MRSA Precautions

Methicillin-resistant Staphylococcus aureus (MRSA)

This happens all the time. You get called to the nursing home. There is a sign on the patient door that says “Contact Precautions.” The staff tells you you have to wear a mask and a gown to enter, so you put it on. You are told the patient has MRSA in their sputum. They may also have C-Diff or other infectious problems. So you put the mask on and sometimes the gown, and you get the patient, who is often in respiratory distress, and you take them to the hospital and you enter the hospital still wearing the gown and mask, and the hospital staff laughs. And the triage nurse sans mask, talks to the patient, and the register, sans mask and gloves, talks to the patient, and puts on a wrist band, and then they tell you to put the patient in the crowded hallway outside room whatever. (This provides a good laugh as all the patients you pass in the hallway look at you in horror as you, gowned and gloved, wheel the patient past them. You squeeze the bed in between two other beds in the hallway after asking some visitors to get up from their chairs, and then you, gowned and gloved, leave the patient right next to them.

I wrote about a code we did a few weeks ago where we get all gowned up and sent into a room only to find the patient in cardiac arrest. We get the patient back enough to have to transport. We show up at the hospital — all the EMTs who have showed up at our back ambulance doors to help us unload the patient, turn and flee when they see us in our gowns and masks. We go into the cardiac room, and no one on the ED staff wears anything more than gloves as they take over the code. And this is a patient with colostomy, foley, sores, and MRSA in sputum and C-Diff.

This also happens all the time — MRSA-less people walk into the hospital for one problem and walk out with MRSA. A friend of mine’s wife goes to the hospital for a knee operation, comes out (and soon has to go back to the hospital) with double pneumonia with MRSA.

I’ve put some links at the bottom of this post. An interesting one is the Yahoo answers where health care providers disagree with each other on what you need to do with a patient with respiratory MRSA.

For what it is worth, after browsing through the literature, this will be my policy:

If I am going to be within 3 feet of the patient and providing direct care that may contact body fluids such as sputum, I will wear a mask, gown and gloves.

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CDC Multidrug Resistant Fact Sheet

Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007

Does anyone know if MRSA in a persons sputum can infect people caring for the sick person?

Contact Precautions

MRSA Policy Introduction

MRSA Level III

7 Comments

  • AttorneyMedic says:

    How common is sickness passed to customers in restaurants in your area, due to employees not washing their hands?

  • AttorneyMedic says:

    Great entry, great blog. Linking to mine…www.MedicInterrupted.blogspot.combest,AttorneyMedic

  • studentdoctoruk says:

    I see it in hospitals all the time, patients in side rooms being barrier nursed, nursing wearing gloves/aprons/masks everytime they go in whereas none of the doctors pay any attention to the signs and just walk straight in. Normally accompanied with the entire staff of the ward round.

  • FireResQGuru says:

    I wish they would figure out a way to kill that little bug, along with TB & AIDS. What a pain in the 4th point of contact it is to have to put all that crap on and ride in with it all on, when, in the case of MRSA – you’re probably gonna get it anyway!!! It is always good for a laugh though, you’re right, when you leave the patient in the hall or an open bay ER and you walk off to take all that crap off and wash up.

  • kvegas911 says:

    We just had a problem locally where half the high school’s football team got MRSA. I have no clue how THAT happened. Love your blog, BTW. Got a link on my page.

  • GhettoMedic says:

    Had a similar encounter — find out patient has MRSA. Respiratory MRSA. We put on N95 masks, vent the truck really well. I walk into the ER and they’re looking at me like WTF is going on here. I explain, the patient has MRSA. The doctor says, in what was supposed to be only overheard by those nearby, “Good God. Don’t they know that MRSA is only direct contact?” I looked at her and shrugged, “I just don’t take chances on stuff like this. It’s not for my sake. It’s for the sake of every patient I will have tonight.”My coworker was a little insulted. He went online at the hospital and did a bit of research like you. Same conclusion. If it’s respiratory, it is droplet. In other words, our BSI was not inappropriate at all. But I find it insulting. The protective glasses are somewhat accepted, but face mask is treated like rubber gloves once were — oh, why bother? It will frighten the patient. Thank you for the links. It reaffirms what I’ve been doing with good evidence.

  • Coach says:

    Like one commenter said, this is the new gloves issue. It is easy to be cynical toward the transfer of disease – of course some of us used to gown up for AIDS. Thanks for the post.

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