C-Diff, and isolation precautions

[katrinabreck]

I know that some facilities have taken out isolation precautions on some contageous infections. Should a facility stop using isolation precautions when dealing with infections such as C-Diff?

[Double-Helix, BSN, RN]

I think inpatient facilities are still pretty strict about isolating C-Diff and MRSA, even colonized MRSA. It's the LTC's and SNF's that are a little less stringent about precautions, especially for colonized MRSA. I would feel so badly for the poor MRSA colonized old man at the LTC. Can't have anyone enter his room without gown and gloves. He can't leave his room because there's no way to protect everyone in the common areas. It would be very sad.

[beckster_01, BSN, RN]

My facility is pretty strict about our isolation precautions, mostly because they had a reputation for being the worst offender in the area for nosocomial infection. We do the standard gown/glove/wash hands with soap and water for C-diff and MRSA. However after cleaning a C-diff room environmental services goes through the room with a black light (apparently you can see the spores with the light). If we have three floor-aquired cases of C-diff within a week (or it might be 2), then we get to go on "C-diff lockdown." This means that we treat every patient as if they have C-diff. If they are in a semiprivate we have to change our gown and wash our hands before seeing the patient on the other side of the room. During the 2 weeks there is a contractor who has a UV light machine which apparently kills C-diff, and each room must be cleaned with that as well. Let me tell you, it is a charge nurse nightmare. If our hospital goes to that extreme to prevent the spread of C-diff, I can't imagine them stopping precautions all together.

MRSA is another story. I would be interested to see what would happen if they swabbed a sample of health care workers. Another hospital in the area only does gloves for MRSA (and possibly VRE but I don't remember).

[Lynx25, LPN]

Our LTC has stopped using precautions for C-diff. They are sketch about even TELLING the staff- like CNA's, that the person HAS C-diff.

We are also in the midst of a Noro-virus outbreak, and the infection control is a joke.

Ugh.

Hate working here.

[tokmom, BSN, RN]

I can't seem to quote, but to MunoRN:

I reaaalllyyy wish our facility would drop the MRSA isolation thing. It's such a pain in the rear. If our pts nasal swabs come back neg they are taken off ISO. However, if it was in their little toe in 1967, they still are placed on isolation until dc.

[healthstar, BSN, RN]

Even more annoying: when you have been taking care of a patient for 8 hours and 30 mins later they want you to use isolation precaution bc the results came back positive. Like thats going to make a difference now, I already took care of him for 8 hrs, I am not going to gown up now.

[MunoRN, RN]

Here are a few articles, there are also many more on the subject:

Taking Off the Gloves: Toward a Less Dogmatic Approach to the Use of Contact Isolation

Adverse effects of isolation in hospitalised p... [J Hosp Infect. 2010] - PubMed - NCBI

The Contact Precautions Controversy

My facility uses what one of these articles refers to as "Standard Plus" precautions rather than contact precautions.

[vintagemother, BSN, CNA, LVN, RN]

Our LTC has stopped using precautions for C-diff. They are sketch about even TELLING the staff- like CNA's, that the person HAS C-diff.We are also in the midst of a Noro-virus outbreak, and the infection control is a joke. Ugh. Hate working here.

This sounds just like the ltc I used 2 work at- until I quit. 1st letter facility name= A

[Vespertinas]

Muno, I have always felt that our contact isolation patients get neglected- I'm glad there is evidence for that available.

A hospital I worked at once dispensed clear guidelines on when to begin and when to *discontinue* isolation on patients. They felt it was equally important to d/c when appropriate and I was an advocate of that myself. I still have the pamphlet and it says:

MRSA/VRE

pt off abx effective against the organism >72h before obtaining specimen

1 neg specimen from orig site (if possible) and one from nares/rectum

5 days later, 1 additional neg swab from nares/rectum

C.diff

pt without diarrhea for 72h

Herpes zoster

all lesions dry and crusted

There are more esoteric ones mentioned but not necessary to list. Interestingly enough, I just noticed there was no mention whatsoever of acinetobacter (shudder).

I need to find some good research on this because my facility still makes us gown/glove/mask for Hx of MRSA.

mask??

[That Guy, BSN, RN, EMT-B]

mask??

Sputum/Trachs that are/were colonized

[I_OYVEY]

is herpes zoster contagious when blisters are present and not dried up?

question answered, thank you.

[RainMom]

My facility requires isolation for hx of MRSA also. However, upon starting nights after orientation, I was a bit shocked to find that contact isolation amounts to "gloves only". Now, most of these do tend to be hx of mrsa, so just wearing gloves doesn't bother me so much, but this is a surgical floor & we do occasionally have pts w/ active mrsa of wounds. But very few staff, including the night supervisors, lab techs, RT, etc gown up when going in to do care. This has really started to bother me a bit since I took care of a C. diff pt a few weeks ago. The isolation signs outside the room are no different for C. diff vs MRSA, so I made sure the aide & other RNs knew that it was not just MRSA if they went in to answer the light. One early morning, the lab girl went right in with all her supplies & no more than her gloves. She went a bit pale when I let her know this was not just a MRSA room; did she plan to take that kit into all the rest of her rooms? I also have a problem with how staff will put the bedpans into the bottom drawer of the nightstand, ESPECIALLY when it's in a C. diff room. I'm very doubtful that housekeeping opens those drawers to do a thorough cleaning!

[MomRN0913]

Also, it is acceptable to use sanitizer alone if there is no C-diff. If there is C-diff you MUST wash your hands.

So hiding the fact that a patient is C-diff positive doesn't seem too Kosher to me......