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MRSA Colonization in Healthcare workers and patients

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My understanding, from an infectious disease specialist and the literature I have read, is that you can never reliably decolonize someone.I had sepsis from MRSA in 2004 and will always be considered colonized.

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You can decolonized someone and some stay decolonized, some don't. To say it can never happen is not accurate. Some will be recolonized after just 3 months. MRSA is transient, but it can be irradicated by following a strict protocol. Admittedly, it doesn't work for everyone.The people that decolonization matters most to are people who are undergoing invasive procedures. Decolonization, even if it is temporary results, will decrease their likelihood of an active infection 7 times over. Also, if they are having surgery, the appropriate pre op antibiotics can be administered. You might or you might not be colonized. If I was you, I would request a screening if I was readmitted to the hospital. It is always valuable information to know if you are colonized. Many hospitals do have a policy of "once colonized, always colonized" and I honestly believe that is just the easy way out...no screening culture needed. But, they will isolate you in most cases.

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You misread -- I said never reliably decolonize.

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I guess I did misread your quote.I still feel that decolonization is always worthwhile to attempt when the results may be helpful in prevention of an active infection. I had this argument with an epidemiologist when I fought for MRSA screening in Maine, and it seemed that this treatment, for prevention purposes is rationed and only used for certain patients. Every patient deserves to be as protected as possible from an active MRSA infection.And, for your personal purposes, it is important to remember that not all MRSA is equal. You may be colonized or not and your MRSA may be the same one as you had before or may be a new strain. It is always important to know your status, particularly if you are facing an invasive procedure, or if you are discovered in an investigation of an outbreak. Those two situations (at the least) are important times to be decolonized. MRSA is transient, tough and persistant, but active infections can be prevented with the correct steps.

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Mammy1111 - Thanks for posting the article. I was surprised to see how low the colonization rate was for healthcare workers (~4%).

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Over-treating colonized/not active infections will just make MRSA even more antibiotic resistant. It's the same as giving antibiotics to someone with the flu "just in case."I took care of a patient for 4 days, and on the 4th day, the IC nurse calls and says he has to be on contact precautions because 5 years ago, he had MRSA in his gtube site, and he will forever have to be on contact precautions unless he gets the gtube out. I'm really starting to feel like MRSA, unless it's oozing, should just be treated like any other infection. It's not the gowning up that's protecting other patients, it's the washing my hands after I'm in the room. Unless the patient is dripping MRSA wound juices, the MRSA isn't flying around the room, attaching to whatever it can find. I'm really thinking that putting everyone on precautions just makes us more likely to take it less seriously for a patient that REALLY should be on precautions.

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It is scientific fact that colonized MRSA can spread. It is also scientific fact that a patient is 7 time more likely to develop an active MRSA infection if they are not decolonized. I am not suggesting that every single colonized person be decolonized...only the ones who are facing an invasive procedure, and nurses who are discovered colonized in an outbreak investigation.A colonized patient can and does spread MRSA into his environment, so it is not only your hands that pick up the microbe, it is also your uniform and any medical devices used. If the patient is coughing, he/she can spew it up to 4 feet into the air.So, contact precautions including handwashing, gloves, gown, (mask if actively coughing or doing a procedure that induces coughing) are all necessary to stop the spread of MRSA. If there will be no direct contact with the patient and or his environment...ie. passing him a pill...there would be no need for the gown.Without actively detecting MRSA, Isolation and contact precautions, decolonization when necessary, education, and adequate room decontamination, the MRSA epidemic will continue to grow and spread. It is a crime, since we know that ADI works. Take a look at the VA program and the results of it.

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I am kind of shocked the percentage of healthcare workers colonized is not higher. However, I know that if I ever get admitted to the hospital I am refusing MRSA swabbing. Unless I am a patient in the ICU and actively dying, I do not want to know if I am colonized with MRSA or not.

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While I do understand your feelings about not being swabbed, I feel that it is unwise. If you are colonized, you are at much higher risk (at least 7 times more likely) of active infection. The things that doctors do differently if you are MRSA colonized are 1. decolonize prior to risky procedures thereby decreasing your chances of active infection, 2. give appropriate antibiotics preoperatively instead of something that will encourage growth and antibiotic resistance of your MRSA colonization, and 3. separate you from other patients to avoid spread of desease. So, swabbing is and a tremendously valuable test for both you and the patients around you. Fear or swabbing is unwarranted and puts you and those around you at greater risk...if it leads you to refuse swabbing. I, for one, will ask for swabbing if I am admitted to the hospital. I have witnessed the death of my father because a hospital did not initiate screening after a known outbreak and 2 other previous deaths. Now after over a year of MRSA advocacy and activism, I have spoken with and met hundreds of victims of MRSA. I will do all I can to avoid an active infection including MRSA screening....for myself and anybody else that I care for. I will continue to work with legislators and others to mandate that at the least, high risk patients be tested on admission, or just prior to admission to hospitals. I am 100% convinced that ADI (Active Detection and Isolation)saves lives. It is proven over and over....check out the VA hospitals MRSA program.

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"It is also scientific fact that a patient is 7 time more likely to develop an active MRSA infection if they are not decolonized."H again,Can I get details on the research that supports this (see quote above).Thank you

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I will get that to you as soon as i find it in my research articles....this afternoon sometime.

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Thanks. No rush or anything.
Author: peter  3-06-2015, 16:36   Views: 862   
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