MRSA Positive Patient

A patient was referred to Clinic X from Hospital Y. The patient was Methicillin-resistent staphylococcus aureus (MRSA) positive. The staff at Clinic X believed that the patient might pose a risk to other patients attending the clinic and as such, requested that the patient attend Clinic X when it was least busy (e.g., before lunch or at the end of the day).

The patient, dependant upon a third party for transportation to and from the clinic, was unable to attend at either of the preferred times and considered the restriction on appointment times as a clear indication of discrimination on the part of clinic staff toward patients with MRSA.

Clinic staff, while conscious of its responsibility to the patient with MRSA, was equally conscious of their responsibility to their current patients.

Ethics

MRSA infection can develop in hospital patients who are elderly, very sick, have an open wound, or who are have a line or tube inserted (e.g., urinary catheter). The spread of this particular infection is almost always through physical contact and although it is treatable, while the patient is deemed positive the following precautions should be taken to prevent the condition spreading:

Contact the hospital or referring facility for information on the patient's status regarding the infection (e.g., what treatment has the patient received for this condition?) and obtain recommendations related to infection control while working with this patient;
Develop guidelines to ensure that clinic staff follows universal infection control procedures to prevent the spread of infection including hand washing after each patient, wearing gloves and washing hands after removing the gloves, disinfecting and cleaning equipment, and changing linen after patient use.
Educate clinic staff about MRSA and how it is spread;
Arrange treatment times when the clinic is least busy or when patients who are frail and vulnerable to infection are not attending the clinic. If the clinic is consistently busy or the patient is unable to attend at the preferred treatment times, contact the referring facility and try to arrange care in the patient's home.

In the above scenario, the clinic staff does have a responsibility to provide treatment to the MRSA patient, but its first responsibility is to protect the interest of its current patients. If the clinic staff had offered the patient the best available appointment times, explained the reasons for the restrictions in appointment times, the benefits of treatment and the impact of not attending treatment, and the patient still refused the appointment times offered, clinic staff would have the following choices:

Contact the referring source again and explore the situation to determine if there are any other treatment options available;
Provide the patient with a list of other clinics in his or her area that might be able to offer more convenient treatment times;

Throughout, it is important that clinic staff document all actions taken in its attempts to accommodate the patient while trying to protect the interests of its current patients.