Assigned to home health client with feces on floor

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Hello, I am back to work after an 8-year break and am a new home health case manager. I have just been assigned a case I haven't been to yet but have been told his home is 'disgusting' because he is wheelchair-bound and apparently feces is falling on the floor and he is rolling in it.

I do not know the whole scenario-but there was an insinuation from my supervisor that this behavior was anti-social and antagonistic and that he was doing it on purpose. Regardless, I am wondering if I have the right to ask if said feces be checked for possible pathogens and also if it is OK to wear full PPE in this house, considering if he may sling feces I do not know if may be contaminated. I do not want to overreact and make a bad impression on my supervisors and seem like I'm overstepping but I also don't want to risk my own health. Thank you 

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Specializes in Tele, ICU, Staff Development.

I hope one of our onsite home health experts  weigh in on this. This is such an urgent and challenging situation, and I'd really value insights from someone in the field regarding what actions the agency should be taking to support both you and the client.

Shouldn't infection control/prevention already be involved? Social services? Adult Protective Services? Is it an expectation that visits are paused in such conditions?

If there is potential risk of neglect or abuse (including self-neglect), are there mandatory reporting guidelines in your jurisdiction and your agency's policy?  Your supervisor should be able to provide clarification.

What I can say with certainty is you must absolutely protect yourself.

Immediate safety and PPE

Do not enter an environment with visible soiling without appropriate PPE. At minimum, wear gloves, a disposable isolation gown, and eye protection if there is a risk of splatter or contact with feces.

If you are unsure about PPE requirements, check your agency's Infection Prevention and Control policy or contact the on-call infection preventionist. It's better to err on the side of caution.

Pathogen testing and clinical considerations

Orders for pathogen testing would have to come from the  supervising clinician or an established protocol.

I'm unsure how a provider would code lab tests without clear medical necessity or which specific organisms to target, especially in asymptomatic patients. Perhaps the risk of environmental fecal contamination alone is enough. However, it seems obtaining orders to protect caregivers is ultimately the agency's responsibility, not the visiting nurse's.

Assess and document

  • Upon arrival, document the environment neutrally (without judgments about the client). Note the condition of the home, presence of hazards (slippery floors, strong odors, soiled areas), and the client's abilities and supports.
  • Note the client's functional status, stool continence management routines, and any use of incontinence products or assistive devices.
  • If there is fecal matter on floors or surfaces, document risks and the need for cleaning. A photograph is generally not appropriate in home health without consent and policy; check your agency's guidance before taking photos.

Escalate and involve colleagues

Immediately inform your supervisor about the environmental hazards and your safety concerns.

If there is suspected behavior that is intentional or due tocognitive or /behavioral issues, involve the supervising clinician to determine if a behavioral assessment, social workconsultationt, or care plan adjustment is needed.

 

Best wishes and be safe,

Nurse Beth

 

 

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