Do you think "isolation precautions" are outdated?

Zizka · Dec 27, 2006

:smiletea: After some pondering and a lot of dressing up and back down at work tonight, I wonder, Do you ALL put people on contact iso if they have a hx. of mrsa, no matter what?? Often pts come in and have a wound or pneumonia or diarrhea. Tests are run, one to two days later, whammo, they have MRSA, or cdiff and they are rushed into a pvt. room, contact iso. How smart isTHAT??? or they come in and four years ago they had MRSA pneumonia, but are in for stomach pains, yet they get put in contact iso with droplet precautions... If we all use universal precautions and they dont have TB, active cough, etc, and if MRSA is truly the staph of today and everyone gets or has it, and if all RN's nostrils probably carry MRSA anyway, why do we do this??? Im still fairly new, but don't you wonder? Havent you also seen docs and family members go in and out without the gowns, gloves and masks?? Lets get real, havent we, as nurses, sometimes done the same in a hurry? But we always wash, we always take precautions around body fluids, etc.
So what does your facility do? What do YOU do>>>??? :smokin:

Agree. There's alot of BS out there. Obviously "isolation" is not workling.

"In the United States, it has been estimated that as many as one hospital patient in ten acquires a nosocomial infection, or 2 million patients a year. Estimates of the annual cost range from $4.5 billion to $11 billion and up. Nosocomial infections contributed to 88,000 deaths in the U.S. in 1995. One third of nosocomial infections are considered preventable."

Nosocomial infection - Wikipedia, the free encyclopedia

"Handwashing frequently is called the single most important measure to reduce the risks of transmitting microorganisms from one person to another or from one site to another on the same patient.

Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions."

Paging Dr handy.

Hoozdo, ADN · Dec 27, 2006

:smiletea: Havent you also seen docs and family members go in and out without the gowns, gloves and masks?? Lets get real, havent we, as nurses, sometimes done the same in a hurry? But we always wash, we always take precautions around body fluids, etc.
So what does your facility do? What do YOU do>>>??? :smokin:

In my experience, only pts with ACTIVE MRSA (or other infections requiring isolation), are put in isolation. It doesn't count if they had an infection 4 years ago. These are usually pts with septic infections. I work in ICU, so I run into a lot of septic pts.

It pisses me off when I see respiratory, housekeeping, or anyone go into a room without a gown and I DO say something. I have yet to see a Dr not wear a gown. The other night at work, and I just have to shake my head, I saw a nurse taking care of a pt with MRSA in the blood wearing a mask and gloves, no gown. I asked him, why the mask? This is not droplet precautions, it is CONTACT precautions.

It also highly irritates me when an RT says, "I am just going to touch the vent so I don't need a gown." Does he know how many times I have pressed the 100% oxygenation button with slightly snotty gloves on? I think if they thought this out a bit, they would wear a gown :trout:

Sorry to get on a soap box, but this is one of my big pet peeves in nursing. I am a transplant recipient and have to take immune suppressants. Don't be germing up my enviroment and spreading crap to other pts rooms! Knock on wood, I have never picked up an infection yet from a pt.....and I don't intend to!

talaxandra · Dec 27, 2006

We don't isolate MRSA patients at all, unless they have an MRSA chest infestion. We do isolate (as in put them in a single room) patients with VRE or VISA colonisation, but they only get the gloves-and-gown treatment if they have a VRE/VISA-infected wound (haven't had one of those yet) or a colonised and fecally incontinent - then it's glove, gown and 1:1 special.

oramar · Dec 27, 2006

My personal opinion is that if to many patients are in isolation all at once it gets ignored. Best to do it for respiratory infections only. Private rooms with universal precautions for everybody is the way to go. If their are 24 patients on the unit and 19 of them are in for MRSA precautions it becomes impossible to do all the extra steps that go with isolation. Put the ones that have active infections in isolation. Yes, it would help if they did a better job of identifying the people that have active infections from the get go. For those finger waggers out there that are going to give lectures. Let me tell you that I have not worked anywhere that did not allow managment to bend isolation rules when beds were tight. The other day I had supervisor tell me it was OK to put a VRE+ patient in room with another patient that was negative as long as staff wore gowns and gloves and practice proper hand washing. YIKES!

BJLynn · Dec 27, 2006

All residents of my facility that present with MRSA or C-Diff are automatically put in isolation and they have a staff member present outside their door. With VRE things get a bit more touchy. Most times they require more intense therapy and are transferred to skilled care at a hospital or a nursing home where they can recieve IV antibiotics.

The LTC I worked at before this scared me with their treatment of MRSA. We had a lady with stasis ulcers on her legs that were oozing. BADLY. C&S confirmed MRSA. This lady was to be contact Isolation and had to be showered in a specific shower and then the shower discenfected immediately after. However, even with the wounds that drained so badly that it soaked through her pant legs, she was allowed to go anywhere and do anything she wanted within the facility. She'd scratch a leg and then touch the table and so forth...scary. Took three or four months to clear up those wounds.

KaroSnowQueen, RN · Dec 27, 2006

Anybody at my hospital who has a HISTORY of Mrsa, vre, or whatever is always in isolation. What gets me is they book a bed in a double room, send the patient up, THEN we read in the admit notes from the dr's office that the patient is suspected mrsa, c diff, whatever. THEN we have to get a private room and bed booking gets all bent out of shape over it.

AlisonBSN · Dec 27, 2006

If I'm just dropping off a box of tissues or something, I will just open the door, place it on the table, and walk out without putting on gloves. But what I think is silly is when we're waiting on a stool sample to check for C. Dif and they're not in isolation, but as soon as we get the sample and it tests positive, then there's they're in isolation. As if they didn't have it before we put them on isolation.

We check all the nursing home patients for MRSA in the nares. It seems like most of them have it.

We should probably just put on gloves for all contact. You'd spend at least an hour of your time washing your hands if you did so between every contact. I understand its importance, but you just can't for every little bit of contact.

I think the precautions are kind of silly, but we have to at least attempt to keep the number of infections down.

lsyorke, RN · Dec 27, 2006

All residents of my facility that present with MRSA or C-Diff are automatically put in isolation and they have a staff member present outside their door.

They have a staff member at their door???? Wow.. that's a bit over the top!

Fairlythere, ASN, RN · Dec 28, 2006

what I think is silly is when we're waiting on a stool sample to check for C. Dif and they're not in isolation, but as soon as we get the sample and it tests positive, then there's they're in isolation. As if they didn't have it before we put them on isolation..

I had a lady come up tonight! Put her in a rm with a comfort care pt. Orders say CDIFF TOX SCREEN ASAP - hx diarrhea and others at her facility have been sick. You just KNOW its gonna be positive -I can SMELL it!

ARRRRRRGGGGGHHHH.:uhoh21:

Fairlythere, ASN, RN · Dec 28, 2006

In my experience, only pts with ACTIVE MRSA (or other infections requiring isolation), are put in isolation. It doesn't count if they had an infection 4 years ago.

I wish. We have to track labs on new pts as far back as we can to see if they have a history of MRSA, VRE, CDIFF, Etc. If they do, they go to ISO. Unfortunately, its the new cases we don't know if they have it yet who go to non-private rooms until its discovered. How stoopid is that?? :monkeydance:

bklynborn · Dec 28, 2006

I think ISO for "history of" is crazy but it is policy so we do it. If it was in a wound and the wound is healed I use standard precautions. Hx of airborne and no cough present then I don't gown or mask.

I too get annoyed when there are new admits and 4 days later after admit they are diagnosed with resp MRSA. I say standard precautins for one and all. And if there is active coughing, use a mask.