Contact precaution question

[SchoolNurseLaura]

I have a stupid question, but I want to see what others would do. I have a pt with mrsa in a wound, who is therefore on contact precautions, they say they want glove, gown and mask...they as in the wound specailists...well she also has a PICC line. In the morning I go in and cap off the antibiotics from the PICC and flush the line...but I have no contact other than that. I just went in with gloves, flushed and capped, washed my hands and left. Well who happens to walk on, the wound specialists...they walked in then out and I know they were making comments. It will probably end up as a write up, but I wanted to see...is gloving reasonable for capping and flushing? I saw no reason to gown since I was not dealing with bodily fluids or having any other contact with the wound. Comments anyone?? I do know that technically I should gown, but i'd be spending more time with that than anything and for capping off a picc is that necessary?!

[jal1234, LPN, LVN]

Our hospital only requires gloves for contact precautions, unless it is CDIFF, then we have to gown and glove. No mask unless it is airborne precaution. i see people going in with no gloves, but washing before they leave stating "it's only history of MRSA" or how many people do you think come in here that have MRSA as visitors? It is a lose/lose battle in my opinion; yes there is some control, but there is never full control unless P&P are adhered to 100% of the time by 100% of the staff and that is highly unlikely. All it takes is one person to go in without PPE and come out and contaminate other surfaces...

[tjwalshrn]

I have worked in the past in a large hospital in Phoenix, as an IC RN. I think all nurses should be required to follow the ICRN in the hospital they will be employed in as part of they're orientation, but I know this is not feasible. There is a reason for the rules that have been put into place, and into practice guidelines for hospital staff, and not just nurses. But as the RN, is it not your responsibility first and foremost to protect the health of yours and other nurses' patients? Not to mention the whole advocacy bit. It may seem a bother, and an unescessary precaution to gown, but you are brushing up against beds, furniture, lines, etc. Things that you aren't even aware of. Central line infections are a HUGE source of sepsis, and ultimately death for many hospitalized patient's every year. Interestingly, studies have shown the correllation of how MRSA, VRE, and other resistant bugs pass from hospital personnell between rooms. The extra 10 seconds it takes for you to gown and glove up may save a life.

[malgosiaRN84]

DEFINATELY gown up b/c u do not know what you are touching with your scrubs (sheets/blanket/gown) and then u are spreading mrsa and therefore pts will be colonized with it despite not having an active mrsa infection. PLUs there is a bunch of crap in the air as well.

[LouisVRN, RN]

ETA While YOU had the intention of only going in the room to heplock the IV and flush it, there have been multiple reasons I have walked in a patients room for one thing only to end up in a very different situation.

Example 1 - Go in to patient's room at end of shift just to say goodbye. Pt was young ambulatory, weak and on a heparin drip, he asked if I would mind assisting him to the bathroom and back, sure no problem. Then as he is getting back into bed, somehow he manages to tear the IV tubing in two. Now there is blood spurting everywhere out of the pts end of tubing and heparin dripping all over the floor. Very glad I had gloves on when I went into that room.

Example 2 - Medicating someone else's patient for pain, pt states she would like to go to the bathroom first. Okay, waiting for patient to get back, about 2 feet from bed, abdominal wound dehisces and there is blood everywhere.

I always wear gloves before going into a patients room and will always wear all neccessary PPE for precautions. Sometimes extra.

[BabyLady, BSN, RN]

Contact precautions at our facility is gloves, gown, but no mask.

If you violate that here, you are written up.

The purpose of contact precautions is to protect other patients of the hospital including yourself....if you remember that, you'll remember that..you'll know why they would be upset.

[merlee]

I don't know where it all begins and ends, but whenever I am out in public and see people with lower legs that have ugly old dressings on them, I want to run in the opposite direction.

My brother had TWO courses of IV antibiotics as a home-health pt due to hospital-acquired MRSA; I don't think he ever got rid of it. Don't know if my SIL or niece were ever colonized.

And who polices all the docs? Last May, I had a cardiac cath, and I had to remind EVERYONE who put their stethoscope in my groin to listen at the site that they should clean off the 'scope BEFORE wrapping it around their neck....... Ah, infection control...when does it end?

[AsatruRN]

I think the gown is necessary. The MRSA is in the wound only in theory. You don't know how many folks before you might have cross contaminated any surface in the room. Did your scrubs touch bed sheets, curtains, equipment, any other surface? So then when you left the room you are cross contaminating everything in the hallway - in theory.

This is how we bring superbugs home to our families.

[Belle Epoque]

What part of contact precautions is hard to understand? Did you have contact with the patient? Yes, therefore you breached protocol and are now looking for justification for your actions. This is the very reason hospitals get shut down from rising infectious disease rates - something currently taking place at my hospital at this very moment - because of lazy careless hospital staff who should know better but just can't be bothered to act responsibly and professionally.

[BluegrassRN]

Any contact with the patient or "potentially contaminated areas in the patient's environment" is supposed to involve gloves and gowns, so contact with the PICC should include contact precautions. (per the CDC).

Muno's post is spot on.

Our contact precautions include the terms "contact with pt's environment" for the requirement for a gown. I see no reason why you would need a mask, though, for a wound.

In short, yes, if a patient is on contact isolation, about the only time I won't wear a gown is if I'm taking something in to someone (the nurse calls in and asks me to bring her something) or if I know I'm only going in there to do something like put more time on a beeping IV pump. Then I only glove up. If a quick trip evolves into something more prolonged and involved, I usually just say "Sure, I'd be happy to help you to the bathroom. Let me step out and grab a gown really quick."