Did I break the isolation code??

Nurses Safety

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I'm a nursing assistant in the float pool. I got floated today to a med-surg floor. All was going well until I went into a patient's room who was in isolation without a gown. I usually wear a gown and gloves when I'm going to be doing something in contact, otherwise I just went in to pick up the patient's lunch tray. I put it towards the edge of the door, and I was washing my hands. Then, the case manager, not the floor manager, walks into the room and tells me that it's an isolation room and that I need to gown up. I told her I was just picking up the tray and she said I'm breaking the isolation code because I didn't gown up, yet alone, wear gloves. I told her okay. I finished washing my hands. But what she didn't know was, I was going to wear new gloves to bring the tray out. The patient in the room and his wife told me that no one gowned up the entire week he was there. I was putting in the intake for the patient and that lady comes to me again and tells me, I need to follow the protocol at all times. I told her okay. But I see nurses not wearing gowns and only wearing gloves when going into the patient's room to give meds. Or OTHER CASE MANAGERS, DOCTORS, AND SOCIAL WORKERS not following the protocol, yet I"M the one being yelled at???????

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Have a close look at your policies. My hospitals states you do not need any ppe just to enter a room ( ask a question, drop off supplies-many take this to mean give meds as well). I never have seen a housekeeper wear a gown to pick up trays, I haven't either if that's all I'm doing. We do put on gloves though, and wash our hands. I think you should have totally taken the tray out then returned to wash your hands.

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I understand your confusion and frustration! We often have patients on contact and/or droplet precautions so there are gloves, gowns, and face masks outside their rooms. As a CNA, when I go in to take vitals, check their I&Os, change linen, etc, I always wear the appropriate PPEs. Yet there are other staff members who will walk in without any PPEs and do whatever they need to do with the patient. And family members never wear ANY of it, which I don't understand! If their child is on contact and/or droplet precautions for RSV, flu, MRSA, CRE, etc and is coughing and sneezing all over them, and then the parent leaves the room to go to the cafeteria, hug other family members, eat at one of the tables, touches the chairs, etc...aren't they potentially spreading whatever virus/bacteria their child has?

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I understand your confusion and frustration! We often have patients on contact and/or droplet precautions so there are gloves, gowns, and face masks outside their rooms. As a CNA, when I go in to take vitals, check their I&Os, change linen, etc, I always wear the appropriate PPEs. Yet there are other staff members who will walk in without any PPEs and do whatever they need to do with the patient. And family members never wear ANY of it, which I don't understand! If their child is on contact and/or droplet precautions for RSV, flu, MRSA, CRE, etc and is coughing and sneezing all over them, and then the parent leaves the room to go to the cafeteria, hug other family members, eat at one of the tables, touches the chairs, etc...aren't they potentially spreading whatever virus/bacteria their child has?

You brought up some fair points...but you have to consider the rest of the situation. As the previous poster pointed out, the facility policy for infection control is the law of the land so to speak. The hospital I work at has a very specific infection control policy (all of the hospitals I have worked in have had them). My current work environment (procedure area) has a policy that is the brain child of both our department and our institution's Infection Control/Epidemiology Department, and it is something like 70+ pages in addition to the hospital/system wide policy we have.

I know, for a fact, that for our patients on contact isolation at my present job, you do not have to don PPE if you are not actively taking care of your patient. OBVIOUSLY, nobody should be going into a TB room without of mask/protection on. Our policy at work has a cute little table that lists types of isolation, and explains the restrictions etc by isolation type with organism related specifics/key points (example from our policy: c diff patients are contact but you must use soap and water not alcohol rub for hand hygiene).

I can't speak about your coworkers, I don't know specifically what you mean (what tasks you are referring to them doing, and I don't know your facility's policy). If I was just rounding q1-2 hours at night to check on (mostly) sleeping patients, no, I did not put PPE on. For most tasks with patients I did wear a gown (almost always wore gloves whether or not a contact patient). At beginning or end of shift to introduce my replacement/update whiteboard in room, we didn't always wear PPE. My first code, ever, was as an assistant, was a patient on contact for MRSA. No. Not everybody in that room was wearing the proper PPE...

The thing about the family and PPE...policy will very from hospital to hospital. We cannot require a gown or gloves, unless the family member is helping with patient care. We can try to get compliance with hand hygiene but honestly, as a floor nurse I really did have bigger problems than whether the family in 15 washed their hands or not. I handled it in this manner - discussed policy, provided educational material and documented as such in the education documentation flow sheets in the patient's chart. As an RN I can do that. My scope of practice was very different as an RN than it was as an assistant.

Also, for what it's worth. Consider that MOST people do not come into the hospital and acquire flu, MRSA, VRE etc. Sometimes it's hospital acquired, most times it is not. With respect to RSV and flu and anything really, it's abundantly likely that the family members were exposed to the patient before anybody knew what the patient had and something happened that the patient ended up being admitted (usually the person who was sick gets worse and get admitted) and cultures came back positive for whatever. Most people actually, if you swabbed their entire body, they have MRSA somewhere on them, especially those of us in healthcare. The thing is, it is not harmful unless there are specific conditions allowing the MRSA to outnumber the flora that should be somewhere. VRE is usually, 98% of the patients I've taken care of on contact for VRE were on contact for VRE in the urine - and most family members are probably not handling the patient's urine.

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You're the one who got yelled at because you're the one who got caught.

You are supposed to wear all the garb when going into a contact room - every time. I know it's annoying. It usually never fails either that right after you take it all off, the patient will ask for something trivial. That's why it's a good idea to poke your head in the door and ask the patient if they need anything at all before you go in so you can gather everything you/they need and lessen the chances of having to gown up and re-gown 15 times.

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