Viral meningitis - precautions?

[JennyAS, BSN, RN]

I'm a new nurse, have been working in the ER for 5 months now (and loving it!).

Last night I offered to take a pt up to the floor for another nurse. Dx: viral meningitis (strange to already have that dx in the ER, aren't you supposed to wait till cultures come back?). Anyway, MD was confident it was viral. On the floor I am greeted by a nurse and tech wearing droplet precaution masks; both are looking at me like I'm crazy. I say, "hey guys, it's viral." "Yeah, that's droplet precautions." "I'm pretty sure it's standard." "No, he should be wearing a mask." I told them CDC recommends standard (http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007_appendixA.pdf) but they told me they had a sheet somewhere saying it was droplet because if the patient sneezes they can transmit the virus. When I came back down to the ER everyone agreed it's standard... but these floor nurses make me question it.

So my question is: viral meningitis - standard or droplet?

Another source: http://info.med.yale.edu/ynhh/infection/dislist/intro.html. But maybe there's new research out?

On another note - I had one of those nights where one patient was screaming bloody murder at me for touching the tape around her IV and wouldn't let me do anything unless a doctor ok'd it (lady, I know what phlebitis looks like, I don't need an MD to tell me), and another ask if a doctor could put in her IV bc I missed the first try... I guess it was just one of those nights. I'm still developing my thick skin

[nrsang97, BSN, RN]

Viral menningits is standard precautions. Bacterial menningitis is droplet, and the pt is much much sicker.

[tryingtohaveitall]

That link was very informative, thanks for sharing it! :>)

My thought is that they may be misinformed, and this is a great site to share with them. The other is that as you said, it's early. The dr is fairly sure it's viral. Did he have the results of the gram stain back? If not, I think it's better to be safe than sorry.

[JennyAS, BSN, RN]

I actually did share the site with the nurse, but he was uninterested. haha. Gram stain neg.

[Ivanna_Nurse, BSN, RN]

As a nurse and as a pt who had meningitis... my hospital they treats the pt as bacterial until proven otherwise, that includes the isolation gear and abx. ~Cheers, Ivanna

[NeosynephRN]

We have had a couple meningitis cases lately...they were all in dropplet isolation until proven to not be bacterial....which we ended up with one of each...I am sorry I have kids at home I am not going on the hunch of an ER doc...or any other doc, until I see the results I am taking every precaution I can.

[Aneroo, LPN]

Was the room a negative pressure room? If not, they need to back on down. LOL

[mwboswell]

....hmmm

Well the Gram's Stain is designed to tell you which family of BACTERIA are predominate. If it's VIRAL your results are difficult to draw conclusions from.

What you can get back within 10-30 minutes is the CSF GLUCOSE. If the GLUCOSE is LOW then probably bacterial, if GLUCOSE normal then probably viral (as viruses do not need a food source; the bacteria use the glucose for food and "eat it up").

As to the types of precautions....regardless of what the CDC says, you should default to your hospital's infection control practices. The hospital may make their guidelines more stringent than the CDC; such as recommending droplet/isolation for ALL meningitis regardless of pathogen, OR until the Cultures (2-3 day turn around) come back.

And even if the hospital policy is more strict than the CDC, it's whether you follow your hospital policy or not that incurs your liability as the nurse.

Hope this helps!

Good case discussion however!

-MB

[MIA-RN]

I've had a couple viral meningitis patients and my understanding is that its a common virus that just happens to infect the meninges (please correct me if I am wrong). So you need the same precautions for viral as you would for a cold...good old standard precautions.

I asked one of the ED docs about it and they said that the quality of the CSF is a good indicator of bacterial or viral--clear is generally viral, cloudy is bacterial.

[rex.jr_RN]

So what the precaution used then?

[rex.jr_RN]

Is it Standard or Droplet?

[rex.jr_RN]

I have read that N. Meningitides requires Droplet same with M. meningitis.