McCleary MRSA Prevention

http://www.fiercehealthcare.com/story/four-percent-healthcare-workers-mrsa-positive/2010-04-07

The link above reveals results of a study of MRSA prevalence in healthcare workers.  Very few studies have been done regarding this subject.

Amost every nurse I spoke with at the recent MSNA convention said “all of us probably have MRSA colonization”.  One nurse in particular was very upset at the prospect of ever being screened for MRSA, because of her constant exposure to it and because if she turned up positive, it might cost her the job that she needs to support her family. 

I was surprised that only 4% of healthcare workers, both direct caregivers and remote workers were infected in this study.  That is much lower than I expected.  But, at the same time it is encouraging.  My concern is what recommendation comes from this.

As a potential Healthcare consumer , I would not want a nurse who is actively colonized with MRSA caring for me, or for a vulnerable loved one……not unless a special effective precautions are taken.     Were the HC workers who tested positive in this study decolonized or not?  The article does not tell it all.  Even if they were decolonized, we know that MRSA is transient and many of these employees may turn up positive again 3 months after decolonization. Do we retest?  Maybe more than Standard and Universal precautions are necessary when a HC worker is colonized with MRSA.  Education is absolutely necessary.  The colonized HCW should be educated about not only using meticulous Standard and Universal precautions, but also using reverse precautions at all times.  They should be told not to work when they are actively infected with a respiratory illness (or an open MRSA lesion), especially while actively coughing, sneezing and blowing their nose.   MRSA can be coughed about 4 feet into the environment. There should be paid sick leave for this, since it is work acquired.  Also, a known colonized HC worker should always wear a mask while doing invasive sterile procedures, like dressing changes and catheterizations.    So, are these the answers to this dilemma…….. to use decolonization and education about extra precautions?  I’m not 100% sure, but I do know SOMETHING definitive needs to be done and the things I have suggested here may be a start. Why doesn’t OSHA take a stand on MRSA and other work related and acquired infections.   One thing I know for sure is that we can’t continue to ignore the problem.

Now as a nurse, I have to wonder if my job is jeopardized if I am diagnosed.  Is it?  If my employer finds that I am colonized, will it affect my job.  Will I be put out of work?  Will it affect job promotions or transfers into other departments?   These are legitimate and serious concerns.  MRSA now becomes not only a threat to my health and possibly my family’s health, but it is also a threat to my livelihood!  As a member of MSNA and the NNU and a long time supporter of Nurses Unions, I am proud to say that nurses represented by a union will have some protections in place regarding employment.  My chronically colonized friend, whom I have written about a few months ago on my blog, is a non union nurse.  She was exposed at work.  Since her MRSA pneumonia and sepsis, followed by a lengthy recovery and lingering disability, she has been unable to find work as an ICU nurse.  She feels that the places who will not hire her discriminate because they know her MRSA status.  Another nurse I know tested positive in an investigation for an outbreak in her hospital.  Her employment was not affected, but the records of her MRSA colonization and her decolonization treatment for it were buried………..she was told there was no record of it.  Healthcare facilities get the right to ignore the elephant in the room regarding the risk of infectious disease to employees.  They get to decide on policy that is either good and effective or lax and ineffective.  Unfortunately, very few organizations come to the plate with the safety of their nurses in mind. 

I see many problems at many levels with all of the above.  Nobody is recognizing the fact that Healthcare workers in hospitals become colonized with MRSA.  The problem is not acknowledged or addressed.  If someone is discovered to be colonized, the records are “unavailable”.  This may be because of fear on the part of the hospitals. They fear liability for their employees, because they have become colonized (and sometimes actively infected)  on the job.  And they fear liability from patients who become infected while hospitalized.  So, the usual reaction to that fear is to keep it all a secret or sweep it under the carpet???  News alert…these problems are not going away unless the hospitals get on board with prevention. These unresolved problems feed on each other!   We cannot fix what we do not acknowledge and measure.

I believe MRSA needs to be put out there, as an issue and a problem within healthcare facilities, for both patients and employees.  Preventing spread of MRSA by screening and Isolating patients is the first step to “getting to ZERO” with MRSA infections.  Addressing employees concerns by recognizing MRSA as a work related infection and doing appropriate and timely testing, treatment and education for it is the best approach. 

Trying to hide/bury the problem, or ignoring the huge population of patients who come in the door colonized,  and who subsequently become infected is no longer acceptable.  Too many times, it takes days or weeks to diagnose an active MRSA infection in a patient.  Most of the time, the earlier causitive problem, MRSA colonization, is never even detected because there has been no screening.   By the time infection is diagnosed dozens of HC workers and family members are all exposed.  Active Detection and Isolation will prevent this from happening.

Early detection of colonization or infection, isolation of affected patients, decolonization when appropriate and education are all necessary steps toward stopping MRSA.

NO NURSE should feel that their job or their health are  jeopardized by MRSA colonization.  It is job related and should be addressed as such, but it should not be ignored.   And NO PATIENT should have the worry that proper MRSA detection and prevention of MRSA is not being used in their hospitals or that their HC giver may spread MRSA to them. 

http://www.bangordailynews.com/detail/135860.html

Below is a photo of a Hand MRSA.  Many of the infections on Vinalhaven affected the hands.

This is an update on a link I added here a few days back.  It is good to hear that the MRSA outbreak on Vinalhaven Island in Maine has been controlled.  Comments in this article make it sound like they were plagued with flea  bites. 

MRSA is a bit more serious than claimed here.  Some of these victims had to be treated with powerful IV antibiotics.  Some of them will be plagued with repeated infections and all of the victims families have been exposed within their homes to MRSA.  Simple exposure is not in and of itself a problem.  But, many of them may have become colonized.  that means they will carry the MRSA bug.  That is also not a problem UNLESS they become gravely ill and/or need hospitalization for invasive procedure. MRSA can then rear it’s ugly head and cause a myriad of problems.  Patients must make their doctor and hospital aware of their close exposure to the infection.  If the doctor does not order a MRSA screening, the patient should demand one.  If they are colonized, they can have a simple treatment that will decrease their chances of serious active infection a great deal.  And, they can be separated from patient who do not carry MRSA thus avoiding spread of the desease.

I suggested that former MRSA patients and caretakers of MRSA patients to be included in the populations to be screened by our hospitals here in Maine.  They were not included.  My opinion is that was a big mistake.  Nobody wants to incite panic, but a little bit of panic makes people pay attention and absorb important information about their health and risks to it.   MRSA status on admission to the hospitals is a very important status to be aware of.

So, it is good that the Maine CDC got right on this outbreak and worked to control it.  I just hope they added  this  important patient education (about avoiding serious infection in the future) to their investigation  process on the Island.