Contact precautions and nowhere to wash my hands?

allnurses Guide · Oct 6, 2009

I will usually take off my gown and gloves at the sink, wash hands and leave room without touching anything.

november17, ASN, RN · Oct 6, 2009

I will usually take off my gown and gloves at the sink, wash hands and leave room without touching anything.

But you're still touching stuff just to wash your hands. Either way, the policy states if you're in the room you need to have gloves and a gown.

I mean, even if you're turning the water off with a paper towel in your hand your hands are wet and if the faucet is wet you're providing a conduit for germs to cross contaminate your hands immediately after washing. I know I'm overanalyzing...meh...

tewdles, RN · Oct 6, 2009

You should remove your gear before leaving the patient room and wash your hands in that sink...use a paper towel to open the door and leave the room. According to the CDC Contact Precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient's environment. Donning PPE before room entry and discarding before exiting the patient room is done to contain pathogens. Remember that contact isolation does not by itself even require a private room, it is recommended and preferred by not required. So, the bottom line is this...don the gear, go in, get 'er done, dump the gear, wash the hands, get out.

allnurses Guide · Oct 10, 2009

But you're still touching stuff just to wash your hands. Either way, the policy states if you're in the room you need to have gloves and a gown.
I mean, even if you're turning the water off with a paper towel in your hand your hands are wet and if the faucet is wet you're providing a conduit for germs to cross contaminate your hands immediately after washing. I know I'm overanalyzing...meh...

No, I'm not. The sinks have sensors so I am not touching anything. The door is open so I just walk out.

november17, ASN, RN · Oct 10, 2009

I showed this to my friend (the infection control nurse) to illustrate how silly the contact precautions policy is. They seriously ding you for going in the room for no gloves/gown it doesn't really make sense.

Mammy1111 · Jan 13, 2010

Contact precautions when done properly are never silly. They may save someone's life.

YOu must wash your hands in the room before you leave and use dry paper towels if you must touch any surface such as a faucet or door handle.

It is as simple as that. Ideally, the sink would be near the door just before you exit, but nothing is ever perfect.

kanzi monkey · Jan 14, 2010

Don't think OP was saying contact precautions are silly themselves. A policy that is "unimplementable" IS though. (Not getting spell check on that one...must actually be a word )

Anyway, I work at a large teaching hospital and I'm up against some of the same roadblocks to maintaining precautions. We have 15 patients per section on our floor--5 are in private rooms, mostly used for precaution patients. We have ~4-6 laundry bins total, and our gowns are reusable. So there are no "dedicated" bins for precaution rooms--meaning we have to leave the room and FIND a bin to discard our gowns in. Can't do it in the patient room. Even i f we could, the sinks aren't automatic, and the trashbins are sometimes in an inaccessible corner of the tiny rooms. Only other sink is at the nurses' station. There is a container for alcohol wash on each pt door, but they are often empty.

There is some kind of solution for each of these problems, I know. But it involves coordination between everyone who goes into and out of the rooms, or stocks supplies on the floor. Many of us try to maintain good systems, but there are enough people in and out of the place that pay no attention to the needs of others that make things hard (for example, leaving the trash in an unaccessible corner, or moving a laundry bin to a hidden spot on the floor. Or dumping a chart on top of a bin, etc, etc)

When up against these obstacles, I make my own precaution rules. That is, if I'm gowned/gloved, I don't touch anything even if I have to go to the hallway to find a bin or search for someone to help me find a bin.

Even if I prepare enough by bringing a bin to the door before going into the patient's room, it's usually not there by the time I'm through. It's just the annoying reality of things.

Mammy1111 · Jan 14, 2010

As a group, your nursing staff should write all of the obvious obstructions to effective infection prevention and address them. There is no point in doing IC halfway. A facility will never stop infections that way. And...hospital acquired infections should NEVER be considered part of doing business in a hospital. YOU must make the change.

I am an "older" retired nurse. I have found over the years that a big group of nurse's voices is better than one or two. Make the difference. Don't ever look at something as unchangable or insurmountable. With adjustments...consistant practices and enforcement, any hospital can accomplish effective infection control. Your own lives and those of your patients depend on it.

kanzi monkey · Jan 14, 2010

As a group, your nursing staff should write all of the obvious obstructions to effective infection prevention and address them. There is no point in doing IC halfway. A facility will never stop infections that way. And...hospital acquired infections should NEVER be considered part of doing business in a hospital. YOU must make the change.
I am an "older" retired nurse. I have found over the years that a big group of nurse's voices is better than one or two. Make the difference. Don't ever look at something as unchangable or insurmountable. With adjustments...consistant practices and enforcement, any hospital can accomplish effective infection control. Your own lives and those of your patients depend on it.

Of course nothing is unchangeable or insurmountable--in the long run. But on a day to day basis, there are some things that cannot be changed. I cannot summon the equipment I need out of thin air, and I don't have time to ensure the floor is stocked properly, or that the rooms are organized so that there is access to a waste bin and a laundry basket. I don't dispute that there's no point in doing IC halfway--but I WOULD argue that some improvised IC (that is, non-policy-adhering) on the fly is necessary when working in an imperfect system. Like the poster above noted:

"According to the CDC Contact Precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient's environment."

When perfection is unattainable in any given moment, the best anyone can do is consider the type of precaution and pay attention to avoid direct or indirect contact with the pt/environment.

Our nursing staff makes every effort to identify the obstacles we face, and we make changes. When something fails, we try again. Our infection control staff does what they can to implement new strategies. I think on the whole, people try to abide by the rules. But it's an imperfect system, and when the floor becomes chaotic (which is most times), we can only do our best.

Just because there are obstacles to meeting the standards set in a given policy doesn't mean that the rationale for the policy is misunderstood or ignored. OBVIOUSLY hospital acquired infections are not "part of doing business", and I've seen people die from unnecessary infections. No one is lackadaisical about preventing their transmission. But I think saying "YOU must make the change" kind of oversimplifies the problem that anyone working in a hospital is up against. I can only do what is in my power to do. The same goes for everyone else who enters a hospital.

Mammy1111 · Jan 14, 2010

It seems that you are declaring defeat. During my career, I worked in a busy ER and I know chaos and difficulties. I also know that alone you cannot address ongoing issues and make change. What I was suggesting is that YOU join with your coworkers, come to concensus on what the obstacles are to good consistant IC on your unit or units, and fix them. If everybody is on board from your manager on down to the housekeepers, a lot can be accomplished. I dont' think this is idealistic or unrealistic. There isn't anything that can't be changed. I have read about groups of nurses and others changing what you call "unchangable" to stop unintended infection transmission.

I have seen people die of infection to, for example, my own father. My mother and I both were by his side when he died of HA MRSA Pneumonia. He contracted his MRSA during a short hospital stay to rehab with a minor ankle fracture. That is why I am so passionate about positive change in IC and MRSA prevention.

november17, ASN, RN · Jan 19, 2010

Just for the sake of argument, lets say I have a patient on droplet precautions. The patient's bed is next to the sink (which is the configuration where I work). I degown, deglove, and take off my mask prior to washing. I'm already breaking policy by doing this, mind you, because I'm in the patient's room with no PPE. The patient turns to ask me a question and coughs all over me from 2 feet away. I'm kind contaminated then, eh. The precautions policy where I work is a joke.