Contact Isolation: Do YOU always gown up?

[RNDreamer]

There have been situations when I was the only person in the room to gown and glove up when with a patient on contact isolation. I have seen family members in the room wearing nothing, but I guess I don't really expect them to follow the rules.

However, my question is geared towards staff members. I have seen nursing/NA staff go into a room with no gown or gloves and perform procedures such as cleaning up the patient. Because I never know the Dx of the patient, I don't know if it's me who is overreacting or the staff members who are wrong. (Maybe the PT is no longer on contact isolation but they forgot to take the sign down.)

But it still has me wondering. I always gown and glove up when entering a contact isolation room. Do you?

[canigraduate]

For me, it really depends on what they're on contact for.

If they're on contact for history of infection, then I don't gown up. I always use gloves when I am doing patient contact, whether they're on isolation or not. I also use gloves when I am doing anything with a tray, 'cause I hate getting food and fluids on my hands.

If the patient is on precaution or is positive for C. dif., then I always gown, glove, and wash with soap and water before leaving the pt's room and wash with soap and water again after leaving the pt's room.

[MassED, BSN, RN]

for me, depends on the organism. Where I work, a DRO (Drug resistant organism) cart is put out for any person who had previously been identified with any type of MRSA/VRE/C-Dif, etc. But if I knew they had a wound years ago that was +MRSA, then only gloves. Course no one else I work with does that, but whatever. Most of the time, we have no idea of that history when they present to the ED and only learn once they're admitted then get all of the orders. So what's the point. Unless they're symptomatic w/ a respiratory complaint, or oozing from somewhere, then I'd gown up.

[Bill E. Rubin]

I have seen family members in the room wearing nothing,

Wait, you have naked family members visiting your patients??

[cherrybreeze, ADN, RN]

Where I work at least, family members visiting a patient on iso are not required to gown up. The reason for doing so is to prevent transmission to other patients, and family members aren't going in to anybody else's rooms when they visit. The iso gear isn't to protect us, it's for the protection of other vulnerable patients.

Do some facilities actually require visitors to gown and glove? It can't be to protect the community outside of the hospital, because people with MRSA (and other) diagnoses walk around in public all the time.

[wannabecnl]

I'm a student, and I see a mix of practices among different nurses in different situations. I generally gown and glove up if the patient is on precautions, which is always a barrel of laughs as I tend to forget half my equipment and have to keep going in and out of the room, which I can't do with gown/gloves on, so I stand there at the door, peering down the hallway, praying for someone to come out so I can flag them down for help!

I think all the nurses I've seen with pts on precautions wear gloves and clean their hands consistently, but the gown is what varies. C. diff? Absolutely. MRSA? Varies, depends on where it is. I always wear gown/gloves, though, both because I am a student and will "get in trouble" if I don't AND because I have a sleep-deprived immune system and other patients who are more vulnerable than I am. It is not always convenient, though.

[kaliRN]

Originally posted by cherrybreeze:

"Do some facilities actually require visitors to gown and glove? It can't be to protect the community outside of the hospital, because people with MRSA (and other) diagnoses walk around in public all the time."

Here's what I've seen on the subject - most acute care facilities in my region do require gowns and gloves for visitors. It is intended to protect the visitor and prevent the visitor from becoming a vector. Just because the visitor is not going into another patient's room, does not mean they are not coming into contact with items other patients may share. Additionally, community-acquired MRSA is considered a less virulent organism than a nocosomial infection with MRSA.

[nickos]

Okay, this might be diverting a bit from the original topic, but I see a few people who say "regardless of contact precautions, I glove up any time I make contact with the patient".

Really? So if you go in to give them a glass of water or take vital signs, you put gloves on? even if the pt has intact, clean skin and isn't coughing or spitting or on any precautions? I always wash my hands before and after pt care but I don't glove every time...only if precautions are in place or there are fluids/ickiness involved..

[Ruby Vee, BSN]

it's the standard where we are to gown and glove. visitors who aren't gowned and gloved either get with it or get out. we tell anyone who attempts to cross over the line (into our isolation rooms) that they cannot come in unless they wear the garish yellow isolation gowns.

however, if i've been taking care of someone for nine of my twelve hours and then find out that they have mrsa or vre, it seems rather silly to suddenly start gowning up every time i go near them. i've been known to say to the charge nurse who comes to me at 4:00 with the news that my patient needs to go into isolation "not on my shift, they don't!" i've already been taking care of them all day, i've already got the vre all over me. i do go home and shower immediately, though!

[Ruby Vee, BSN]

wait, you have naked family members visiting your patients??

raising hand, "i've had that!!!"

[canigraduate]

Okay, this might be diverting a bit from the original topic, but I see a few people who say "regardless of contact precautions, I glove up any time I make contact with the patient".

Really? So if you go in to give them a glass of water or take vital signs, you put gloves on? even if the pt has intact, clean skin and isn't coughing or spitting or on any precautions? I always wash my hands before and after pt care but I don't glove every time...only if precautions are in place or there are fluids/ickiness involved..

By contact, I meant direct physical "I am touching you" contact. That's just my standard practice because I don't know what's on their skin. Although, sometimes, I leave the gloves off if I am just patting a shoulder or touching a hand for emotional support. (I ALWAYS ALWAYS ALWAYS wash with soap and water afterward.) I think it creeps people out if you are comforting them with gloves on.

VS counts as physical contact to me because I have to touch the patient. And just because the patient has visibly intact skin, it doesn't mean that the patient hasn't been scratching elsewhere and rubbing the skin you are touching. I can't tell you how many times I have seen patients picking at themselves and rubbing their skin in other places. YUCK!

[krimicrat]

In my hospital, we are expected to gown/glove up if you step into the room - regardless of the reason. I comply.