Caught between the Infection control nurse and the doctors!!

  1. Anyone else run into this problem? Our Infection control nurse is in the process of updating all our isolation precautions. Now, for years I have thought that our hospital was about 30 years behind the times when it came to infection control. A lot of inconsistency amongst the staff of what kind of precautions we are suppose to use for different organisms (except for Universal Precautions). Anyway in a recent staff meeting, our infection control nurse was telling us about Standard Precautions, Droplet Precautions, Airborne and Contact. She said that the recommendations now are for a meningitis pt after 24 hours of antibiotic therapy the isolation precautions can be d/c (except of course universal/standard precautions that should be used on everyone). So, we have this pt who was a possible meningitis case. Put the pt in the isolation precautions, start antibiotics. After 48 hours, the nursing staff asked the MD if the isolation precautions could be d/c. The MD refused, stated the pt needed to remain in iso. So what are we suppose to do? A lot of times what the infection control nurse says is appropriate and what the MD says is appropriate conflict. And the floor staff gets caught in the middle. I don't necessarily want to tick off our infection control nurse, but I don't want to have an argument with a doc either (unless it totally justified ). What are other hospitals doing for isolation precautions? Anyone know of any websites (besides the CDC) that I could get info off of? Any help will be appreciated. Thanks.
    Last edit by deespoohbear on Sep 28, '02
    •  
  2. 10 Comments

  3. by   OC_An Khe
    Why ask the MD to dc the isolation? Just follow hospital policy and if he asks why, refer him to the suits that made the policy.
    You can bet that this policy went through a million committees that had MDs on it. Inappropriate isolation is a terrible waste of Nursing resources.
  4. by   nakitamoon
    Very good answer,,,,ocankhe,,,, Always going to be a power struggle with a doctor over something,,, just follow policy and refer him to the ppl who mandate the policy~~~~

    Let them argue it out,,,, you don't have the time~~~

    ~kitamoon
  5. by   hoolahan
    Have the infection control nurse invite him to an infection control meeting. Have the infection control nurse put togther a short list of the isolation precautions per disease (actulally the CDC has already done this, she can just copy and pass them out.) to all the docs.

    Is the doc in question an Infectious Disease Specialist? If so, he must be pretty old, b/c that rule about meningitis was in effect when I did a short stint in infection control in 1992!

    I'll just bet the doc has not speant much time with isoaltion precautions. He worries about the treatments, and leaves those things to the nursing staff and hospital policies. Did he order isolation in the first place? Is it a hospital policy to have an order to D/C isolation? If the answer is no to those, then I agree, just proceed per protocol.
  6. by   CaliNurse
    Yes, there are hospitals behind the times. In 1996 all the isolation precautions were updated. We use Standard precaution, which ='s the old universal precautions, on everyone. If you have an HIV patient you will use standard precautions.

    The current standard of pratice for isolation is - Contact, Droplet & Airborne.

    If the doctor has already disagreed with you, then it is the responsibility of the Infection Control Nurse to give the doctor a call. It is time for a little education for the doctor. It is also mandatory that each year all departments be educated in infection control. I think the doctors don't take this seriously and assume it doesn't mean them. Did you guys know that if you have a medical license there is nothing that state you need a CPR card? Wouldn't it make sense that the doctor should have a current CPR card?

    I hope this helps deespoohbear,

    Cali
  7. by   rncountry
    I do wounds and infection control where I work. This is standard policy, following APIC and CDC guidelines. It should not be the infection control nurse that addresses this issue however, it should be the infection control director, who should be a physician, to address this with the physician who is obviously way behind times. You should speak to the infection control nurse who should then request the director of the infection control committee to speak with the physician. It is a much easier issue to deal with when it is physician to physician. To keep a patient in contact isolation when it is not warrented is a poor use of dollars. The amount of gowns and isolation equipment needed is a cost that is not necessary. It always gets someone's attention if the cost is pointed out.
    Last, I am a bit curious why it is necessary to ask the doc to take a patient out of contact, that is usually done per policy. Otherwise why have an infection control person at all?
  8. by   deespoohbear
    Unfortunately, I work for a small hospital and it is still the "old boys' school." We have a pathologist who is suppose to be infection control MD, but he is only there 3 times a week. Our infection control nurse will back us up, but then the MD's go running to our DON and administrator who back up the physicians. The doc I am talking about in the case I posted is only about 50 years old.

    rncountry-What are the guidelines now for RSV? We are getting into that season and I am curious what other facilities do. I have looked up several different policies on the web, but they all range from just standard universal precautions to gowns, gloves, mask. Thanks for your help.
  9. by   NicuGal
    We always tell our doc...talk to ID, we have to do what they say

    RSV...we gown, glove, mask with all care! If you have severe cold symptoms you have to go to ID and get the big swab!
  10. by   BadBird
    If the Dr. doesn't want isolation dc'd then have him write a order for isolation. When charts are audited, he will have to justify his order. Let him and infection control fight it out.
  11. by   rncountry
    I'll have to look that one up. We do not have peds population, so it isn't something we would normally deal with. Let you know after I work tomorrow and see what my nifty book says.
  12. by   rncountry
    standard/universal precautions.

close