[kiyasmom]

Currently I am in private duty nursing with one wee one. The child is wonderful and his illness is burn related, not disease related. I was giving report to the day nurse two days ago, meanwhile she is doing a visual examination of the client. I mention the client hadn't slept well most of the night and when he finally fell asleep for good it wasn't until after 4 AM. Normally I change him three times per night even though he's good with 1-2 changes. I just can't stand the thought of leaving an innocent, helpless person in an uncomfortable situation so I change him at start, middle, and end of shift. This particular night I chose not to change him at EOS because 1. he wasn't really wet (maybe x1) and 2. it was more important that I allow him to rest before school than risk waking him at 6:45 when he is hard to put back to sleep and had slept so little during the night. Day nurse agrees and start feeling around in his brief without a glove with the back of her hand. She confirms what I said (that he wasn't so wet that a change was necessary) and then she pulled her hand out of his brief, put the Purell on them, and grabbed my timesheet to sign.

Ummm...I'm going to need you to wear gloves next time!

That's what I said jokingly and she laughed it off. OK, but I'm serious. I have found, especially in home health, that we as caretakers tend to be less cautious and procedural than we are in a more formal setting. I have oriented on cases and have seen nurses connect tubes to the mickey button ungloved and commence to preparing/administering meds/formula with naked hands. Diaper changes go ungloved, creams and ointments are given with bare hands.... C'mon guys. I know it is drilled into us to make being at home as seamless and comfortable for the client as possible. I know part of our job is fitting in with the family and assimilating. That does not mean we should continue to put ourselves and our clients at risk by refusing to follow the most basic precaution procedures to keep everyone safe.

I know some agencies encourage their employees to do as many procedures as possible without gloves or gowns as some clients tend to feel isolated by the use of the barriers. This theory may have some truth to it but in the end we have to use the critical thinking skills we all tout so proudly. We have to use common sense and do our jobs with the client and our own health in mind.

I am not trying to be a witch. I'm just thinking it's time to get back to the basics. Even for the "small things," wear gloves please.

[hinakhoja]

I completely agree with you. Basic universal precautions are to be followed strictly. Wearing gloves are very necessary for the both and on the other hand, hand washing practices have to be followed regardless of anything as we are taught since beginning.

[BSNDec06]

Wearing gloves is not necessary for tube feedings and giving meds but hand-washing is a must!

[kiyasmom]

Originally Posted by BSNDec06

Wearing gloves is not necessary for tube feedings and giving meds but hand-washing is a must!

I would agree for most tube feedings but when you are dealing with a mickey button, inserting and removing the tube at each flush and feeding it is prudent to wear gloves to decrease the incidence of infection at the G-Tube site. I was taught to wear gloves during tube feeds and while giving eye ointments both in LPN school and last year in LPN to RN Transitions (condensed Fundamentals review) but my information may be outdated. I apologize for the misspeak.

[Hopefull2009]

Originally Posted by kiyasmom

I am not trying to be a witch. I'm just thinking it's time to get back to the basics. Even for the "small things," wear gloves please.

You're not a witch, you are smart.

It has blown my mind what I have seen in a hospital setting. I saw a nurse, in a non-emergency situation, start an IV without gloves, and when she went to attach the line, blood backed up and got all over her hands, and she just looked at me and said, "Oh well, sometimes you just get blood on you."

Well, I would rather minimize my contact. It was 100% unnecessary and there was no reason she couldn't wear gloves. I can understand needing bare hands to FIND a vein, but not with puncturing.

I know that touching blood can sometimes be unavoidable in a true emergency when even a milisecond counts...but those are very few and far between.

The more you expose yourself the greater the chance for you infecting yourself or the other way around.

Our instructors and clinical instructors at the hospitals have told us, that things like MRSA and hospital-based infections are on the rise when there is more education and more equipment to protect yourself than ever before.

This is because, we were told, too many nurses are getting complacent with the basics.

I remember walking with my father (who really needs to retire!) when I made a short visit with hiim at the hospital recently. There was a nurse helping a patient with ambulation.

He said to me, "You see how that patient is leaned all over the nurse....that is how you get sick, because they are breathing right on you, it gets on your uniform...it's harder, but when you start nursing you have to learn to support the patient...if you watch the 'old school' nurses that have been around forever, you'll see that they do it differently from the younger ones."

By gosh he was right.

[sonoran]

I worked at a well-regarded hospital in my area and was shocked at how many nurses, many techs, and even some doctors ignored contact precautions (and would go in rooms for MRSA and C-Diff) sans gown and lean on bedrails, etc. Because of a lack of sinks, people used hand sanitizers instead (and not always). I also was shocked at the lack of handwashing. I think the lack of compliance was because the unit did not enforce it. Also, the unit was sprawled out with nurses stations tucked away and no one supervising for that issue. I told the unit manager about the issue, but she was new to the unit and said she wanted to gain the staff's trust. She lost mine. (Many of the nurses were very bad about the contact precautions and handwashing, which blew my mind as they should have taken microbiology.) (One nurse told me we did not need to observe MRSA precautions for one patient--and the very next day --his labs came back positive for MRSA. --I took a lot of flak from her and some other nurses for saying something as they seemed to feel that I had no place in questioning them as I was only a tech.)

At one other hospital I worked at as a tech, the units were circular, and the charge nurse enforced the contact precaution policy. (There, everyone had high compliance with hand sanitization and washing.)

--BUT --I didn't like the first hospital as they had poor staffing levels.

I am on a waiting list for nursing school. I don't know if I want to do nursing as I'd like to work at an all-around good hospital --where staffing levels are decent and universal/contact precautions are enforced. (And where nurses understand microbiological issues.)

[porcelina]

I hear you. I see this all the time in LTC. Nurses and aides who feel under the patient to see if the bed is wet, not wearing gloves. It really bothers me and it's not like there are no gloves. We have a wide assortment of gloves, so there is no reason to not wear gloves. I am an older nurse and I remember back in the day no one wore gloves, but..that was a long time ago. No reason to not wear gloves. I would have probably said something too because the spread of germs and disease is so prevalent.

[dialysis12041999]

Originally Posted by kiyasmom

Currently I am in private duty nursing with one wee one. The child is wonderful and his illness is burn related, not disease related. I was giving report to the day nurse two days ago, meanwhile she is doing a visual examination of the client. I mention the client hadn't slept well most of the night and when he finally fell asleep for good it wasn't until after 4 AM. Normally I change him three times per night even though he's good with 1-2 changes. I just can't stand the thought of leaving an innocent, helpless person in an uncomfortable situation so I change him at start, middle, and end of shift. This particular night I chose not to change him at EOS because 1. he wasn't really wet (maybe x1) and 2. it was more important that I allow him to rest before school than risk waking him at 6:45 when he is hard to put back to sleep and had slept so little during the night. Day nurse agrees and start feeling around in his brief without a glove with the back of her hand. She confirms what I said (that he wasn't so wet that a change was necessary) and then she pulled her hand out of his brief, put the Purell on them, and grabbed my timesheet to sign.

Ummm...I'm going to need you to wear gloves next time!

That's what I said jokingly and she laughed it off. OK, but I'm serious. I have found, especially in home health, that we as caretakers tend to be less cautious and procedural than we are in a more formal setting. I have oriented on cases and have seen nurses connect tubes to the mickey button ungloved and commence to preparing/administering meds/formula with naked hands. Diaper changes go ungloved, creams and ointments are given with bare hands.... C'mon guys. I know it is drilled into us to make being at home as seamless and comfortable for the client as possible. I know part of our job is fitting in with the family and assimilating. That does not mean we should continue to put ourselves and our clients at risk by refusing to follow the most basic precaution procedures to keep everyone safe.

I know some agencies encourage their employees to do as many procedures as possible without gloves or gowns as some clients tend to feel isolated by the use of the barriers. This theory may have some truth to it but in the end we have to use the critical thinking skills we all tout so proudly. We have to use common sense and do our jobs with the client and our own health in mind.

I am not trying to be a witch. I'm just thinking it's time to get back to the basics. Even for the "small things," wear gloves please.

Oh yes I do agree with you. We can become comfortable when we are working in a home setting. Yesterday we were discussing at work those that worked in hospitals that remembered that you could not take your hospital scrubs home with you. You had to change your clothes at the hospital. We they did that for several reasons- Infection control and security. We were discussing the other night that as soon as we get home now that we take our clothes of and shower or change. I love my family and I would feel so bad if I gave them something from work.
You gave a Great topic of discussion. I wonder how many colds did we give to our family because of wearing our work clothes in our car?

[kiyasmom]

Originally Posted by dialysis12041999

Oh yes I do agree with you. We can become comfortable when we are working in a home setting. Yesterday we were discussing at work those that worked in hospitals that remembered that you could not take your hospital scrubs home with you. You had to change your clothes at the hospital. We they did that for several reasons- Infection control and security. We were discussing the other night that as soon as we get home now that we take our clothes of and shower or change. I love my family and I would feel so bad if I gave them something from work.
You gave a Great topic of discussion. I wonder how many colds did we give to our family because of wearing our work clothes in our car?

I am guilty of that crime. I will leave work and jump in the car with all the baddies of my shift still on my clothes. I will go to the supermarket on the way home with nary a thought about what I may be introducing into the general population. Yet, as soon as I hit the threshold of my house I am disrobing and continuing through the house nakedly to the shower for fear of infecting my four young children or husband. And really, it's pointless because I don't sanitize my seats after driving home in my possibly infected clothes. Then we have to think about casual dress days at the hospital/LTC or in home health. That's a lot to think about. Infection control isn't cut and dry, is it? In the grand scheme of things maybe the glove issue isn't as serious as I thought...