Contact precaution, their visitors, and HIPPA

[anon456, BSN, RN]

I am a student nurse . . . today I had a patient on contact precautions for suspected c.diff. They had a sign on the door and a cart with the PPE outside the door. I can see how it would not be that obvious to a visitor to know what was going on because they wouldn't know what contact precautions meant.

The patient had some visitors including a young child who was putting its hands on everything in the room. I told my staff nurse about it, and she said to instruct the visitors about the contact precautions but to be sure not to violate HIPPA when doing so. It was a busy day and I didn't ask her further instructions .She just said to make sure not to tell them specifics about the patient, but speak in general terms.

I was not sure how to do this, but felt that it was urgent to inform the visitors since they seemed to be unaware, especially for the child's sake. When the patient was in the bathroom I told the visitors, "This patient has been put on contact precautions. We do this any time there is a chance that the people coming into a patient's room might be exposed to something that can cause an infection. I would suggest that you not allow the child to touch anything in the room, and please make sure to wash your hands when you leave to protect you against anything that might cause an infection."

Was this okay? HIPPA is such a sticky issue-- it's hard to know what to do sometimes.

Also the patient did not seem to be aware that they were on contact precautions or being tested for c.diff based on their confusion as to why they were getting such bad diarrhea. The diarrhea had nothing to do with their main reason for being there. Shouldn't someone have told them about a suspected infection?

[jorjaRN]

First, sounds like what you said to the visitors was perfect to me. In the facility where I work, the visitors are informed that they need to wear all of the proper PPE in order to enter an isolation room, for thier protection, as well as that of any other patients they might encounter while they are in the hospital (hallways, cafeteria, etc). We have restricted access for young children under these circumstances, especially within the last year with H1N1 (when children under 18 who weren't patients weren't allowed in the hospital at all). If it become a recurrent issue with visitors repeatedly refusing to comply, security has been involved. 99% of the time, it's not an issue, and once given an explanation such as the one you gave, visitors are cooperative with PPE.

Secondly, if the patient was alert and oriented, he absolutely should have been informed of the possibility of a complication such as c. diff. I can see where it would get overlooked if it was just something they were ruling out, especially since it seems like anyone who has diarrhea gets checked. However, wasn't he wondering why all the staff were wearing a gown and gloves to come into his room? Unless there was some reason he wasn't informed, he should have been filled in about his condition.

[gr8rnpjt, RN]

Sorry, pet peeve: it's HIPAA.

You did fine. Given the urgency of the situation and the need to get the visitors to get a clue, what you said was perfectly worded.

[anon456, BSN, RN]

Whew! Thanks! :) Yes the pt was alert and oriented. I will explain to them tomorrow that it's important to alert visitors to the precautions and why.

[caliotter3]

I'm sorry but I think if those in charge found it necessary to place the patient on contact precautions, then steps should have been taken to see that the child was not allowed to enter the room. The visitors could have been headed off at the visitor's desk or the nurses' station. The child was placed at risk and done a disservice.

[sassy_cassie]

Sounds like you did well. At my facillity visitors do not have to gown and glove if they will not be visiting other pts in the hospital. If they choose to gown that is fine. With C.Diff the family needs to be informed to scrub there hands with soap and water not just the alcohol. I would talk to them infront of the pt, so they can ask the pt questions about the condition.

[Orca, ADN, ASN, RN]

You did not reveal specifics about the patient's condition. You simply warned the visitors about the risks of infection with their child handling things in the room. Your response was textbook perfect.