SNF/nares MRSA

[pistolchick]

I've worked in hospitals where standard admission protocol involved a nasal swab for any patient who had been at a SNF or LTC for any period of time, because many of them are positive for MRSA in the nares.

Now I'm working at a LTC facility and there's no swabbing, nor acknowledgment of any residents with MRSA in their nares. Anyone have any experience with this?

[roser13, ASN, RN]

Not sure what you mean by "experience with this" but will just remind you that you're talking about 2 different entities....a nursing home and a hospital. The hospital has a vested interest in recognizing and treating any "new" MRSA cases in order to decrease their nosocomial infection rate. The nursing home, on the other hand, probably recognizes the status quo.....many residents and many staff are already colonized.

Colonization does not equal infection. An LTD is "home" to its residents and those residents' immune systems are apparently coping with the presence of a MRSA bacteria that they have become used to. A hospital patient, on the other hand, may be highly susceptible to a new strain of infection (acute illness, decreased immune status, etc) and must be protected.

[NotFlo]

I work in a SNF. We don't do any routine testing for the presence of MRSA in the nares on existing or new patients. However, if an admission comes in with a positive of MRSA in the nares from the hospital we treat with bactroban then reculture. After three negatives the person comes off precautions.

[CathyLew]

our hospital is doing a MRSA study. So any patient that is admitted to our ICU is swabbed when admitted and then swabbed upon discharge. Its an infection control study..and that was the part out facility decided on. Your facility may have been doing something similar, but they chose to do the long term care residence that were admitted to acute care.

[BlessedMomRN]

We swab every admission to ICU. The med/surg floor swabs those with certain high risk factors. Once a positive comes back we put them in contact isolation. A local healthcare system stopped swabbing and decided it was too expensive to put everyone who has MRSA in their nares in isolation. I think it's going to be called normal flora pretty soon.

[misschiatia]

I work in long term care. You have to keep in mind that a successful nursing home feels like "home". The idea is to care for and treat chronic and emerging medical conditions, while minimizing the amount of "medical intervention" in our residents lives.

I work for an upscale midwest company with multiple communities. We do not routinely test for MRSA upon admission. We already have 3 required sticks a year with the PPD and mandatory flu shots. We could hardly appeal to our population if they felt that the emphasis on their stay would be medical.

But at the same time, I understand your concern. I will say that 9/10 times we get an admission, that type of information would be part of their admitting history(after all, the hospital has often done a very extensive workup and treated the most acute problems by the time we get them). We have not had any problems with MRSA in our setting. But our max census is like 72, and we dont have the turnover that some other places have.

Hope this helps

[pistolchick]

All good information, thank you all for sharing. NotFlo, your facility DOES put people on precautions for MRSA in the nares, it sounds like?

[NotFlo]

Yes we do. If they come in with a positive from the hospital they go on precautions until we are able to treat and clear them.

[misschiatia]

Yes, if someone is positive for MRSA, they are put on isolation until we can definitively show that the infection has cleared or is no longer contagious to others(keeping the expectation in mind that with standard universal precautions in place, no one should be exposed to each others body fluids and such ANYWAY under any circumstances, even if they're not MRSA positive)