Do you actually wear gloves/gowns/masks ?

[Nepenthe Sea]

I am a second-semester nursing student, and just finished my first clinical rotation at a local hopsital. I know that nursing school is different from the real world, and that working nurses will do things differently from what we were taught in school. But I am just wondering if you guys actually use your gloves/gowns/masks when a patient is on special precautions. At the hospital where I was assigned, I had patients with VRE, MRSA and C-diff. All of them were on contact precuations and one also had droplet precautions. NONE of the nurses caring for these patients wore anything besides gloves. My friends that were assigned to a different hospital said that they encountered the same thing, except that alot of the nurses there didn't even wear gloves. Is this pretty common in the real world? I know that Medicaid and/or Medicare has decided that they will no longer reimburse for treatment of hospital-acquired infections, so it seems like everybody would really be using their PPE. I personally have two small children and the last thing I need is to expose them to any of this stuff, so I used the gowns and masks. Do you just quit being afraid after awhile, or are there just alot of careless nurses where I live? Please don't flame me, I'm just asking for an honest answer.

Thanks!

[trudyrn02]

Contact precautions mean just that. If you will make contact with the patient or anything the patient may touch, glove up and gown up! Remember, that pt. may not always be able to wash their hands and you don't know where the hands have been! If the patient is incontinent, has draining wounds, or a foley, you are likely to be in contact with body fluids! Airborne precautions require a mask. Again, your pt. may or may not be ambulatory. If you aren't sure, it is best to keep yourself protected. Remember, you are responsible to keep yourself and your other patients protected as well.

[Connie Elder]

Good morning to you all. After reading some of these stories, I felt compelled to write a response. I have been a nurse for 32 years with the last 5 years being a travel nurse. I have taken care of, AIDS, HIC, TB, Typhoid, VRE, MRSA, Step, staph, different type of Hepatitis, c-diff, flu, H1N1, flu and a few others. The only thing I have caught is the common cold. PPE equipment will go a long way if they are used for their intended purpose. Every hopsitla that I have ever worked in has provided the staff with what is required to take care of the patients. If used properly you will get the protection that is necessary. I have seend nurses and Doctors go in and out of rooms with no protection on, IV'S started with no gloves, lab drawn with no gloves(by both nursing and lab personnel). I have worked in hopsitals where they don't even have infection control signs to place on the door way when needed. I am currently working in a peds. er where they don't have a positive pressure room for somoeone with TB, they don't have signs that you can place on the doors when needed to tell staff what type of pretection in needed to care for this pt. Their response when I've asked is "Tape a face mask on the door so people will know that they need to wear one." Now that's a scarey thing to me. Handwashing is another story. At times it is almost nonexistent. I am very much a pt. advocant and tell the pts. I take care of, I tell them not to be afraid to ask the staff taking care of you, coming into your room, to wash their hands. I've had families and pts. ask me why I'm the only that does this.

Thanks for listening.

Connie

A Nursing Veteran

[NtannRN]

As I sat here and read the posts, I find it disgusting that a facility would not provide PPE for their employees or visitors. How do they keep their accreditation? Do they care about the liability there? Especially with this sue happy society that we live in. I work in an ICU and I try very hard to follow all precautions. I took care of one of the worst tb cases our doc. had ever seen for 7 straight nights 12 hrs at a wack. Wore all my ppe's even if I was just poking my head in to fix a pump etc. My ppd is (-). As a nurse you MUST take all people in your area into consideration. Many times the door was left open to my neg. pressure room. Helllooo can we say defeating the purpose? Everyone entering any precaution room needs to be responsible for themselves and others. Anyway, I have had difficulties with pt's family members wearing ppe. "we don't wear it at home" is what I get, or they put it on then decide to leave the room and go to the kitchen with everything still on. And when redirected, they tend to become a bit *****. If I require my pt's visitors to wear it i better be wearing it as well or my reputation regardless of my nursing skills goes right down the toilet. I do have a question. What types of masks do you wear for your H1N1 pt's. My facility does not have any protocol but in all my reading, we should be wearing the N95 tb mask.Not the regular surgical masks. People wear both at my work

[Connie Elder]

Hospitals that I've worked at wear both. I've been told that you can wear a full face surgical mask. However I prefer to wear the N95. I don't don't if I mentioned in my response to thiis questions, but the hopsital I am working at right now don't even post signs in the ER to let others know that this pt. is in isolation. Contact, etc. This I have a hard time They don't have a positive pressure room either. "We don't get any TB pts." I don't think thats the right answer. I won't be taking care of nay TB pt. if they come this facility. I will wear what I need to wear to protect myself.

[Connie Elder]

This is for the person that started out her blog by saying let's be honest, who wears there PPE in a grcoery store? That is the worng mentality for you as a nurse to have. By you saying what you did, you miss the whole picture. Anyone in nursing knows that MRSA and VRE is in the public,, nursing homes, etc. The fact is you have JCAHO and OSHA breathing down your back to wear the stuff. WHy in the heck would you not? If this is how you do things by not always wearing the PPE, then you are fortunate not to of caught anything. Why is your hospital swapping people that ofter? Are they worried about the employees catching something? Also, as far as it goes by the hospital sayingdon't wear PPE in the hallways, that a bunch of bull. Are you trying to tell me that you don't even wear gloves and a mask? Thats basic PPE. Do you even wash your hands if you think this way?

[chaschata]

It is different when u r actually working as a nurse. Anyone who has MRSA, VRE, etc are on at least contact precautions. But once u work for a while and u know what type and where, u just use ur own judgement. Depends on what u r going in the room 2 do w/ the patient as 2 what u have 2 wear. If u just walk in the room w/ someone that has C-Diff and put everything on just 2 check the IV bag, or something 2 that nature for example??? No, there is no point b/c u know there is no contact w/ it. Just remember ur basic handwashing precations. U learn 2 pick and choose what ur gonna take the time 4.

I am not nurse, however I have had C-Diff twice, both times caught in the hospital. You say if you walk in the room w/someone that has C-Diff and put everything on just 2 check the IV bag or something 2 that example??? There is no point. How do you know that the patient that has the C-Diff didn't get up and go to the bathroom, then not wash his hands and touched the IV pole or bag or door knob, oxygen tubing, whatever, you don't know, you just don't know. Or maybe you just walk in the bathroom to turn off the light or something, do you realize the spores from the C-Diff come out of the toilet up to 10 feet in the air and land of the walls, on the floor, on the sink, etc. and can live for several weeks on hard surfaces unless washed with soap, water and clorox, and 2 years in just plain old dirt. There should be lids on the toilets in hospitals, but I haven't seen them. You put your other patients at risk, not to mention the cost of vancomicin in pill form at 28.00 + a pill 4 times a day for 3 weeks. You also put the people you work with at risk, yourself and your family.

[StaffEducator]

What a shame that we have nurses who choose to use "common sense" when dealing with isolation precautions. Saying that you don't wear PPE to go in and just fix an alarm or check an IV bag shows that you really don't have any "common sense" at all! I was an oncology nurse for 10 years at the bedside before I became an infection preventionist. Someone said that we (infection control) should see their (bedside nurse) side. Are you kidding me! I've been on both sides of the fence and have alway followed isolation precautions! One time my unit had a scabies outbreak and about 90% of the staff had to be treated. The 10% that didn't....you guessed it wore their PPE (I was one of the 10%).

I do a lot of observations for hand hygiene, but I observe other things too. The biggest and most frequent excuse I get is, "I was just going to silence the alarm." But while you are in there you just happen to check the IV bag (contaminated) pour the patient some water (contaminated) turn off the light (contaminated and close the curtain (contaminated).

We performed environmental culturing on the units and grew multiple organisms off sufaces like IV pump screens and buttons, Pyxis screens and keyboards, ventilator switches, telephones, computer keyboards and bed rails. All those things you like to touch without gloves. For every "common sense" reason you have not to wear gloves I have 10 evidence based reasons you should.

Stop being lazy people, wear your PPE and wash your hands!