Respiratory MRSA

sbic56, BSN, RN · Jan 16, 2008

Does anyone know?

Mammy1111 · Jan 28, 2009

My father just died of HA MRSA pneumonia. He contracted it in his hospital while rehabilitating from a minor ankle fracture

While in the hospital, he went from no precautions to full precautions with mask. Actually, the nursing home he ended up in was better and more consistant with precautions than the hospital was. I have read in my research that if you are not within 3 feet of a coughing patient, you don't need a mask. Why take the chance though. My family always wore them when we visited. We did better with precautions than the hospital staff did.

I am working on MRSA legislative mandates in the State of Maine. There is way too much leeway with infection control policies regarding MRSA and HA infections are rampant. It's time to have mandated steps in infection control for MRSA. A lot of hospitals have taken the CDC and SHEA recommendations out there and written good policies, but the hospital my father was in did absolutely NO screening....so infected patients were housed with noninfected patients. I wonder why there have been so many deaths there from MRSA in the past several months. Also, reporting is not mandated, so hospitals are not held accountable on any level. All of this has to change to reduce the number of unnecessary infections and deaths.

Elvish, BSN, DNP, RN, NP · Jan 28, 2009

Unless CA-MRSA has become resistant, which I don't think it has, it can be treated with Bactrim or the generic. I used to work in a community health center and we saw several outbreaks among migrant farmworkers. 60-day course of Bactrim. Long time.

sbic56, BSN, RN · Jan 28, 2009

I am sorry to hear of your tragic loss. This is especially pertinent to me as I am in Maine. I work in the community mental health field and am always looking for the most current recommendations and find standards to be sorely lacking Thus I hesitant when admitting clients with MRSA or hx of to units always erring on the side of caution in order to protect the other clients. I think the reason for the lack of standard is because the medical community really does not have a lot of the answers to this quickly evolving threat. It's frightening, really. Is there a site which one can go to to see what legislative mandates that are being proposed in Maine?

Mammy1111 · Jan 28, 2009

There is only one legislative proposal for Maine. I wrote it. If you email me privately, I will send you my entire proposal. It will be different in wording once the leigislative writers are finished with it. It is with the writers now. Once that is done and I approve the final draft it will be presented (by my local representative) as a bill to the Health and Human Services Committee. That is when I will testify about my proposal. My husband, sons, brother and nephew (13 years old) will go with me when I do that. They all lost my father, not just me.

I hope that my proposal is recognizable when I get it back from the writers. They will put my words into legal words. I am adamant about this proposal. It is strong and comprehensive and it was modeled after SHEA standards. I confess, I added a few extra componants myself and I hope they stick.

Thanks for your interest in legislative steps to prevent MRSA. It is supported by MSNA and MSEA.

http://www.consumersunion.org/campaigns/CU%20summary%20of%20MRSA%20laws%20as%20of%2010-08.pdf

This webpage summarizes legislation on other States regarding MRSA.

http://www.mrsasurvivors.org/

This webpage is very good. Jeanine Thomas is a relentless and experienced MRSA victims advocate. She has been a tremendous help while I have been working on my proposal. She got the first MRSA legislation passed in Illinois in 2007.

sbic56, BSN, RN · Jan 28, 2009

Thank you for all you are doing...and for those links. I know it is personal to you, but you are helping many with your efforts. I sent you a PM...I look forward to reading your proposal.

gruchi1 · Apr 19, 2009

I understand about the precautions in the hospital setting but have both some insight and a question about your posts. First of all, one reason the spread may be so rampant is because patients fail to inform their healthcare provider that they have an active infection, or have been treated for MRSA in the past. Yes, as healthcare workers we should see an open wound but they are obviously overlooked. As for respiratory MRSA, I have a relative (in-law) that has had MRSA in the respiratory tract several times. This person suffers from COPD, so they are actively wheezing and coughing all the time. I don't know if it is because of the "stigma" of MRSA, this person REFUSES to inform healthcare workers. I have personally seen her in the hospital in respiratory distress and asked if she had informed them of her hx. She won't do it. So, if patients are not routinely screened for MRSA in the nares, throat, lungs, etc....the spread will continue. Handwashing is great, but MRSA lives on surfaces for a long time. Any dietary worker delivering trays can pick it up in one room and transfer it to the next...and the next..and the next.

My question is this; as a family member, knowing that this person has had MRSA in the past and has lied to us about it, are we wrong in keeping our newborns and immuno-comprimised family members away from her? She absolutely refuses to wear a mask..believe me, we have asked. She has attended family gatherings (while being treated for active resp. MRSA) and refused to wear a mask, breathing and coughing on a one week old baby. She turns it around that we are treating her like a leper, but we feel that we cannot trust her and have collectively decided to err on the side of caution, for our children.

Mammy1111 · Apr 19, 2009

I hate to say thing but your relative is very selfish. You and your other relatives who are parents must do everything you can to protect your children. Have you considered giving her some articles about babies and children who have died becasue MRSA infections and also some general information about the disease and how it is spread? Ignorance is not bliss when you are around vulnerable family members, including small infants.

Perhaps somebody ought to call her physician and explain how she spreads her MRSA around and refuses to wear a mask. Patients will sometimes listen to a doctor if they are willing to discuss her disease with her.

In a nursing home or hospital if a respiratory MRSA patient will not observe what is called respiratory etiquette (maske, handwashing,not touching other patients things, etc), then they are not allowed in the common areas. This is exactly how you should treat your selfish relative. This sounds cruel but the reality is that even if she is only colonized, she can spread her MRSA around. She should have scrubbed hands and a mask at the very minimum ......and still her clothing could be contaminated. I would not allow her to touch my 1 week old infant.

gruchi1 · Apr 19, 2009

Thank you, thank you, thank you!! This has caused a great division in the family. The two of us that are connected with the healhcare field have gathered articles and talked to the others. Unfortunately, they choose not to listen. Her doctor has told her what precautions she should take and she has chosen not to take them. It is a difficult position to be in; we warn those who are most at risk (those with young babies, sick children, etc) who visit with her. She even refused to inform her cleaning lady (who does her laundry, cleans the bathroom, etc)...so one of our family members had to. Like I said, it is a difficult position to be in because she has COPD (close to end stage) and we know she won't be around much longer. However, we are obligated to protect our own children and do what we know is right. Thank you...not so much for agreeing with me, but for sharing what precautions are taken on a day to day basis in long term facilities.. I wish the CDC would hurry up and publish some updated information on this rapidly spreading, dangerous infection. There's plenty "out there" about other sites of MRSA infections, but precious little on infections of the respiratory tract.

Another good reason for routine swabs being done in patients with s&s of respiratory infection is the "new" law passed concerning third party payors not reimbursing for nosocomial infections. Although the cost of testing may be cumbersome, it would pay off in the long run by catching the infection upon admission and demanding full precautions be taken with each MRSA positive patient. The spread of infection would be hindered (meaning that those patients who would have been infected won't be...whereas if they had been, they wouldn't be able to pay out of pocket the cost of treatment). It would be a win-win situation. Lives would be saved, others protected and long term cost reduction!! :yeah:

Thank you again for your reply. I am so sick of this family situation...the only good thing that has come out of it is that, as a nursing student, I know I must take every precaution I can reasonably take with every patient I see...because, to quote Dr. Gregory House, "everybody lies.";)

socaligirl72 · Feb 7, 2011

Respiratory MRSA is very contagious. I am an ICU RN and was unfortunate enough to get bilateral MRSA pneumonia from a patient who was coughing non stop. I placed her in isolation only to find out i wasnt allowed to do that unless the patient had a diagnosis that deemed her to be in isolation. I am a young health person who went from perfect health back in march 2010 to not being able to work since then. Come to find out the coughing patient came back with a positive sputum culture with MRSA. I ended up intubated for a week and went untreated for mrsa pneumonia for over a month and a half because some how my sputum cultures never made it to my doctor or to the hospital i was flown to. I found out i had it from the infection control nurse and i then had to call my doctor to let him know. Sure enough he was able to pull them up in the computer and there they were I had been treated with multiple drugs that didn't help at all. i walked around for a month and a half feeling like i was dying and possibly passing this on to everyone i came in contact in. By the time they realized it was mrsa it was to late it had already taken hold in my lungs and was colonized says the infectious disease doctor i now see. They were able to clear the infection in my lungs but the damage to them was already done. Now i got this from work was put on LNI and I still cough, still am very SOB and am now very self concious about going out in public for fear i will pass this on. Now my doctor says the chance of me passing it to a healthy individual in less then 1% but passing it on to someone who is already immunocompromised is about 90%. As it is the hospital i worked at has since fired me due to my illness and i have to have 3 negative sputums within a year all 4 months apart before they will even think of releasing me to go back to work. I have a new daily routine have to wash with hibaclense everyday i have to spray bactroban up my nose twice a day and so does anyone who lives with me my animals have to have it rubbed on their noses twice a day as well. I have since had to cough up multiple sputums and all have come back positive. The sad thing is this could have all been prevented had they just left the original patient in isolation. Its better to be safe then sorry and they are lucky i am the only one who caught it. I make sure i tell every doctor, nurse or any healthcare provider that i am positive with resp mrsa because i dont want to pass this on to anyone. They say only 4% of people are colonized with mrsa but it is going to be a lot larger then that if the nurses arent allowed to make educated decisions on their own. The one thing i loved doing was being an ICU RN and now I can't even do that. I am wondering if anyone else has any stories similar to mine and what they are doing to deal with what has happened to them?