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Old 07-12-2007, 02:42 AM
augigi
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In Australian ICU, we generally do swab everyone on admission: nares, underarms, groin and throat swabs. We then "isolate" - but as everywhere else, doctors walk in and take charts in and out, don't wash hands etc.... so it's not REALLY isolation.

I recently did a shift at a hospital that treats someone who has EVER had MRSA as being MRSA-positive for the rest of their life - every admission, they don't re-culture, they just automatically isolate and do the gown/glove thing. Pretty useless, as the rooms in this ICU were not negative ventilation, just had a curtain... gee, you think the MRSA germs know not to cross the curtain? Heh. I also don't understand doing MRSA "isolation" with no masks... where do you think it comes from? Heh.

I have been to work in Norway before, where they have NO MRSA in the country, and also WA (state of Australia with no MRSA). They are rabid - visiting staff have to have a Phisohex bath and mupirocin to nares before coming into the ICU or OR, and get negative swabs before being permitted to even observe surgical procedures.

They also use no street clothes, only hospital clogs and scrubs so you can't bring your germy clothes in with you.

PS: THe best thing I've seen for longterm MRSA wounds, esp non-healing diabetic wounds, is HONEY as the wound dressing. Sterilises most wounds within a week, and the healing is awesome! Check out "manuka honey" if you want to know more.
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Old 09-16-2007, 02:52 PM
starkissed
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Every admission gets nasal swabbed upon arrival to the floors. And then they get swabbed again at discharge. If they come back + for mrsa in the nares, then they are placed on droplet precautions but have not seen any of the docs prescribe antibiotics for this as of yet (which makes no sense). If they are + for mrsa in the sputum, then they are put on droplet precautions, but for mrsa in the blood, urine or wounds, it is contact precautions. Strict handwashing in all of the patients helps, but we also teach the families about handwashing in our isolation patients in hopes that they don't carry any of the bugs home with them.
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Old 09-16-2007, 04:15 PM
jojodow
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I worked on an Internal Med floor that had also been considered the Infectious disease floor.

We had everything...TB, MRSA, VRE, Shingles. There was usually a Contact isolation cart in front of every other door.

Wanna hear the ironic thing? It was the only Med/surg unit left in the city that had semi-private rooms as half of our rooms.

We were constantly shuffling people around or blocking off beds in the semis because they tested positive for something.

We had the carts, with gowns and clothes, lots of hand washing. If I was just going in to ask a question or hand them something I wouldn't go in gowned...just gloved. I gowned up for assessments and procedures.

It was hard...when you had 5-6 patients and 4-5 of them were on contact...you'd spend too much time in the hallway getting ready to walk in the room. You had to pick and choose which time it was REALLY approproate.

You had to use some common sense too.
If The MRSA was in the blood or urine and there were no open wounds vs MRSA in a nasty foot wound. The transmissibility (is that a word?) factor changes.
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