Taking someone off of isolation...

[MadisonsMomRN]

We have a guy that is positive for MRSA in his sputum. The medical director has been saying that he does not need to be on isolation. Well, the charge nurse and the rest of nurses have been demanding that he be in isolation. Well, the medical director presented it to his other doctors and THEY AGREE that this guy does not need to be on isolation. He says that he does not have a respiratory illness so he can be out of isolation.

This guy is a train wreck. He has a chronic cough, DM, chronic renal failure, HTN, seizure disorder, CHF, you name it. He has gone into to respiratory arrest twice in the past month.

He usually shares a room with a patient with lung CA in remission and an HIV positive patient. Great, huh?

Some of the doctors are really mad because "us nurses" are bucking up against them. What do you think?

I need some info PLEASE... someone did give me a link but I lost it.

Thanks in advance!

Edited to add: I work in a prison infirmary. I didnt put this on the correctional forum because its slower and I believe that isolation precautions are standard wherever you work... MRSA is rampant in there. There are so many with skin abscesses its not funny. They just let them go back out in population. I am so sick of it!

I was wondering... is there something I don't understand? Is he OK off of isolation?

[suzanne4, RN]

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.

But notice that this poster did say that this patient has a chronic cough, and that the sputum was positive. This is different from someone that is not coughing, and is only positive for a nasal swab.

They are also in a confined area in the prison, and have a higher than normal incidence of MRSA. So the only way to get it under control is to isolate it, not group patients that are not positive with it in the same room. Especially someone who is debilitated from lung Ca. Perfect set-up for him to get it as well.

Same thing that would be done if a nursing unit had an outbreak of it. You do not add more patients into rooms that house someone with that infection. Like patients that are positive can be roomed together.

I would not want to share a room with someone that was actively coughing and known to have MRSA of their sputum. The sputum can become MRSA free after treatment with antibiotics. But if they are resistant to antibiotics, why try to give it to someone else?

[EmmaG, RN]

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.

Ok, I'm a bit confused. Is he simply positive for MRSA (colonized) or is his expectorated sputum positive as well?

[herecomestrouble]

This struck a chord with me since my son just told me his Dr dx'ed him with MRSA in a sore on his leg today.Gave him a script for Vanco and sent him home to his wife and 2 yr old son.He says that the cut on his leg had been bothering him for about 5-6 days and got so bad yesterday he finally saw the Dr,was not told anything about being contagious,isolation or anything.He(my son,not the Dr) didn't even seem to realize that this was a serious thing he had.

As for as putting this pt(from the op) in with a pt who is HIV+,what is that pt's CD4 count and percentage?I have taken care of many pt's with MRSA with no problems but my CD4 is 586 so I am WNL.If his count is low than this could be a recipe for disaster.

If MRSA is that bad in there they really do need to re-think their policy on isolation.Why can't they put the MRSA pt's together apart from the rest of the pt's.