There have been situations when I was the only person in the room to gown and glove up when with a patient on contact isolation. I have seen family members in the room wearing nothing, but I guess I don't really expect them to follow the rules.
However, my question is geared towards staff members. I have seen nursing/NA staff go into a room with no gown or gloves and perform procedures such as cleaning up the patient. Because I never know the Dx of the patient, I don't know if it's me who is overreacting or the staff members who are wrong. (Maybe the PT is no longer on contact isolation but they forgot to take the sign down.)
But it still has me wondering. I always gown and glove up when entering a contact isolation room. Do you?
Specializes in Nurse Leader specializing in Labor & Delivery.
Actually, I don't think one is required to gown up for contact precautions EVERY time you enter the room per OSHA. So it's not "non compliance" to not gown up unless you will have direct physical contact with the pt.
Actually, I don't think one is required to gown up for contact precautions EVERY time you enter the room per OSHA. So it's not "non compliance" to not gown up unless you will have direct physical contact with the pt.
I am curious about this. Our door signs re: contact precautions say to gown up upon entering room, period. I admit that I do not if I am bringing in a snack, or something equally simple and not involving contact.
If I'm going to have any contact with the patient or anything in the patient's surroundings... bed, sink, etc, then I will gown up.
If I know that I am going in for the sole purpose of touching the pumps... IV, feeding, whatever... then I will only glove-up, and make darn sure that no other part of my body has contact with anything in the room exept for my shoes on the floor.
Specializes in Nurse Leader specializing in Labor & Delivery.
I just went to OSHA's site, and they defer to CDC. CDC has a 225-page document on isolation precautions. Page 70 addresses contact precautions, and states:
Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient’s environment.
My position on this is that you do not know what has just gone on in that room. Hypothetically,the previous nurse or CNA goes in with gown/gloves and touches the infected patient,and the patient asks them for the TV remote control. You come in 5 minutes later to deliver a snack and decide it isn't important to gown/glove because you are not anticipating any DIRECT contact however the snack tray knocks the TV remote control off the table which you quickly pick up but you are not wearing gloves. You have effectively just 'touched' the patient via that remote control and have potentially picked up some hand-hitchhikers.
No glove....no love... oh wait that's condoms isn't it?... but same principle applies.
I agree with the posters that said I gown unless I am just dropping something off or fixing the IV pump in which case I glove only. Unless the patient has C-diff, and then I'm gowning no matter what. I put gloves on before I enter ANY patients room EVERY time. If I am going into a contact isolation room, I will always wear at least 2 pair, sometimes 3 if I know I'm heading in for a dirty job.
If the patient has family or I am precepting I will gown up every time I go in, or better yet I just won't ungown to go grab water or something for the patient, I'll just hit the call light and have someone bring it to me.
If an IV's beeping and all I'm going to do is press a few buttons, I'll just glove up. If I need to ask the pt a question or drop something off in the room of a walkie talkie, I might now wear anything, depending on the circumstances (the reason for the isolation, the pt's history, independence level, etc).
That 36 year old who is in contact isolation until we get a three negative c diff specimens because in the ED she complained of diarrhea in the two days previous to her admission but she has no history of recent abx use or past dx of cdiff, her dx is pancreatitis and she hasn't pooped for four days? I'm not so concerned.
The guy who is coughing up orange goo, recently traveled to India on business, doesn't cover his mouth, spiking bad temps, spitting everywhere, picks his nose and doesn't wash his hands regularly? I'm donning a hazmat suit when I even *think* about entering his room, and soaking in purell bath when I exit.
For MRSA (maybe even CDiff), this is what I don't understand. A patient of mine (I'm a student) was on contact precautions for the length of his hospital stay, including discharge day. The second day I had him as a patient, he was discharged. Walked right out of the room, touched the elevator button, and down the elevator he went. He may have even stopped in the cafe for some food.
So, are contact precautions for MRSA (possibly CDiff) for the protection of other patients that the healthcare workers take care of, rather than a true community infection risk? After all, we never seem to be able to get rid of these infections while hospitalized.
I believe that the isolation precautions are meant first to minimize transmission of infections from one patient to another via the healthcare provider as carrier. Although staff benefits from the protection as well, I doubt that we're the first line concern! :)
"Actually, I don't think one is required to gown up for contact precautions EVERY time you enter the room per OSHA. So it's not "non compliance" to not gown up unless you will have direct physical contact with the pt."
I'm sorry, klone, you are right. What I was stating with "non-compliance" was with family/visitors, who have direct physical contact with the environment (bed rails - chairs - sink) and likely the patient than staff following this standard. If it's my own patient and I've explained the reasons for isolation and why when I come in to alter the IV pump, I only put gloves on, then its not going to change their mentality. However, if I am helping a fellow nurse with a beeping IV and family is present - I don't want them refusing to gown because I didn't. She may have been battling with them all day and sometimes another nurse not gowning up raises red flags.
I put it on when IC rounds because well, they hate seeing it, and you're guilty until proven innocent. Other nurses warned me of this, so I just take their word for it. I'd rather not take the time to defend my isolation practices with OSHA standards.
klone, MSN, RN
14,857 Posts
Actually, I don't think one is required to gown up for contact precautions EVERY time you enter the room per OSHA. So it's not "non compliance" to not gown up unless you will have direct physical contact with the pt.