When employees become patients
At a recent infection prevention training seminar, I came across an interesting question regarding employees who come into their own facility for surgery. This particular infection preventionist said a MRSA screening revealed this person was colonized, and wondered if this information should be part of his or her employee records.
This situation could become more frequent, since it isn’t uncommon for employees to go to their own facility for care. Healthcare workers could be considered “high risk” for MRSA and may be screened by some healthcare facilities on admission or before surgery. Many facilities have begun screening high risk patients for MRSA, and as more begin to do so, a scenario that reveals IC information could make IPs feel obligated to take action.
However, from the IP’s point of view, I would handle this information as if that person was any other patient. I would be sure the patient was placed in the proper isolation and treated to decrease bioburden, if our protocol recommended such. The information would not go into the employee’s employee health or HR chart. If the patient was an employee at another facility I would not pass that information on to the IP at that facility either. Under this scenario, the positive results are for patient care – not for employee healthcare.
Furthermore, this begins to enter the jurisdiction of the Health Insurance Portability and Accountability Act (HIPPA) Privacy rule. Ultimately the test results are Protected Health Information, which should not be disclosed except in accordance with HIPAA regulations. That would certainly not include employee records.
MRSA carriage by employees is only a concern if you are in an outbreak situation. At that time, as a last resort, you may screen employees and treat to decrease the bioburden and risk of transmission. First however, you should assess and reinforce proper standards and contact precautions and follow the guidance of CDC for outbreak investigations.
Has a situation like this occurred in your facility? Share you experience and solutions below.
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Peggy Luebbert
Peggy Prinz Luebbert, MS,MT(ASCP), CIC, CHSP, is the owner and consultant for Healthcare Interventions, Inc., Omaha, NE. Luebbert, a medical technologist with a master's degree in pathology, has worked in infection control for more than 20 years, and has published and lectured extensively on a national level. She is certified in infection control and healthcare safety.
Most recently, Luebbert authored the Third Edition of the Infection Control Compliance Guide.
Peggy has written 21 posts.
Comments
Our Healthcare System’s Health Insurance is self funded, so the majority of our employees do come to our Hospital. We just had an ED Nurse admitted with axillary abscess which cultured positive for MRSA.
We have an IC policy for employees with wet lesions which addresses restrictions for direct patient care, handling of equipment, or food to prevent transmission of BBP or staph infections.
I agree with the information you present in the article, also if you used the information related to position/ employment you would have to screen all employees. How many would be colonized and what would you do?
Several staff members where I work are indeed mrsa patients. Their isolation status alerts others and visitors to their plight. Several have had abcesses requiring inpatient treatment. Other staff constantly talk about these members and want to know what is being done about it. “We gown and glove for colonized patients, what about our co-workers?” I have a mrsa history, but have not revealed this when admitted because of these issues. I have had several surgeries and have not shared the information for fear of what may happen. My next surgery typically involves mrsa screening. Suggestions?
From Peg Luebbert:
Nancy, thank you for your input on this new phenomenon.
It is difficult to know what is the proper thing to do. In your situation, it is your right to not disclose if you don’t want to, although depending upon the facility’s compliance to standard precautions you may be taking the chance that others may be put at risk during transmission. You can decrease your “bioburden” with chg bathing a couple of times before planned admission and using bacitracin nasal treatment prior to admission as well. This would decrease the risk of healthcare transmission and decrease your risk of getting an MRSA HAI.
I know this can be frustrating and wish you wellness!
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