Does this concern anyone else?

[handyrn]

Ok, here is the situation: A pregnant CNA is giving a bath to a resident with an open wound with documented MRSA in the wound. She is wearing gloves to protect herself and unborn baby. DON sees this and is very upset stating that this is humiliating to the patient and CNA should take her gloves off immediately! After the bath is done, CNA approaches DON to discuss the issue. DON tells CNA that she is more likely to get MRSA from a shopping cart than from open wound. DON states that she could "stick her finger in the open wound with MRSA and then stick that finger in her eye and not get MRSA." So CNA is never to humiliate a patient by wearing gloves just because patient has MRSA. (Also, in our facility, we are not allowed to have carts with protective equipment for patients with MRSA/VRE.) Am I off my rocker or does this disturb anyone else?

[AprilRNhere]

Insane! I wouldn't bathe someone without glove regardless. ANyone with MRSA should be gown and glove. My last job told us we didn't have to. I did anyway..and the pt appreciated it. She said she was worried that noone did- because when she was in the hospital they all did. She didn't feel embarrassed- she wanted us to protect ourselves AND other residents.

[MEME123]

Good Golly, Miss Molly:bugeyes:

This DON, lost her mind.

I also agree, could administration be on her back to save the pennies on gloves? Would not surprise me. If staff is kind enough for birthdays or holidays, you know a good book on such would be a great gift.

[Virgo_RN, BSN, RN]

Well the whole thing bothers me because I thought you always wear gloves when doing patient care.......MRSA or not. I remember doing patient baths and wearing gloves no matter what. Sounds like she needs some re-education badly.

You don't have to wear gloves just to do a bath, but you might want to put them on before doing peri care or changing a brief. According to the CDC:

Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intactskin (e.g., of a patient incontinent of stool or urine) could occur.

http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html

The patient in the OP should be on contact precautions. MRSA in the wound does not mean that the MRSA is only in the wound. The patient is colonized, and should be on contact precautions until they are no longer colonized.

[TiredMD]

She's probably not going to get MRSA from the patient, and yes, she's just as likely to get MRSA from a shopping cart as she is from the patient's wound. And if the patient is getting antibiotics for the infection, she could likely stick her finger in the wound and stick it in her eye, and not get an infection. Most likely. Last I checked though, we don't base our use of Personal Protective Equipment on whether or not we are "likely" to catch bugs from patients, we do it if there's any chance of catching it. Duh.

Of course, that's not even the real reason we get all dressed up when we treat MRSA patients. We do it because we spread the bacteria to other patients.

If you don't want to mess with OSHA or other gov't agencies, think about dropping a quick email note to the Medical Director of this facility. It sounds like the DON needs a little remedial infection control education.

[fultzymom]

You don't have to wear gloves just to do a bath, but you might want to put them on before doing peri care or changing a brief. According to the CDC:

http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html

The patient in the OP should be on contact precautions. MRSA in the wound does not mean that the MRSA is only in the wound. The patient is colonized, and should be on contact precautions until they are no longer colonized.

Our facility policy and my nursing school taught us to wear gloves whenever we are doing bathing. I think it is gross to think about giving someone a bath without gloves. The only person I bathe without gloves is myself and my kids, neice, ect. Maybe I am just weird but when I give a patient a bath, I am wearing gloves. Think about how many patients have BM's and urinate when they are in the shower. I want no part of that getting on me while I am bathing them. YUCK!!

[Virgo_RN, BSN, RN]

Once again:

Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intactskin (e.g., of a patient incontinent of stool or urine) could occur.

Not every patient is incontinent, and wearing gloves just because you think it's "gross" to touch another human being with your bare hands does take away from the patient's dignity, IMO.

I think it's important to balance taking reasonable precautions with patient dignity and obviously, safety trumps dignity. But that "reasonable" piece is really important, and we need to think about what we're doing and why.

[pagandeva2000, LPN]

I would definitely glove up even not being pregnant. I do remember in nursing school, however, where we were instructed to only wear gloves when we reached the perineal area, or when there were wounds or open cuts on the patient. I found that to be strange, because I have seen patients do strange things. I would certainly consider giving OSHA a call...no doubt. And, if they can produce this in writing, then, the CNA can shove it down the DON's throat.

[sunny261]

When I first went to school for nursing yes we were told not to wear gloves during care....now I think you can lose your license in some states for not using universal precautions. Now every patient is to be treated as if they have a bloodborne pathogen. This was done to protect the healthcare workers but also if you treat all the patients as if they might have aids or such then you don't discriminate.......imho

[vamedic4, EMT-P]

That DON doesn't need a course in infection control, she (or he) needs to be shown the door. Oh, and I'd shove something down the DONs throat regardless. What a buffoon.

Protecting yourself is of utmost concern at all times, but especially when you're pregnant. In addition to the gloves, I'd have been gowned up too. No need to get dirty water on my scrubs during or after bathing said patient. I recognize the issues before me, but a little explanation to the patient goes a long way.

[RN1982]

I don't care who I offend, its for the safety of me and the patient. I don't want what they have.

[hellerd2003, RN]

In our hospital MRSA is contact precautions. Gloves and gowns if you are within 3ft of pt. I'd not stick my finger ANYWHERE in a MRSA patient without gloves and gown.

[DutchgirlRN, ASN, RN]

i would say a call to the local health department is in order.