Question about MRSA/VRE protocols.

RKpianoman, APRN · Jul 18, 2011

I'm a fellow nursing student doing my externship this summer, and right now half of my unit is on contact isolation :uhoh3: Patients are usually screened for MRSA on arrival, and are put on contact isolation if they are positive or if they have a positive history. The only VRE patient I have had was put on contact isolation after it was discovered in a urine sample for UTI symptoms. When the patient is discharged, the room is "terminally cleaned", meaning first it is cleaned like a normal room, then the curtains are removed and washed, and all surfaces and equipment in the room are wiped down. I'm not sure if there are special cleaners used for MRSA and VRE other than what would normally be used, but C.Diff requires bleach wipes at my hospital.

delabeaux, MSN · Jul 18, 2011

Our hospital uses cleaner that kills all forms of staph. The only time a cleaner is changed is when a bacteria that creates spores (Clostridium), or is spore-like (TB), in which case usually a chlorine based cleaner is used. All pt.s with MRSA, VRE, ETC. are on contact precautions at a minimum.

Please note, however, contact precautions vary by hospital.

At my hospital, contact entails wearing a gown and gloves when entering the room AND when transporting the patient.

At another hospital 30 miles North of us, contact means wearing gown/gloves in the room but removing them while in transport.

Personally, if a patient has weeping wounds with with MRSA in it, I'm wearing a gown if they're getting transported. If they decide to code in the hallway the other hospital is SOL...

tokmom, BSN, RN · Jul 18, 2011

Rooms are terminally cleaned as mentioned above.

If anyone even has a positive history, they are placed isolation. If they have coughs, draining wounds, they are placed on isolation.

We have a community living environment that admits frequently, and has a very high MRSA population. They are guilty before proven innocent and are placed on isolation and stay there until the tests come back negative.

nerdtonurse?, BSN, RN · Jul 18, 2011

We swab nares of all patients admitted to the ICU. About a 3rd of our ICU population is positive for something at any given time. I have seen over reaction to a lot of things -- patients thought to have VRE when they only had IBS, a "necrotizing fasciatis" that was just plain old cellulitis. Then you'll walk in the room and your nose will say "c-diff" or "pseudomonas" and you have to beat the doc over the head with a bedpan to get him to order the lab to test it. If I have anyone who truly has an infectious bowel disease (like VRE) and they aren't 100% continent and a/o x3, they get a flexiseal to contain that stuff so it doesn't go all over the place. I know when I've had a person bleed out from a ruptured esophageal varice, there was blood dripping off the bed on all 4 sides. They did not rip the bed apart and clean the nooks and cranies. Somebody could make a fortune if they designed a bed robust enough to be disassembled and cleaned in a jinormous autoclave.

There was a great study they did at Baylor several years ago about the levels of MRSA in their patient community -- and it was much, much higher than they predicted (think it was Baylor). If you do a google on Texas and MRSA study, you might be able to find it.

I know our infection control nurse said the patient population with the highest % MRSA positive wasn't the folks from nursing homes and jails -- it was toddlers admitted for recurrent ear infections. In our area, they are almost always MRSA.

mama_d, BSN, RN · Jul 18, 2011

LOL @ the ginormous autoclave!

Past history equals automatic isolation, they can only come off after three negatives in a row. All group living and dialysis pts get nasal and rectal swabs.

Rooms are terminally cleaned, and then they use an UV pulse light for 15 minutes. It's fairly new and a pretty cool idea.

1southernstudent · Jul 18, 2011

Thanks so much for the answers!!! It's a huge help.