Took Care of a Patient with MRSA Today

[HappyMeNow]

He wasn't my patient but I was helping someone out. I rushed in to empty his foley bag and didn't gown up (did not see the sign). I used gloves though. I don't think anything splashed on me, but now I'm super paranoid about catching it.

I don't know where this patient's MRSA is contained. I don't think I'll ever forget to gown up again.

I also don't get a chance to come home and take a shower before my kids rush up and hug me. The thought of getting them sick is terrifying!!!

[bill4745, RN]

For every pt you take care of with MRSA, how many do you think are you taking care of that have it but you don't know about it?

[Music in My Heart]

Thank you all so much! I feel a lot better.

One last question before I rest tonight, I remembered that I have a cut inside my nostril. I think it's from dry air and blowing it too much. I don't know if my scab is healed or if it's open, and after knowing that a lot of us carry MRSA in our nares make me think that i'm at high risk of having MRSA entering through the cut in my nose.

Should I have worn a face mask to protect my nose?

Chill out... if you're not immunocompromised, you're not at particularly high risk of a serious MRSA infection... that's not to say it can't happen but if you're healthy, you've not too much to worry about.

And no, there's no need to wear a mask when emptying a Foley bag... unless it makes you more comfortable in which case, go for it... though you might prefer a face shield instead (eyes, you know?)

I share your concern about dragging hospital bugs home with me... I actually change at the hospital before I go home and I practically bathe in alcohol rub after washing my upper extremities from tips to pits.

[Hoozdo, ADN]

For every pt you take care of with MRSA, how many do you think are you taking care of that have it but you don't know about it?

It depends.

[Lisa, MA]

My mother is diabetic, full renal failure....she gets MRSA frequently. It is something she tends to pick up easily. That said, I care for her and have not yet ever gotten it from her. I don't gown up but I do wear gloves when I tend to her wounds.

As long as you are not coming into contact with the infection (ie: touching the discharge) you should be fine.

[Lisa, MA]

I share your concern about dragging hospital bugs home with me... I actually change at the hospital before I go home and I practically bathe in alcohol rub after washing my upper extremities from tips to pits.

hahahaha....I thought I was the only freaky one! Years ago, I had Gestapo Nurse as an instructor. She spent a week with us on proper hand washing and showering after work. She drilled into our heads that the minute we get off work, we are to go home and put our uniform into the wash and shower. No ifs ands or buts.

You should have seen the maniac I was when I had my first child and went back to work. Now mind you, I worked in a very low risk peds office setting. My biggest exposures came from diapers, throad cultures and vomit. But I had this "routine" for when I got home before I would even breastfeed her! LOL No one outside of the medical field can appreciate this work induced OCD! :) Although I have sadly seen plenty of nursing personnel who are just plain gross when it comes to hygene. YUCK! I've also seen my fair share of poor technique and risky behavior. IE: my hubby has HCV. During his last endo to check for varices, the nurse placing his IV was not wearing gloves. I pointed this out to her...reminding her that he has HCV. She shrugged and said "well I don't have any open cuts on my hands". I said "well I don't want him catching anything from YOU so please glove up". She didn't like me much.

[Piki]

I cannot count the number of times we've had patients on the floor (we also routinely swab nares for MRSA upon admission/discharge) that have ended up having MRSA, or C-Diff after being on the floor for a few days. After everyone from staff and visitors have been in/out of that room. I honestly don't worry about it. As long as you are using common sense and precautions such as gloves when needed (such as you mentioned, while emptying a foley) there's no big worry. We had a patient on the floor that had been there for weeks that ended up finally contracting MRSA in her urine and then was put into precautions.

What kills me more is the visitors that come in and out of the rooms and don't glove/gown up OR even worse, come out to the nursing station in their gowns and glove and lean all over the counter. We are always reinforcing/educating the visitors.

I often tell patients that end up testing + for MRSA that they could have just as likely contracted it at Wal-Mart from a shopping cart. It's all around.

[Lisa, MA]

We had a patient on the floor that had been there for weeks that ended up finally contracting MRSA in her urine and then was put into precautions.

WOW I had no idea MRSA could be in the urine!

[Music in My Heart]

I often tell patients that end up testing + for MRSA that they could have just as likely contracted it at Wal-Mart from a shopping cart. It's all around.

True, it is all around. However, the CA stuff is (usually) genetically distinct from nosocomial stuff, with the latter being generally more virulent with broader resistance (MRSA by Weigelt, ISBN 1‑4200‑4549‑0) -- for now, anyway.

Personally, I'm an advocate of rapid testing with a sequencer immediately upon admission rather than waiting for cultures to grow out and pt. isolation until confirmed "clean."

[WSU_Ally_RN, BSN, RN]

Thought I'd give my 2 cents on this subject... At my hospital we don't even isolate for MRSA! When I first graduated and accepted this job and realized that, I freaked out! I mean, in school, you're always told MRSA is bad and not to touch anyone without gloves with it...

Where I work, from what I have been told, so many people carry it in their noses everyone would be in isolation and that's just not practical. We use good hand hygiene and universal precautions. That being said, if I knew someone had a nasty wound with MRSA in it, I'd probably gown in addition to glove to change the dressing...

As long as you washed your hands when you were finished, you'll be fine :)

[JulieCVICURN, BSN, RN]

... At my hospital we don't even isolate for MRSA!

Never? This horrifies me. While I don't freak out about MRSA (if I did, I sure couldn't be an ICU nurse!), I do think it's irresponsible to not isolate for anything like this. I've seen patients die from MRSA sepsis. They didn't catch it from a roommate or anything, but still, it makes no sense to put a MRSA patient in with a clean one unless you're in a disaster situation and have no choice.

We don't even cohort two MRSA patients unless we're desperate and our ID doctor and ID nurse ok it.

[WSU_Ally_RN, BSN, RN]

Nope, never! And I work at one of the top 5 hospitals in the country...

[klone, MSN, RN]

As long as they don't have an active MRSA sore, I don't worry about it. I will glove up, but that's it.

I just think the MRSA precautions, as we follow them in our unit (OB), is so ridiculous. MRSA+ mother requires precautions, but then she has her baby in the room, is holding baby, breastfeeding baby, touching baby, etc. and then we bring the baby into the nursery for weights, hearing checks, etc. How is that logical?