Covid Patients on enhanced droplet precautions in a regular room

Nurses COVID

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I worked on a stepdown unit and up until a few days ago worked with covid patients that were placed in a negative pressure room.  I didn't have a problem with this, however the other day I was informed I was to expect to admit a covid positive patient on 6 liters High Flow Nasal Cannula into a regular room on enhanced droplet precautions. In other words, they were being placed in a regular room and not in a negative pressure room.  Managements rationale was that the patient "was not coughing" so my exposure should be minimal.  I did not want to accept the patient because I felt that due to the room not being negative pressure, I would be exposed to a high viral load  and I am no Spring chicken, making me more susceptible to serious symptoms if I contracted the virus. Not only that, every time the door of the room would be opened, the air with the virus in it would go out into the hallway were staff are not wearing N95 masks/PAPR's.  Whereas at least with a negative pressure room, when the door is opened, the air wouldn't automatically/immediately go out into the hallway. 

I found this article https://bit.ly/2KyREAp which concluded that "a growing body of evidence that droplet precautions are not appropriate for SARS-CoV-2."  I was told by my manager that I was expected to take the patient. I declined and a younger nurse in her 20's reluctantly offered to take the patient and I took one of her patients, after I said I would resign there and then and go home. The next morning I tendered my resignation as I was advised I was expected to take these patients in these rooms.  What also bothers me is that management didn't bother to tell us that we were going to start getting these patients in regular rooms on enhanced droplet precautions, we were given no chance to have input into the situation....it was just dropped on us....it felt sneaky.   I called my union rep who advised we "had no choice" in the matter and that the med surg units were already doing it.  Meanwhile the other week management had no problem converting half the step down unit to negative pressure rooms, so why didn't they just do it to the entire stepdown unit?  Anyway, I would appreciate any thoughts/feedback on this issue.  

Specializes in Private Duty Pediatrics.
2 minutes ago, turtlesRcool said:

Not  necessarily.  Any rule-out unit is going to be mixed.  The PUI patients move to regular floors if they test negative, or the COVID floor if they test positive (space permitting because there's not always room on the appropriate unit).  The PUM patients never go to clean floors (unless, I suppose, they are there long enough to qualify for a quarantine).  Many (hopefully most) of them are negative, but they're still in a unit with COVID+ patients for their stay.  I don't like it, but I also can't think of a better option.

Uhh. . . PUM?

11 minutes ago, Kitiger said:

Uhh. . . PUM?

Person under monitoring.  They are at increased risk for exposure to COVID that might be in the incubation period, and be missed by a test.  They cannot "test out" of precautions the way a PUI can.  Basically this is anyone from a facility known to have COVID cases (nursing home, prison, group home for people with developmental delays) or with a known exposure (like a + household member).

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On 12/27/2020 at 9:27 AM, turtlesRcool said:

Not  necessarily.  Any rule-out unit is going to be mixed.  The PUI patients move to regular floors if they test negative, or the COVID floor if they test positive (space permitting because there's not always room on the appropriate unit).  The PUM patients never go to clean floors (unless, I suppose, they are there long enough to qualify for a quarantine).  Many (hopefully most) of them are negative, but they're still in a unit with COVID+ patients for their stay.  I don't like it, but I also can't think of a better option.

A rule-out unit is not the same exposure risk as a unit where both tested-positives and tested-negatives are together.

As a covid-negative patient, would you rather share a nurse with (or be across the hall from) a patient with known covid, or a patient who has some % chance of turning out to be covid positive?

It's some percent chance vs. 100% chance.

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