dec 31, 2003

Originally posted by nursecompassion
Thanks, but too far too drive!:)

I found out last night that that r culture came back negative, but they are still awaiting the results of the second one. Meanwhile the r was out in the hall without a mask, untill the nurse saw and the r put one on.

Yeah, at our nursing home we are allowed to start at 4:30. In order to get done you have too.>quote>...............Please tell me that those early risers get to nap? We had to change our meal times,med pass times and snack times to accomodate a full nights rest and to make sure the residents did not go over a certain number of hours without nourishment....Human service aides make a big difference-they make less then certified cna's but they do so much to help out-make all the beds,pass ice,etc..They would help you out a great deal....

nursecompassion · Jan 1, 2004

We used to have "unit aides" who passed ice and made beds, etc, however they usually only hire them for class when we are short on help. We currently do not have any.

Yes, the r do nap during the day, those who require it or want to.

Some of them go to bed as early as 7:00p.

Our facility goes by the mininum I think on everything they can get away with. Yet, they are one of the cleanest and nicest in our area. However, we also have an alzheimers and therapy here too.

jules