Isolation Patients: what is your protocol for dining ?

[DaddyO]

wondering what is the protocol for sending up food for Pts in Isolation.

For one, should the kitchen be made aware of all isolation patients on a particular floor so disposable trays can be sent up ?

I had this question during one of my clinical rotations. My patient was in isolation, but his food was sent up on a regular tray. I asked my Prof if I should wipe the tray down before placing on the rack to be taken back to the kitchen and she said there was no need for this.

I was puzzled by this since there is a designated stethoscope and dina machine in the room already.

Just wondering what is done in other hospitals.

Thanks in advance !

[pers]

When I first started my facility required one person to get the tray from the room while another would stand outside the room and assist with putting it in a bag. The bagged tray would then be sent to the kitchen with all other trays. Then they went to using disposable trays for isolation patients so there was nothing to send back. Now however, trays for isolation patients are treated the same as all other trays except we wear gloves while transporting it from the room to the cart. Everyone in the kitchen wears gloves when handling any of the trays regardless of isolation status.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf Page 62 covers eating utensils as far as the CDC is concerned.

[RNKel, ASN, RN]

Wow...just shaking my head at this one. We use "regular" trays, however, while still in isolation gear, another co-worker in gloves will stand w/an open plastic tray isolation bag. We work as a team to slide the tray w/minimal exposure to all into the bag and then the food-service folks collect the tray and sanitize everything from there. We also do not use our own stethoscope, etc.--there will be designated ones in the room for staff use. What, do people think that the virus/bacteria know that they're in isolation and to not leave the patient's room?? Weird....

That's exactly how it's done at our hospital.

[Noelani]

Where I used to work, food would be sent up to isolation rooms on disposable trays with all disposable utensils. The kitchen staff would not take it into the room like they did for everyone else, but would instead leave the tray at the nurses station for the PCA to take in, after donning all required PPE.

[DaddyO]

Isolation pts, along with Kosher, got their meals on disposable trays. This all has me wondering-my son is working dietary in aLTC facility-will have to ask if they have disposable trays for isolation ots...

Why Kosher ?

[Redhead28]

No isolation for the isolation trays at our place. Gloves worn when caring out, and all dietary workers wear gloves. Then again, have never seen them change gloves... EVER.

[Jenell Westhoven, BSN]

First time commenting but feel the need to give some perspective here. I have been an RN for 21 years and have been an infection control nurse for almost 5. This debate recently came up at work again. It all comes down to Standard Precautions and the premise of isolation. So standard precautions indicates that all trays are potentially contaminated. We don't check all patients for every microbe, which is why we have standard precautions. The dietary staff is to wear gloves and practice routine hand hygiene when handling all trays. There is nothing aerosolizing or shooting off the tray that would make the microbes jump in the staff members mucous membranes so N95/goggles aren't indicated. In the course of their work, if they get splashes in their eyes or on their clothes, regardless of isolation status, standard precautions would means they wear mask, goggle, and gown in addition. We place someone in isolation for additional protection based on the microbe type and how it is transmitted. We wear indicated PPE based on what we know about the patient status at the time. We wear gowns when we come in with contact precaution patients and their environment because we are immersed and surrounded by a known contaminated environment. The tray is in that environment but once it is removed, as long as we aren't rubbing the tray on our bodies, standard precautions is enough. Further, Nurses unknowing get themselves in trouble if they think that they only need PPE in isolation rooms. Microbes and MDROs are everywhere. My example to get to my point on this: how many times have you gone to assess a new patient (pre COVId) and leave mid Intake because the patient is coughing on you, so you grab a mask and get an Influenza swab order? They have Influenza, you have now been exposed. Most exposures you don't even know about. With every Interaction, with every patient, or their environment the healthcare professional should be thinking about what could they reasonably exposed to and don appropriate PPE. Intubating a trauma patient that quit breathing? N95- you don't know what is aerosolizing....cleaning up an extensive GI bleed or diarrhea patient...gown, gloves, boot covers....giving a breathing treatment....mask....patient spitting at you....gown...gloves....facemask with shield....clearing a patient tray...gloves 

[DavidFR, BSN, MSN, RN]

When I worked in an ID unit the patients got their food on regular trays but on cardboard plates with plastic cutlery. Hence the whole lot went in the bin in the ante-chambre (or sass), the tray got wiped and was handed out.

Some post-reg students doing the ID diploma did a resaerch project into the necessity of this. They concluded it was only really necessary for smear positive TB patients and positive typhoid and paratyphoid patients. The other patients got regular cutlery and plates after that