We have seen an increasing amount of MRSA, VRE pts in the outpt setting. What disturbs me most, however, is that many outpatient clinics are refusing to treat these pts in their clinics. I know specifically of one instance where we accepted a pt transfer from a Gambro unit because, after being hospitalized, the pt was newly diagnosed with VRE and the Gambro unit refused to take him back. This disturbs me immensely. The pt not only had to deal with being newly diagnosed with VRE but had to deal with the additional stress of not being able to return to his original unit. I contacted our network and their reply was to ask me if I would sit on a committee to explore these occurances. The network had no recommendations and could not offer any guidance for my concerns - I suppose if you couldn't make a chart or standard deviation, etc, the network doesn't want to be bothered by the real issues in dialysis these days. I am still quite bothered by this episode, and am hearing that TRC units refuse these patients also. Kind of reminds me of the HIV dilemma back in the early 80's. Handling a VRE, MRSA patient requires stringent infection control practices, something all of us in this field should be well versed in. I am quite aware that if MRSA and VRE spread in a unit it would be quite devastating. However, I do not feel those patients should be discriminated against, and to know for a fact this exists is quite disappointing. Can anyone validate and/or disclaim this?

In Canada in private clinic we ask for a test before the patient come to the clinic to rule out VRE MRSA. they must be negative before they come to the clinic and this is also after each hospital stay.