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
