MRSA and Homebirth? - Page 2

[nobodysmomma]

I just read an article about using cannabis to combat MRSA infections:

http://abcnews.go.com/Technology/story?id=5787866&page=1#.TuZMFkrog7B

I live in a medical marijuana state and I have seen MRSA treated with a topical application of a lotion that contained cannabis as an active healing ingredient. Topical lotions do not result in a "high" and are safe for pregnant women to use. Google "marijuana and MRSA" for more information.

I hope this helps!

[Breathless Wonder]

Originally Posted by tiredmidwife 

Breathless Wonder,

You're mistaken about the MRSA protocols for carriers who don't have active infections, at least when it comes to birth. Look up MRSA on labor and delivery -- it's a huge deal.

You say:

NUMEROUS people carry it in their nasal passages, and never end up with a boil/abcess. 

But Bluesparks has said that her family has had numerous infections, including a current one and past "horrible ones." 

You say:

I just don't get it. . . .I mean seriously- they may have patients who have had MRSA who are wearing t-shirt, sleeveless shirts, shorts, skirts, etc. and sitting on and touching their equipment.  They have NO IDEA. 

But birth is not just about sitting around with dry, intact skin showing, right? Blood, sweat, tears, mucus, feces, urine, vomit... I've seen it all, been splashed by it all, and had all of it get on my equipment at births (and I am careful, believe me). And I've never but never gotten through a water birth without getting wet... with water that has blood, urine, sweat, vaginal mucus, amniotic fluid, and sometimes feces in it. So... a little different from someone sitting in my office in her t-shirt.

I'm not really sure what birth centers and we home birth midwives can do/should do with known MRSA, but I am pretty sure that we shouldn't make light of it and blow it off. That's how the hospitals got into the trouble they're in.

First of all, I have TRIED looking it up, and the little information that I have found is either inconclusive, or conflicting.

Second of all, I was responding in part to this particular situation, and in part to homebirth and birth center births and MRSA in general. 

Third, to my knowledge, blood, tears, feces, urine and vomit are not typical modes of spreading MRSA.  And assuming these are of concern, wouldn't the ever present media panic over transmission of blood borne diseases mean we would have heard more of an outcry over this?  Wouldn't doctors be warning people who have had MRSA to make sure no one touches ANY of their bodily fluids for risk of contracting MRSA?  If the worry is about any bodily fluid, then is breastmilk a concern as well?   Sweat, and mucus ARE known, and typical means of transmission- and these things are UNAVOIDABLE in life in general, not just in birth.  Which means the very clients, building, and equipment they are attempting to protect may have already been exposed and contaminated.  It is not like bluesparks67 failed to disclose it early on- she has been in their office for the entire pregnancy!  If you are worried about community acquired MRSA spreading to your facility, then you need to know the status of individuals before they even walk through your door!  What if a carrier sneezes or sweats in your building, on your furniture, etc.?  Did bluesparks67 or any of her family members ever sneeze or sweat while they were in the office?  It is entirely possible that they have clientele that are asymptomatic carriers, or are having issues with MRSA, and don't know what they are dealing with OR they know and did not disclose for any number of reasons (including being told that at this point, community acquired MRSA is EVERYWHERE!) and impossible to avoid.  I guess my point is, if they were SO concerned, it would seem like they are shutting the barn door after the horse has run off!  That is my problem with this situation.  MRSA has been around since 1961- so now, at 32 weeks of this woman's pregnancy, in 2011. you are going to say, "Oh shit! We should be worried about this?"  It is one thing for the average person to be misinformed about the protocols, but quite another for midwives and birthing centers to not have a clear grasp, and a standing policy regarding MRSA in place at this point!  There is no excuse to be doing a 180 at this time!  To me, it indicates a complete lack of knowledge and preparation for dealing with what you say is a very serious concern when birthing!

I am not suggesting to blow it off, and I am not suggesting to make light of it.  I am just questioning the efficacy of the decision these midwives had made at this point.   

I'd LOVE to see some real, peer reviewed studies on MRSA and birth, and I'm sure if the midwives had approached bluesparks67 with such studies, and talked to her like she was a reasonable human being, her reaction would have been different.  But it doesn't seem as though they did!  It doesn't seem as though they had given this much thought when she first came to them and disclosed her prior MRSA status.  It seems like a FEAR reaction.

In THIS case, there is an active infection in the family, and you are criticizing bluesparks67 for not disclosing the infection.  It does not seem as though she was given a CHANCE to disclose the infection on her own (which made her angry), it does seem like her daughter's doctor may have violated her privacy (which made her angry), and it also seems as though the birth center midwives may need to do a LOT more planning about how do deal with MRSA positive patient (which has made her frustrated).  It is unclear, because we are only getting one side of the story here, but it truly seems as though these midwives did not have a good grasp on MRSA and birth, and/or did not do a good job of communicating their boundaries with regards to MRSA.  Was the issue that there is an active MRSA infection in the household (which is what I assume), and if so, was bluesparks67 informed that this would risk her out of birthing there when she disclosed her MRSA status?  Or is the issue due to her MRSA positive status in the past, and the prior infections in the family?  If the second, why was it not a big deal earlier, but is now at 32 weeks?  And if she only had a history of past MRSA infections, and not a current outbreak in her household, would she have been okay then to birth in their birth center?  If no, then why did they continue to see her up until 32 weeks?

Is MRSA something that is omnipresent, and thus once a carrier, always a carrier?  Or can you be "cured"?  How long do you (or your household) need to be infection free to be considered "clear"?  Because I have never found a definitive answer to this question... 

I guess my final question is: does treating previously positive MRSA patients (or their families) like pariahs actually reduce the spread of MRSA?  I understand trying to protect your clientele, but I am unsure if the tactics thus employed by this particular birth center are in any way truly effective.

[Onemoreontheway]

I am so sad for the original poster who has been treated like a leper. At the same time - the kind of MRSA it sounds like you have is not something that is 'no big deal' either. I don't blame the birth center at all, and I think if the shoe was on the other foot - you wouldn't either.

My heart hurts for you OP, but I agree 110% with tiredmidwife.

What other birth options do you have? Unassisted and Hospital?

[Onemoreontheway]

Originally Posted by Breathless Wonder 

There is no excuse to be doing a 180 at this time!  To me, it indicates a complete lack of knowledge and preparation for dealing with what you say is a very serious concern when birthing!

This too! I doubt they have the knowledge or ability to help protect themselves and other clients also. This should have been explored at the intake interview. There was a midwife in Oregon who transferred the flesh eating virus to a clients lady parts - clearly having a set of initials by your name does not equal competence. Really late in the game for the poor OP...every one loses, really.

[krst234]

This is an important discussion.

MRSA is becoming more prevalent - and the organisms are becoming resistant to more and more antibiotics.

On a personal level - this is so heartbreaking for the OP. And the reality of the matter is difficult to hear, I think.

But on a broader level, midwives and the homebirth/OOH birth community would be wise to address this issue.

MRSA is not just a hospital problem. Nor is MRSA a problem only for people with pre-existing immune issues or weakened immunity.

And even with extra precautions- above and beyond standard precautions - MRSA can spread to healthy individuals who are hospitalized. And there are increasing cases of community acquired MRSA infections.

The last thing any health care provider should want is to contribute to the spread of MRSA. It's a tricky situation.

How do birth centers minimize the risk of spreading MRSA?

Really important discussion.

[erniebobernie]

I would be pissed if my MD called the birthing center regarding my family members personal medical history. Especially because my family member was not being seen or treated at the birthing center. As a healthcare facility, the birthing center should have protocols and policies already set up for dealing with MRSA patients. Depending on where the MRSA is patients may or may not be "isolated" in acute care settings. I'm so sorry that this was not addressed earlier in pregnancy. So you and your family could have worked out any wrinkles sooner rather than later. You can always contact Infectious Disease at the local hospital or an  ID MD in town and ask questions. I was wondering where you were located, OP?

For those unfamiliar with MRSA,

Staphylococcus aureus is a bacteria that is usually called “staph.” It is often found on the skin, nose, vagina and rectum of healthy people. Many people can carry staph bacteria without having an illness. Staph bacteria can cause common skin infections that are usually minor (pimples or boils). Sometimes, these infections can become serious. If serious, pneumonia, surgical wound infections, blood infections, or abscesses can develop. In the past, these more serious staph infections were treated with a penicillin-like antibiotic called methicillin. Eventually, the bacteria became resistant to the antibiotic, and is now called Methicillin Resistant Staphylococcus Aureus infection (MRSA). MRSA first started in hospitals because of overuse of the antibiotic. This caused the bacteria to adapt and become resistant to methicillin. MRSA is spread though direct contact not through the air.

HA-MRSA (Hospital-Associated MRSA) infections occur in hospitals, healthcare facilities and nursing homes and is usually more severe. Community associated MRSA (CA-MRSA) usually causes skin infections but can develop into a more serious illness.

For pregnant woman

• Pregnant women can be a carrier of MRSA bacteria and not have an infection.
• If the mother is a carrier of MRSA but has no illness ( infection), there is no risk to the baby.
• If a pregnant patient has a MRSA infection, there is a small chance of passing the infection to the baby during a vaginal delivery.
• There is no current proof of increased risk of miscarriage or birth defects in pregnant women with MRSA carrier state or active infection.
• A MRSA carrier who just had a baby can develop a MRSA infection after going home from the hospital. It is important to be aware of MRSA infection symptoms.
• If you are found to be infected with MRSA, treatment should be started right away.
• Antibiotic treatment of a pregnant woman with MRSA infection is safe for the mother and the fetus.
• Women with MRSA infection in a place other than the breast can keep breastfeeding when taking antibiotics.
• If the infection is in the breast, one should not breastfeed the baby until the infection has been treated and is no longer present.
• When a pregnant patient is screened for Group B Streptococcal (GBS) infection, MRSA may also be found even though there is no infection symptoms. In other words, both germs may be present at the same time. If this is found, your caregiver will talk to you about the best course of action.

Cause

Staphylococcus aureus bacteria that is resistant to methicillin. It can also be resistant to other antibiotics.

Symptoms

• Pimple with pus in it.
• A boil on the skin.
• Pus draining from the skin.
• Abscess under the skin or somewhere in your body.
• Shortness of breath if you have pneumonia.
• Fever with or without chills.

Diagnosis

• Physical exam of the infection.
• If infection is present, a culture will be obtained from that area.
• It is not necessary to routinely screen all pregnant women for MRSA. If there has been contact with someone who is known to have a MRSA infection, your caregiver may get cultures from several areas where MRSA may be carried.

 TREATMENT FOR THE INFECTED PREGNANT WOMAN

• The pimple, boil or abscess may be drained or cut ( incision).
• Antibiotics are given that are not resistant to staphylococcus aureus.

TREATMENT FOR THE MRSA INFECTED BABY

• Isolation in the intensive care nursery.
• Antibiotics as stated above that are not resistant to staphylococcus aureus.
• Avoid a high fever.
• Keep the baby well hydrated with enough fluids.

HOME CARE INSTRUCTIONS

• Take your medications as prescribed and follow your caregiver’s advice.
• Finish all your antibiotic medication even after leaving the hospital.
• Wash your hands often with soap and warm water. Do this especially after using the restroom, changing diapers, handling money and right after leaving public places.
• Avoid people known to have an MRSA infection.
• Do not come in contact with people with sores and bandages that protect sores.
• Clean cuts and scrapes thoroughly. Cover them with a bandage.
• Do not share towels, soaps, razors and other personal items with other people.
• If you have an MRSA infection, protect your baby from coming in contact with it.
• Wash your laundry separately from the rest of the family's if you have an MRSA infection.
• Do not breastfeed if you have an MRSA infection on your body AND you are not being treated with an antibiotic.
• Do not breastfeed if you have a MRSA infection of the breast even if you are on an antibiotic.
• If you are pregnant or planning to become pregnant and you are a MRSA carrier, treatment may be recommended. With the advice of your caregiver, a prescription topical antibiotic can be applied around the nose (a common place for MRSA in the carrier state).

Document Released: 09/26/2009 Document Re-Released: 03/14/2011

ExitCare® Patient Information ©2011 ExitCare, LLC.

[sosurreal09]

As an aide whenever a patient had MRSA we just gowned up and used standard precautions.