Discussion

Airborne Precautions

Aug 17, 201015 yr

In my years as a CNA I've never come across a resident on Airborne Precautions - not droplet precautions, but airborne - until recently. Pt tested positive for a active drug-resistant infection and definitely is on airborne precautions. From school, I know that this normally requires a special mask which staff should be fitted for, use of negative pressure rooms, etc.

My concern: I've seen two boxes on N-95 disposable masks. Once those were gone, these were replaced by boxes of regular procedure masks. Once the facilities store of masks were exhausted, we went the weekend without. Pt is is a regular room, with the door shut AAT. Without proper equipment, most staff avoid the room as much as possible, and address pt by standing at the open doorway. Pt is able to complete ADLs independently, but after several weeks on isolation is incredibly lonely, call light happy, and eager to engage in lengthy conversations - can't blame the poor guy.

questions:

Is the disposable N95 adequate protection without proper fitting and education of the staff? My unlicensed coworkers mistakenly believed these "duck masks" were cheaper due to the uncomfortable fit and preferred the regular masks. I've advised several on how to ensure the mask formed a good seal to the face.

Since this pt isn't dx w/ active Tb, but a drug-resistant organism, are regular face masks adequate protection? A regular unpressurized room? (Standing with the doorway open to address the resident in lieu of mask??? :uhoh3: )

A couple of the nurses must have seen how this was going to go, wise prescient beings that nurses are, and have labelled and saved their disposable n95 mask for repeated use, keeping them in plastic bags in the isolation cart outside the pt's door. I know that airborne precautions are specified for organisms that must be inhaled to cause infection, so theoretically, is this practice ok? Cause for me it still carries an ick factor. But if disposable masks can be used by the same nurse for the same pt, then if those "duck bill masks" make a reappearance, I may do the same. Is this better than a regular mask, or no mask?

And on a personal rant, why isn't the activity department required to provide one-on-one time with residents on isolation precautions?

Shockingly, for me, this facility is one of the nicest I've worked in. It is evident that price wasn't a concern in the design of the building or when it comes to satisfaction scores. Employee satisfaction and safety, sadly, are not as important concerns. No reason why the weekend manager couldn't pick up some masks for the staff at the pharmacy down the street!

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Aug 17, 201015 yr

This is a question for your facility's infection control department. You'll have to ask them, because we can't tell you if the mask is adequate for the organism in question without knowing what the organism in question is, and even then, it's not likely that we'll know.

Secondly, ask an RN to ask the patient's physician to write an MD order for the activity department to stop by daily to provide bedside activities. It might not happen, but it can't hurt to have an order.

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Aug 17, 201015 yr

Unacceptable. OSHA requires properly fitting N95 masks to protect staff. And no negative pressure? I'm at a loss for words other than W*T*F?

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Aug 17, 201015 yr

I would contact your supervisor, employee health, infection control, and distribution to verify no masks are available. N95s should be fit tested every year, and I have seen them being used throughout the 12 hour shift as you have described. It seems crazy to me, because if the nurse cannot get in there with a mask on then she cannot assess her patient. Also ancillary staff need to be able to safely care for the patient. Not to mention (heaven forbid) something like a code happens to that patient where there are multiple people in the room! Scary!

Not sure if you are a RN or care partner from reading the post, but either way I would believe it is the duty of the RN to ensure that the masks are available.

Good luck!

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Aug 17, 201015 yr

I'd report this to OSHA so fast people's heads would spin.

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Aug 17, 201015 yr

Let's slow down a little here.

Where is the drug resistant infection? Is it colonized or active? Is the patient trached? Is the patient in a high risk group for TB? Are they now being treated for an infection? How many days into the treatment? Who ordered Airborne precautions and why? Here RNs can initiate it in the acute setting for any at risk patients until proven otherwise.

It may be time to re-evaluate this patient. Even MRSA with a trach patient does not always warrant Airborne precautions. Droplet and contact will usually be sufficient unless the patient is still being ruled out for TB or another serious infection which can include H1N1.

The one thing that the past year's H1N1 infection brought out is nobody in charge of public health (local, county, state or Federal) could make up their mind about how much protection especially when it comes to economic concerns. When the N-95 masks were in short supply, all of a sudden it was okay to do droplet precautions. For this situation I still went to the side of higher precautions even though management yelled about it everyday. But, it is good to be well versed in the many types of infections out there.

Read your facility's P&P for infection control and the different precautions so you can make your points valid when you talk to the RNs and administration.

CDC Recommendations:

http://www.cdc.gov/hicpac/2007ip/2007ip_table2.html

http://www.cdc.gov/hicpac/2007IP/2007ip_part3.html

List of all infectious diseases and precautions:

http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html

CDC infections main page:

http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

CDC drug resistant bacteria including Acinetbacter (the biggie)

http://www.cdc.gov/ncidod/dhqp/ar_acinetobacter.html

Good PowerPoint on drug resistant bacteria from Louisiana DPH.

http://www.dhh.louisiana.gov/offices/publications/pubs-249/MRSA_VRE.pdf

Great current article from American Journal of Critical Care with some excellent references cited.