Hand Hygiene

mindofmidwifery, ADN · Oct 16, 2015

At the nursing home I worked at, there were signs everywhere telling the residents that it's okay to ask their aides and nurses if they've washed their hands.

RainMom · Oct 16, 2015

You would be well within your rights as the pt to ask staff to wash their hands upon entering your room. They may not like hearing it but too bad. Report non-compliance to the charge or manager if necessary. We remove sanitizer from c. diff rooms since staff will automatically use it out of habit, even when they know it's ineffective.

psu_213, BSN, RN · Oct 16, 2015

You would be well within your rights as the pt to ask staff to wash their hands upon entering your room. They may not like hearing it but too bad. Report non-compliance to the charge or manager if necessary.

Agreed. Also, if you have C. diff or are "on" isolation for anything else, the infection control nurse should be rounding on you. Tell him or her your issues--there is usually very little patience in facilities (by the IC personnel) for staff members who do not follow precautions properly.

Dikid · Oct 16, 2015

No one came to ask if the nurses were doing their jobs? There was no infectious disease nurse or doctor that saw me.

I wasn't hospitalized for c. Diff I got it in the hospital and experienced the same apathy towards the rules in both facilities.

chevygirl1987 · Oct 16, 2015

Sorry you're going through all of that.

At my hospital, the infection control people don't usually round on people. ID may or may not be consulted, it's up to the attending. You can ask people to wash their hands. You shouldn't feel funny about it, and they shouldn't be offended. It is a matter of patient safety.

I would probably call and let management know, people need to be reminded especially as we enter flu season.

MunoRN, RN · Oct 17, 2015

C diff that results from being on antibiotics isn't actually something you catch from staff or other patients, it's usually that you already had C diff bacteria in your GI tract which is held in check be the rest of your normal GI flora (bacteria), then when you take an antibiotic that kills everything but the C. Diff bacteria, the C Diff is now unopposed and flourishes.

You seem to be describing a failure of staff to wash rather than gel when coming into the room which is actually necessary when coming into the room of a C diff patient, only going out of the room.

allnurses Guide · Oct 17, 2015

C diff that results from being on antibiotics isn't actually something you catch from staff or other patients, it's usually that you already had C diff bacteria in your GI tract which is held in check be the rest of your normal GI flora (bacteria), then when you take an antibiotic that kills everything but the C. Diff bacteria, the C Diff is now unopposed and flourishes.
You seem to be describing a failure of staff to wash rather than gel when coming into the room which is actually necessary when coming into the room of a C diff patient, only going out of the room.

I'm sorry but I'll have to respectfully disagree with you here.

C diff can be transmitted by touching contaminated surfaces as a result of poor hand hygiene techniques. That's why it's classed as an infectious disease.

Although it may not pose a problem in healthy individuals it is a risk to those who are unwell, frail etc. Cross infection is a real risk which is why hand hygiene and barrier precautions as so important.

Antibiotics interfere with the normal gut flora which allow the spores to flourish.

I've added some information sheets for you to read

Clostridium difficile - NHS Choices

Fact Sheet Â– Clostridium difficile (C. difficile) - Public Health Agency of Canada

The World Health Organisation 5 moments describe before during and after contact hand hygiene to prevent cross infection.

WHO | About SAVE LIVES: Clean Your Hands

It's good practice to clean your hands when you enter a patient space.

MunoRN, RN · Oct 17, 2015

I'm sorry but I'll have to respectfully disagree with you here.
C diff can be transmitted by touching contaminated surfaces as a result of poor hand hygiene techniques. That's why it's classed as an infectious disease.
Although it may not pose a problem in healthy individuals it is a risk to those who are unwell, frail etc. Cross infection is a real risk which is why hand hygiene and barrier precautions as so important.
Antibiotics interfere with the normal gut flora which allow the spores to flourish.
I've added some information sheets for you to read
Clostridium difficile - NHS Choices
Fact Sheet Â– Clostridium difficile (C. difficile) - Public Health Agency of Canada
The World Health Organisation 5 moments describe before during and after contact hand hygiene to prevent cross infection.
WHO | About SAVE LIVES: Clean Your Hands

I think you're confusing hand washing (soap and water) with hand hygiene which can consist of gelling or washing. My statement was that hand hygiene in the form of gelling is sufficient when entering the room, not that no hand hygiene is necessary.

Excessively frequent washing can actually increase your risk of harboring bacteria and transmitting to another patient, which is why hand hygiene should consist of both gelling and washing when frequent hand hygiene is necessary. When leaving a C-diff room only washing (soap and water) should be used as gels generally aren't effect against C diff. When entering a C diff room cleaning using gel is sufficient.

JVoEDrn · Oct 17, 2015

Deleted my post Bc

I just reread

One that I thought was incorrect in answering

Glycerine82, LPN · Oct 17, 2015

I am posting this from " the other side"
I am a nursing student. I was hospitalized for about 3 weeks. I contracted a c. Diff infection while in the hospital ( prophylactic iv antibiotics).
I was put on contact precautions and a very clear sign outside my door and on the Purell dispenser clearly stated that hands needed to be washed with soap and water along with the need to wear gloves and gowns. I understand that nurses are busy but it made me very upset when they did not follow protocol. But the Patient techs were infuriating for the most part. They didn't just avoid the wash with soap and water but hardly gloved up. Many didn't even take
Purell. I thought it was just that hospital. But I was transferred to another hospital due to complications and needing a higher level of care. The staff in this internationally acclaimed medical center also failed to follow protocol.
what makes me scared is that I had a relatively minor and difficult to catch contagion. What if the patient next to me had Mrsa or worse and I am on chemotherapy? my immune system is very weak and an infection like Mrsa could prove fatal or at least incredibly debilitating. Sure enough, I got a nosocomial infection that turned into a very bad respiratory tract infection. I can't say it was caused by the lack of hygiene but it may have been a contributing factor.
What I am really asking is that you please enforce the rules that have been put in place for both the staff and patients safety.
Please ensure your patient care technicians do the same.
Thanks for reading

C-diff is NOT "relatively minor", for one. It's hard to catch only for those who are not immunocompromised in some way. (Antibiotics, illness, infection, etc. ) For those who ARE, it's quite easy to catch. Which is why there are such contact precautions in place and why the infection is so prevalent.

Depending on where the sink is located in the room, sometimes I'll wash my hands again directly after leaving the room to avoid having to walk back through the room without my gown on, since its the spores we need to look out for. Just food for thought.

la_chica_suerte85, BSN, RN · Oct 17, 2015

This should be directed at the facilities you were at -- the reminder is appreciated but if you have aides coming in without even gloving up.... :nailbiting:

Keep in mind things happen that would make you really wonder. For instance, I have patients that I have to get stool samples on that are being ruled out for C. diff. They aren't already on precautions because they don't know if they even have it yet. But, there I go, having to go get the sample (thank god one wasn't diarrhea -- one was, however, so....eek) without knowing what I might be leaving the room with. Of course I wash my hands after I'm done with everything but still, you gotta wonder, right? Also, there is some evidence suggesting that a big contributor to the spread of C. diff to immune compromised folks is through staff footwear (a la when the aides throw the soiled linen on the floor while changing out a bed).