I am ready to deck one of the teachers where I work. :angryfire :angryfire There is a letter circulating from the local school system about the big bad MRSA staph infections!
I read it and there is a slight chance that anyone can get MRSA.
Anyway, one of the teachers called me into her classroom to look at 'rashes' on a couple of her kids. I told her that were NOT staph infections and went on to explain that everyone has staph on their skin and in their noses. I also explained that a boil, a zit and impetigo are all staph infections and that NONE of the 60 kids in the school had a staph infection!!
She looked at the ugly pictures of MRSA on the 'net and was convinced that one of the children had MRSA. I called his mother and asked her what the MD said about his rash. She said he got it by rolling down the hill at his grandmas and that he also had chiggers. Ok that's enough for me to know that this child did NOT have MRSA!
I went back into her classroom and explained AGAIN what staph infections were and that NO ONE in the building had MRSA.
Just to make sure, I called my PCP and asked his nurse to fax me her info on MRSA. I told her what I had said to the teacher about the boils, etc and she agreed with me.
One of the sheets she faxed had a website so I looked it up and printed out the info that I had already told her about boiles, etc. Before I could get in there to give her the info, I was called into another classroom, so that the teaching assistant could go into her classroom and make sure that the kiddos' didn't have MRSA! :angryfire :angryfire :angryfire
I have 60 physicals and dentals I need to put into the computer and I wasted 15 minutes in a classroom while someone who isn't a nurse checked to make sure the kids didn't have MRSA!!
I told my supervisor that I was angry and why. She tried to defend the teacher and I refused to let her. I told her that I had told her THREE times that no one had MRSA, that I had called my DR and had info to give her. That I didn't appreicate her trying to undermine my and that I wouldn't tolerate it. I have a license to practice nursing, she has a certificate to teach!!
This same teacher tried this crap last year too. I was new and trying to find my way. This year I'm much more experienced and I ask her for NOTHING!!
Thanks for letting me vent!! Now maybe I can sleep!!
I agree the teacher went a little nuts, but MRSA is EVERYWHERE now -- we don't put people in isolation for it anymore.
I remember the year I graduated nursing school (2002), our local infectious disease docs got together with the cardiothoracic surgeons and did a little study... darn near every patient they cultured nasally had MRSA, but it's not a problem unless you're immunocompromised. They stated that it's endemic in the community, and used this information to change hospital policies regarding pts who have a history of MRSA -- no one gets isolated anymore.
So the simple fact is that some of those kids probably DO have MRSA, but so what? It's not something that is likely to cause a problem for anyone, unless they develop a problem with their immune system.
What is MRSA (methicillin-resistant Staphylococcus aureus)?
Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.
--this is saying that MRSA is NOT common--but other staph ARE common. There are many many types of staph, quite a few of which live harmlessly on our skin. But MRSA is, on the whole, not so common (1%=1/100) that we should assume everyone has it and disregard infection control protocol. MRSA was MSSA (methicillin sensitive) before it became resistant. Being that it's resistant to many 1st line abx, and it can make you sick if you get it into your bloodstream (and REALLY sick if you're immunosuppressed), I think it's really a bug that people ought to try to avoid. It eventually WILL resist other abx treatments, and we will have a hard time catching up with it once it does.
I think to test it in the school may be a good idea, but one cannot identify MRSA without a culture. Now, if all these kids have staph that's giving them a rash--maybe they are spreading another staph around, and perhaps need to be treated. There aren't any "honey-crusted" scabs--are there? Be wary of impetigo. It's very gross and uncomfortable...:trout:
Specializes in Acute Hemodialysis, Cardiac, ICU, OR.
I suspect that if we did surveillance cultures on every admission, we'd be isolating most all of them. At some point, it becomes ridiculous to continue doing so... staph is now multi-drug resistant and we simply have to come to terms with that.
Exactly the point of the Infectious Disease Docs in my area.
That's the general public. If healthcare workers were cultured that 1% would rise considerably then average the two figures.
Absoutley! They used to test workers in the UK and if positive, the workers would have to take a week off for treatment. Well, you can imagine how many workers were positive and then figure out how many man(woman!)hours were being lost due to positive results. So, they don't test routinely anymore(except on high risk units).
That's the general public. If healthcare workers were cultured that 1% would rise considerably then average the two figures.
Can you support this with data please? I can't can't find anything online that says anything about the incidence of mrsa among healthcare providers--if anyone has any data, I'd be very grateful. :)
Also, if this IS true, it doesn't speak to the OP's problem of how to best educate school teachers about MRSA--I'm certain that every group has a different incidence of MRSA within the community--hospital, school, prison, paradise island, etc--but the statistic from the CDC is not trying to elaborate on these differences. It is saying that the incidence rate is 1%--in GENERAL. So, where it IS higher in some communities, that actually identifies a problem--MRSA is endemic but only to 1% of the US population. It is regionally epidemic and it is these locales that the CDC, ID specialists, HCP's and others are addressing specifically to stave the progressing epidemic.
I cut and copied a few other CDC links if you're interested. The first link shows a table that indicates that the rate of drug-resistant infections in nursing homes in the US is about 1.7%--this suggests that the incidence in nursing homes is 70% higher than in the general population. But it's still only 1.7%--hardly worth abandoning MRSA contact protocol in any institution. If an institution YOU work for HAS abandoned this protocol, perhaps someone should address this--a nursing home that has a much greater incidence than the national average should probably institue stricter protocol rather than abandoning it altogether.
The next link (from massachusetts dph) also gives some useful info--I copied and pasted their recommendation to approaching staph/mrsa infection in the hospital setting:
How can staph/MRSA infections be prevented in the healthcare setting?
As with other infectious diseases, basic infection control practices should be followed:
Practice hand hygiene. Encourage patients to practice proper handwashing as well.
Use contact precautions for ALL patients with open or draining Staphylococcus aureus skin and soft tissue infections (SSTI) and all patients known to be infected with MRSA.
The rest of the links below are also good but are mostly accessible from the links above--if you're interested and want a quick peek, click away. If you want to find it for yourself, there's a wealth of information online.
Specializes in icu, er, transplant, case management, ps.
I don't know the advisability of isolating MRSA patients. I do know what happen to a friend of mine, in a Brooklyn hospital. She suffers from MS. And she was admitted for evaluation and treatment of a kidney infection. She had already been admitted with a foley so she didn't need one. I watched nurses, house staff, attendings all enter her room, without washing their hands, examine her, including her foley, and leave, again not washing their hands. Why was I not surprised when she later came down with a UTI that grew out MRSA. And even after she was diagnosed, they continued to enter and leave without washing their hands. I wonder who passed MRSA on to her? And I wonder who they passed it on to after leaving her room. And how it all could have likely be avoided if everyone just washed their hands.
And yes, I did complain to nursing and hospital administration, the infection control nurse and doctor. And for a while, everyone would wash their hands, then they go back to not washing them. And I would have to make the rounds complaining once again. I made myself real popular with the staff.
I think what Dutch was saying is that soooo many times we have had a patient that we've been taken care of for at least 2 days, then we find out they're +MRSA somewhere. Meanwhile, we've been exposing ourselves to God only knows what while changing their dressings, emptying Foleys, suctioning trachs, or whatever. I know in my own experience, I had a patient's g-tube juice fly back and hit me in the face. A couple days later I find out she's got MRSA in her g-tube. I am absolutely certain that if you cultured my nares you'd find MRSA.
I know what you are saying too, and I thank you for posting the stuff from CDC. But I would also agree with Dutch's conjecture that healthcare workers are going to have a higher-than-average incidence of MRSA. Nature of the job, I guess. I think you are both right.
I think what Dutch was saying is that soooo many times we have had a patient that we've been taken care of for at least 2 days, then we find out they're +MRSA somewhere. Meanwhile, we've been exposing ourselves to God only knows what while changing their dressings, emptying Foleys, suctioning trachs, or whatever. I know in my own experience, I had a patient's g-tube juice fly back and hit me in the face. A couple days later I find out she's got MRSA in her g-tube. I am absolutely certain that if you cultured my nares you'd find MRSA.
I know what you are saying too, and I thank you for posting the stuff from CDC. But I would also agree with Dutch's conjecture that healthcare workers are going to have a higher-than-average incidence of MRSA. Nature of the job, I guess. I think you are both right.
Thanks Arwen Undomiel! I guess my whole point is that--while it may seem logical that we would have a higher incidence of MRSA as HCP's, I think it's dangerous to assume we do and thus abandon our precaution practices (which is what other posters are saying actually happens in their facilities:nono:)
It's not THAT easy to get it--I read something recently that said researchers in the past have placed an inordinate amount of weight on the relevance of fomites in MRSA transmission; in one of those CDC links it says the best way to get is literally skin to infection contact. So, contact precaution protocol may seem a little wacky if you are going to simply hang an IV in a patients room. In fact, generally following standard precautions will probably prevent MRSA transmission. So, if you've been taking care of a patient for a week, and haven't come into direct contact with fluids or mucosa, and then you find out they are MRSA positive, you're probably ok. Alas, in your g-tube situation (eww, gross, sorry this happened to you) you might be more likely to end up with a positive swab. However, if you washed off the GT juice immediately (which I'm guessing was your priority :) ), then you still may be fine.
And, not that I searched all that extensively mind you, I really can't target any studies that give any numbers reflecting MRSA incidence in HCPs. But if the US rate in LTC's is 1.7%, I would imagine it would be around that or lower in nurses--I had a swab recently (because my doc is convinced that a 30 year old is not supposed to have ANY pimples--but that's neither here nor there) and it came back staph negative.
So I guess what I'm saying is, even if we have a heavy MRSA population at times, we shouldn't assume that we've gotten it.
On an unrelated note Arwen, I was kinda hoping for a Pippin/Treebeard run in '08-- 4-8 years of reckless merriment balanced with quiet reflections on ancient lore. Could be interesting!
bravo for defending your cause to practice your skill of school nursing and not buckling to the will of your supervisor! having someone who is not trained in nursing and determined to practice it (ie. assessing students) is downright mean spirited and not a team player! how would she like it if you took over her class! ! !
my mom was a school nurse and i know how taxing doing your work is...for low pay! should i mention monthly reports! geesh, talk about brazen stupidity by a net surfer! i wish we could sue people that practice nursing without a license. can we? would it be worth it in the end? perhaps let this one battle go! i'm sure physicians face the same mess of net surfers thinking that they know it all from the info they glean!
why couldn't this teacher get you on something legit like why doesn't johny have reading glasses? or have you looked into the possibility of neglect for mary jane didn't look like she's received adequate hygiene!?
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kanzi monkey
618 Posts
From the above site:
What is MRSA (methicillin-resistant Staphylococcus aureus)?
Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.
--this is saying that MRSA is NOT common--but other staph ARE common. There are many many types of staph, quite a few of which live harmlessly on our skin. But MRSA is, on the whole, not so common (1%=1/100) that we should assume everyone has it and disregard infection control protocol. MRSA was MSSA (methicillin sensitive) before it became resistant. Being that it's resistant to many 1st line abx, and it can make you sick if you get it into your bloodstream (and REALLY sick if you're immunosuppressed), I think it's really a bug that people ought to try to avoid. It eventually WILL resist other abx treatments, and we will have a hard time catching up with it once it does.
I think to test it in the school may be a good idea, but one cannot identify MRSA without a culture. Now, if all these kids have staph that's giving them a rash--maybe they are spreading another staph around, and perhaps need to be treated. There aren't any "honey-crusted" scabs--are there? Be wary of impetigo. It's very gross and uncomfortable...:trout: