universal precautions

  1. Aloha,
    I work in a rather unique situation with a group (9) of nurses and an MD who all are dinosaurs. All of the nurses are over 55 and the MD is 70 and all have been out of school etc for 25 or more years. We have a resident who isover 95 yrs old who has a recent dx of hep b (from lab work but has probably had it for years due to place of origin living conditions etc). The MD is freaking and has orderd him in isolation, the DON wants him to have spec BP cuff. I am under the impression that "universal precautions" is what we should for all patients at all times. That is, we do not need to glove if he has intact skin and we are not going to be in contact with body fluids. He is not incontinent per se but does sometimes miss the toilet, should we not clean all bathrooms the same (ie act like all pts have potential diseases in urine and feces and clean accordingly?)
    Also we do some laundry here...pts clothing,draw sheets,towels, pillow cases and send sheets and blankets to a commercial laundry. do we have to do anything special with his stuff.
    Thanks very much for any help. Nancy
  2. Visit nancyluphi profile page

    About nancyluphi

    Joined: Sep '01; Posts: 3
    RN LTC Hansen's Disease


  3. by   nilepoc
    Sounds like you have the right idea, your director is going over the deep end.

    remember, If it is wet and not yours, don't touch it.
  4. by   BrandyBSN
    I do think that DON is overreacting. But then again, I wear gloves for everything (except washing patients hair, latex and rubbing hair is cruel). I wear gloves when giving a patient a bath, when rubing lotion on them, or when giving a backrub.

    I do this because my immune system is not the greatest. I always catch everything, and everything makes my skin itchy. Im a student, but I am hoping that as I spend more time with patients, my immune system will become stronger.

    If a patient ever act offended that I use gloves, I make sure to explain to them that I do this with EVERY patient, regardless of the diagnosis, and that I dont mean to offend them, but i just want to be sure that I stay as healthy as I can, so that I can give them the best care possible. I have never had a patient that didnt understand why I wear gloves after I explain it, and usually get a "thank you for being so careful".

    But a specific BP Cuff for one patient? that is a neurotic.
  5. by   Slowone
    I agree..gloves always. You never know what you may stick your hand in that may not be in direct view.
    But it sounds like your DON and the doc may need a refresher course on how hep b is transmitted!
  6. by   frustratedRN
    if the resident is over 95 and all he has is hep c...thats pretty cool in this day and age.

    the only smart thing is to treat everyone like they have everything.

    niles...your wet theory takes all the fun out of sex
  7. by   prmenrs
    If you're @ Kalaupapa, I'd think that the State of Hawaii Dep't of Health (or whatever it's called there) would have jurisdiction over health care delivery; maybe you could suggest getting guidelines from that agency, and using them.

    If the USPHS is the agency involved, I'm sure CDC's recomendations would be appropriate, (they would be no matter what--the ultimate authority on stuff like that!) I'll find that web site and edit my message after I find it.

    Hepatitis B is a blood-borne pathogen; I don't know how his living conditions could have caused it. He could have gotten it from a blood transfusion, esp if he got it before blood banks knew about or tested for Hep B. Knowledge about Hep B really came out in the mid 70's--before that, he could have had it and no one would have known.

    If he was in the Korean War, he could've gotten it there--there was an outbreak among soldiers of a hepatitis that no one could diagnose because the tests didn't exist. BUT...some bright-eyed epidemiologist @ the CDC drew blood (or more likely, had the Army do it), froze the serum, and when they finally developed the Hep tests, they checked the frozen serum, and voila!, epidemic solved.

    If this little guy went somewhere, got hospitalized, and some well-meaning, but unknowing, personnel isolated him innappropriately isolated him because he comes from Kalaupapa, what would your dinosaur/colleagues have to say? I don't think it would be too pretty!!

    Aloha to you!

    Sandi, another >55 y/o dinosaur

    p.s. as promised, I'm back w/the www's:

    www.cdc.gov/ncidod/hip/ISOLAT/isolat.htm for stuff re: isolation in gen'l

    www.cdc.gov/ncidid/index.htm for info on diseases--use the index search right on the home page for the alphabetical listing--it's a feww spaces after Hansen's! Good Luck w/ your dinosaurs!
    Last edit by prmenrs on Oct 13, '01