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Discussion

Why am I not using ANY precautions with MRSA?

I know that MRSA in the sputum is a contact or droplet precaution. Either way, here is my problem.

In this LTC facility, we admitted someone who is + sputum for MRSA.

  1. There are no precautions being taken other than the pt is to wear a mask when not in their room.
  2. OK, shouldn't the CNA's be wearing gowns when doing hygiene and ADL'S?
  3. Shouldn't staff be wearing masks when within 3 feet?
  4. The pt was initially placed in a room with a healthy dementia resident.

The pt is VERY HOH, so you have to get right down in the face to talk to the pt. And the pt is very congested.

I was the nurse to admit the person, wasn't told by my admin of the sputum (cultured two days prior), only found out after transport told me. Admin was indeed aware of it beforehand, I spoke to them about moving to a private room right away.

I know I have a shift coming up that has that pt and I don't want to "make waves" and (heaven forbid) use the precautions and ask the CNA to use them.

Is this just a really bad place I work at? Or does this seem to happen at even "good" places? WHY NOT just use the precautions? Maybe I'm confused ...

Featured Replies

Check your policies. Residents who have received treaatment and are colonized usually aren't isolated in LTC.

However if the patient is symptomatic (is the congestion new or chronic) or newly diagnosed, as you seem to indicate. Then I understand your concerns.

Is this a brand new diagnosis? Has he been treated anytime in the past for MRSA? Is the positive culture virulent or small in number to indicate colonization?

Good luck.

People are going to drop the ball all around you all the time. You make sure you protect yourself and your team. If you want things done right in LTC, then prepare yourself to "makes waves" from now on. Advocating for your safety and the safety of your residents and CNA's wont always be easy. Do not conform to make it so.

If the pt is wearing a mask, then you dont need one. If not, then you do. Advise your staff accordingly. I personally would wear glasses as well.

Dont follow the practices of others, or they may lead you on a long walk off a short pier.

Good luck!:)

Question. Is the MRSA colonized?

  • Author
Question. Is the MRSA colonized?

I do know that the dx of MRSA is recent, as in the day before coming to our facility.

As for being colonized...I didn't check or know how to check on that. I got all the discharge papers from the hospital and the lab work, but never saw anything to let me know one way or another.

Now that I think of it, when I went to my admin with the MRSA concern, it would have been nice of that person to let me know if it was colonized or what :banghead:

  • Expert

LTC in my area does not isolate or use precautions for MRSA. They are considered colonized.

:imbarWait a sec... MRSA in the sputum should be contact AND droplet? We never put them on droplet.. just contact. Are we doing it wrong???

:imbarWait a sec... MRSA in the sputum should be contact AND droplet? We never put them on droplet.. just contact. Are we doing it wrong???

i guess it depends on the facility. the hospital i used to work at considered respiratory MRSA contact and droplet, the one i am at now does not.

There are CDC recommendations for care of MRSA patients in long-term care settings

http://www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html

I am concerned with the amount of "speculation" that occurs when infection control threads pop up. ("We do it this way, the do it that way") There are evidence-based approaches out there, and all nurses (infection control or not) should be able to do a quick search on the CDC site to find them.

i guess it depends on the facility. the hospital i used to work at considered respiratory MRSA contact and droplet, the one i am at now does not.

CDC recommendations is contact only, no droplet\http://www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html

Keep in mind, one case where you DO want to treat it as a droplet isolation is if they are on a trach with a T attachment doing blow-by. Studies have shown that MRSA will be found "down wind" of the T on the sheets, blankets, etc., so for some part of the transmission, it's airborne. I always use droplet precautions when I've got a + MRSA sputum trach pt.

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