MRSA, VRE, C-diff??????

[LanaBanana]

I'm in nursing school and a newbie CNA at the hospital. But I have some questions about precautions used with MRSA, VRE, and C-diff because we have been having several patients on precautions. But I'm getting some conflicting info about it.

• If you are walking in to a room even a little bit with any of these, do you need gown/gloves or is it just when contacting patient?
  
• Why do room doors not need closed when there is a patient with these? Is it because it is not airborne?
  
• Is it true that if MRSA is in a closed wound you don't need the same precautions?
  
• Is it ever acceptable to reuse isolation gowns if you hang it just inside the door?

It all just seems very confusing. One of our aides said she was told that for one patient it was in the GI tract and if we weren't in contact with GI material then we were ok w/out gowns. But there is always a chance of the pt vomiting, right? It is my inclination to wear a gown always in these rooms, but when we were running short on isolation gowns (seems to be a constant thing!) there was an encouragement from the aides to either skip the gown or hang the ones we used just inside the door to re-use and to just keep track of whose gown was whose.

[UWSRN]

It really depends on hospital protocol with most of these as to what sort of precautions are needed for each of those and it depends on where they have MRSA, VRE, etc (blood?, CSF?). I have never heard of closing doors for contact precautions. For contact isolation you should wear a gown and gloves. Not only are you protecting yourself, but you are also protecting other patients. Technically NO, you're not supposed to reuse contact gowns... but many places do for the lack of supplies.

If a patient has C-Diff... don't use purell... you MUST wash your hands b/c purell does not kill C-Diff.

Being that many bacteria can not live in the acidic environment of the stomach, you're not going to find the ones you talked about. But if the aide meant stool, then you should definately wear a gown and gloves, even if you're not changing a diaper.

[LanaBanana]

So if MRSA is in a closed wound on the leg, should you be wearing a gown for things like vitals and giving meal trays, etc?

[Hoozdo, ADN]

• If you are walking in to a room even a little bit with any of these, do you need gown/gloves or is it just when contacting patient?
  
• Why do room doors not need closed when there is a patient with these? Is it because it is not airborne?
  
• Is it true that if MRSA is in a closed wound you don't need the same precautions?
  
• Is it ever acceptable to reuse isolation gowns if you hang it just inside the door?

I work with patients in isolation quite often and I am immune suppressed r/t being a transplant recipeint......so I am very cautious. My opinions:

1.If you are walking in to a room even a little bit with any of these, do you need gown/gloves or is it just when contacting patient?

I will, upon occasion, walk into a room if I plan on touching NOTHING in the room. For example, just to look at a monitor closely

2.Why do room doors not need closed when there is a patient with these? Is it because it is not airborne?

Typically, you only close the doors in negative pressure rooms. These are used for patients with active TB.

3. Is it true that if MRSA is in a closed wound you don't need the same precautions?

Maybe.......but why take the chance?

4. Is it ever acceptable to reuse isolation gowns if you hang it just inside the door?

No. Be careful when you take off your gown.....immediately put it in a dirty linen bin, preferably one in the isolation room. Then take off your gloves. I get out of the room then immediately wash my hands outside of the room.

So far I have never contracted anything, knock on wood :wink2:

[gitterbug]

Following hospital policy and protocal are the only protection you have for if in the future you become infected with any of these.

Too often we think we will not be touching anything in the room, so we will not use a gown, too often we find we need to touch something, why take the risk? Keep gowns, gloves, masks, and other needed items stocked on the isolation cart. Every shift is responsible for checking to make sure the cart is ready for the next shift. Sure it is a bother, but SAFETY is the issue, and we need to be safe going home to our families.

Make sure isolation/haz-mat bags are available for use, use them. Do not expect other to enter the room and take care of soiled items. Housekeepers are taught but they still let the nurse do it.

Closed doors to rooms are generally accepted here when infection is known.

Even when not required by facility. Many patients want the door closed, they know their face will be remembered by other patients visitors rather than their name most of the time. In this area of many smaller communities, last names are repeated, but faces are not, so they like to have privacy.

Good handwashing with soap and water should never be replaced by using some alcohol based cleaner. This is still the single most effective way to combat germs and prevent self-infection.

Double glove. Use a mask . Use the gown. Wash your hands going and coming into the room as instructed. These are simple things to do. Don't second guess the protocols.

[JohnBearPA]

Double glove. Use a mask . Use the gown. Wash your hands going and coming into the room as instructed. These are simple things to do. Don't second guess the protocols.

I agree with following hospital policy regarding isolation and contact precautions, but double glove? I hope no one is doing this in front of said pt's. Let's just think of the pt's feelings here, they're in a hospital, people are masking and donning gowns and gloves to bring in a meal tray? How contagious and infected do we want to make them feel? If you wear one pair of gloves, and wash your hands properly after whatever contact procedure (and bringing in a meal tray isn't a contact procedure) you must perform, you're covered. Let's have a little empathy for the pt here. Not trying to flame you, but put yourself in the pt's place and think of their feelings. I'm all for NOT taking home MRSA or C-Diff, but hey, a good thorough handwashing is protocol anyway, so why unnecessarily embarrass the pt?

If you go into an isolation room with a tray ungloved, and you need to perform a task while in there that requires you to be protected, then get a pair of gloves, gown, mask, whatever is needed and then do the procedure. That's how I was taught, and I've never brought something home from work with me yet!