Taking someone off of isolation...

Tweety, BSN, RN · Jul 22, 2007

Unless they rewrite the policies then you go with hospital established ID practices regardless of what the physicans say. I've run into this stuff before.

Our policy is 1) the antibiodics used to threat the infection must be discontinued

2) after 48 hours of no antibiodics obtain a sputum culture 3) after another 24 more hours obtain another sputum specimen.

Keep the patient on isolation while cultures are pending. Discontinue Isolation if and only if both cultures are negative.

It's usually a good idea to keep the person in a private room even if cultures are negative. But I'm not 100% sure that's our policy. But as a prudent charge nurse this is what I do. The rest of the above is hospital policy and all the MDs and Directors in the place and order me to d/c the iso and I will not until the above has been done.

Good luck.

AliRae · Jul 22, 2007

I don't know what the docs are missing here ... if he's positive for MRSA, he needs to be on isolation!

At my hospital, it doesn't matter if you eventually test negative ... you're on isolation for the duration of your stay.

Tweety, BSN, RN · Jul 22, 2007

Here's a website from the CDC, I'm not sure what it says, but look around.http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html

mamatara · Jul 22, 2007

At both hospitals I do clinicals at it's once MRSA always MRSA! If you have ever tested positive for MRSA in the past you will ALWAYS be on contact isolation forever and ever amen.

Tara

EmmaG, RN · Jul 22, 2007

At both hospitals I do clinicals at it's once MRSA always MRSA! If you have ever tested positive for MRSA in the past you will ALWAYS be on contact isolation forever and ever amen.
Tara

That's a bit extreme. Most places I've worked require a series of consecutive negative cultures before removing a patient from 'automatic' contact isolation. (most have required 3 negs)

Suntina · Jul 22, 2007

If it's MRSA in the sputum he should be in isolation, but when out of the room a face mask must be worn and changed every 20 minutes.

suzanne4, RN · Jul 22, 2007

How is sputum positive for MRSA not respiratory? Where does he think that sputum comes from? It is coughed up or suctioned from the lungs.

And with physicians like this, no wonder it is rampant. They are probably helping in spreading it.

Continue to do the correct thing as a nurse.

And I wonder what this physician would be doing if the patient was not in prison, but in a general hospital and it was his family member that they wished to place in the same room, or even him as a patient. I am sure that you would not see that.

jmgrn65, RN · Jul 22, 2007

Usually if the person is not actively showing s&s of infection then they do not need to be in isolation. This is per our Infectious Disease specialist. Because it is colonized. Most people have, if a c&s were to be done of their nares, would be positive for MRSA.

One of the op said something once positve always positive in our facility that only pertains to VRE.

MadisonsMomRN, BSN, RN · Jul 22, 2007

How is sputum positive for MRSA not respiratory? Where does he think that sputum comes from? It is coughed up or suctioned from the lungs.
And with physicians like this, no wonder it is rampant. They are probably helping in spreading it.
Continue to do the correct thing as a nurse.
And I wonder what this physician would be doing if the patient was not in prison, but in a general hospital and it was his family member that they wished to place in the same room, or even him as a patient. I am sure that you would not see that.

I am assuming the medical director thinks because he doesn't have pneumonia, etc he's ok to be out of isolation. He says he colonized... but the things I have read, even if they are colonized they should be in a single room and educated on the importance of handwashing.

He has made such a big deal out of this. There is a BIG meeting tomorrow about trying to take him OUT!

The charge nurse says she is walking out if they take him out but I told her we need to stand up for whats right.

MadisonsMomRN, BSN, RN · Jul 22, 2007

Oh yea. There is another doctor in there that is from India. She was talking about the charge nurse saying that she should be reprimanded for not conforming to the medical director's wishes and should not question a doctors orders. She said that she is only a nurse and not a doctor. It is nurses that take care of these patients, know these patients and advocate for these patients. We find all kinds of screw ups made by the doctors all the time. What would healthcare be like if we DID NOT question any doctors orders. We are taught to do this if we have reason too. UGH UGH UGH!!!

The DON says "I have always told doctors that its M.D. behind there name and not G.O.D.

MadisonsMomRN, BSN, RN · Jul 22, 2007

Usually if the person is not actively showing s&s of infection then they do not need to be in isolation. This is per our Infectious Disease specialist. Because it is colonized. Most people have, if a c&s were to be done of their nares, would be positive for MRSA.
One of the op said something once positve always positive in our facility that only pertains to VRE.

We have a guy that has VRE of the urine that they are trying to take off isolation too. He is s/p CVA and is incontinent. He does have a foley.

I have been reading about all of this and have learned that you have to do a risk assessment. You must determine if you are putting others at risk. We WOULD be putting others at risk. He would be in a room with 2 other men, one with Lung CA and the other HIV positive. They all share the same toilet, sink and shower. I just dont think its right to put the other guys at risk when we can keep him in a room by himself. I personally want to wear PPE around him. He does cough!

I am sure most healthcare professional do have colonization... but MOST of us practice good hygiene such as handwashing. It still can be spread if you are colonized (from what I have read)