Wednesday, September 17, 2008

MRSA/VRE

In the ED we look after patients with MRSA and VRE. MRSA, also known as methacillin-resistant Staphylcoccus aureus, is a bacteria which is resistant to a number of antibiotics. This means that the antibiotics we would normally use to fight infections by these bugs don't work properly, and thus increases the risk that patients will become sicker, and we have less antibiotics to treat them.

MRSA and VRE are quite common in hospitals, unfortunately due to the overuse and misuse of antibiotics both in the community and in hospitals. It's also (unfortunately) common for MRSA or VRE (vancomycin-resistant enterococcus) to be spread from patient to patient by hospital workers like nurses, doctors, patient support workers.

To combat the spread of this bacteria, it has been mandated in hospitals to screen for these antibiotic resistant bacteria, and to prevent transmission of these bugs by wearing protective gear such as gloves and gowns when entering an MRSA/VRE patient's environment. Also highly important is proper handwashing between patient interactions.

In the ED sometimes we do not even know the person's name, let alone whether they have the resistent bug. If the patient has been hospitalized recently, there is a flag that pops up on the computer. Sometimes, however, we don't find out that this flag has occurred until we have already touched the patient, and been working in their environment for a while. This means that MRSA or VRE could potentially be on our hands, and on our scrubs. With proper handwashing, the bug could be almost completely gone from our hands, but even I can attest that I dont always follow handwashing procedures 100% of the time even though my hands typically are raw from washing them so often.

There have been a few times when we have already recieved admission orders, and have completed them by the time I find out that a patient is MRSA or VRE positive. That usually constitutes HOURS of patient care before gowning and gloving as per our infectious disease policy. Some patients have even asked me why I am now wearing a gown when before I wasn't. I do explain to them about MRSA, and explain that prior interactions I was unaware that these precautions were needed, and that from now on nurses will wear this gear.

I'm not the only one that does not see the flag. I have been given patients from other areas for whom the reporting nurse did not know the MRSA/VRE status.

This is a huge problem, as not only do the patient workers (RNs, MDs, RTs, PTs, OTs) need to know for patient interaction, housekeeping and our other support workers need to know so they can properly decontaminate the area once the patient has been transported to another area, or upstairs to the floor. This means washing everything down,and changing the curtains. Also, if a patient worker did not know that the patient was MRSA/VRE and they took an IV basket into the patient environment, THAT BASKET is now contaminated and everything would need to be thrown out.

That's a HUGE waste.

I think I will see in my practice-lifetime the assumption that ALL patients have MRSA/VRE, that ALL interactions with patients will be with contact precautions until a negative screen occurs. This is a huge time-committment as every time you enter the patient area, you need to be gowned and gloved (EVEN TO FIX AN IV BEEP). I can see a mandate of IV baskets not being allowed in patient areas. Until we can get this silent epidemic of MRSA/VRE to stop spreading, the work of helping people is going to continue to increase.

5 comments:

Anonymous said...

I used to work in housekeeping at a hospital in my teens, I noticed that when we were told to do a mrsa or vre go home, noone ever took down the curtains and sometimes the toilet paper and paper towels wouldn't even be swapped out! It's unfortunate because I know that it can be spread to the next patient that occupies that room. I used to think that if you were admitted to the hospital you were in a very sterile enviroment ... I was wrong! I would rather stay home!

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