Saturday, October 1, 2011

MRSA puts mom "in exile" and it demonstrates holes in the rules

Confined to a wheelchair now, my mom has begun to get stasis ulcers on her lower legs. These are oozing gross wounds that open up on her chins.  Apparently these are ulcers are common for people who have limited motion in their lower extremities (legs and feet).  My niece, the 25-year career nurse - tells me its caused by poor circulation of blood and lymph fluids.  The skin tissue in the legs doesn't get nutrients from blood flow so it begins to breakdown.   Mom insists it only hurts when they apply salve but the tissue around these sores is often so swollen, red and angry looking that I can't imagine it doesn't hurt.  Since June, I've been concerned about a large on her left calf that would not heal.  Over the past 4 months it's improved then become worse and improved again several times.  In early September a nurse called to tell me it tested positive for MRSA and Mom would be put into "isolation" to prevent infecting anyone else.

I was very upset because she had the wound for so long and they hadn't tested it for any virus or bacteria. I asked if there was more they could do - different medication, vitamins, better diet...I got no answers.  They watched the wound closely for changes that indicate MRSA and finally in early September they "swabbed" the wound and ran tests. The nurse told me they look for discharges of pus and blood and a particular odor that indicates staph might be infecting a wound; once they see it, they test for staph infection. 

After the positive MRSA test, they had to put mom into isolation - no room mate, visitors must wear gowns and gloves, a bed side commode but that as long as the wound was covered, she could go to meals in the dining room.   I felt good that she'd have someone to visit with now and then. I also asked if she could have a larger TV until her isolation was over.  I got no answers even after leaving several messages. 

When I was able to visit 2 weeks later, I learned that Mom had NOT been to meals and that she'd been stuck in her room, alone most of the time.   "...being in exile, like Napoleon", she said. I was so angry.  If I'd know she was NOT going to meals, I'd have sent flowers every few days.  I'd have written letters - something, ANYTHING to help lift her spirits.  I tried to talk with the nurse on duty and she gave me a different story - that Mom HAD been to meals, that visitors didn't need gowns or gloves to protect them from infection.. Two hours later aides brought meals to mom in her room but before entering they put on paper gowns and gloves!..  I asked about the inconsistency but could not get a straight answer from the aides or nurses.  Now I have to call and complain because of these inconsistencies.  It makes me so frustrated!  How hard is it to train people to know what to do?  Infections like MRSA, colds, stomach bugs - are pervasive once they get a hold in nursing homes so all of their staff need to treat the patients the SAME way.  Families and visitors need to follow consistent - and best practice - methods to prevent spreading or getting illnesses.  I want to know that the staff does the RIGHT things to keep things from spreading - to my own mom, to themselves, visitors or other patients. 

I hate that Mom had to be "isolated". All of her clothing, towels, bedding and dining plates and utensils had to be bagged in special red biohazard bags before leaving her room.  The nurse tells me that they tried to "enrich" her activities with extra visits from their staff but it's not the same as family or friends.  Given the inconsistent messages from their own nurses and other crap that goes on, I doubt they do much "enrichment".   My family was quite freaked out and didn't want to visit; they feared mom was exhaling the virus and that they'd become infected.  I went anyway because I read enough about MRSA to understand that it was most likely caught quickly and thus a local infection - meaning it was only in the tissue on her leg and not spread throughout her system.  I also spoke with the nurse before my visit and learned that the sores on her legs were nearly completely healed.  I didn't intend to touch her wounds, bandages or the like so I knew that chances of being infected were very, very small.  Visiting my Mom after she'd been isolated for two weeks out weighed my concerns about getting any virus. 

This is the definition of MRSA from wikipedia:
Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans. It may also be called multidrug-resistant Staphylococcus aureus or oxacillin-resistant Staphylococcus aureus (ORSA).

More on stasis or venous ulcers at wikipedia:

How could my mom get MRSA?  Mom has MRSA, can i get it? Dad has MRSA can I get it.  What should nursing homes do about MRSA?