How much of this seems within CDC guidelines?

Posted
by GoAway2020 GoAway2020 (New) New Nurse

I'm an nurse in an inpatient detox in a larger city. Our facility is large and had many extra beds when COVID hit and so we "offered" them up to the county to be used as isolation for positive patients with nowhere to go. 

These patients have mild symptoms, if any, and must be self-sufficient in order to be admitted (e.g. independent with ADLs, compliant with medication on their own, walky/talky, etc.). We mostly have homeless patients, awaiting placement in a shelter or return to a sober home, etc. after their isolation period. We have the periodic pt. who does not want to return home to possibly infect family. 

Again, we are in inpatient detox facility with limited equipment (no oxygen, imaging, no CNAs - we use MHTs). The COVID unit is run by a single RN/LPN. It is voluntary to work. Nurses visit the unit approx. once every 2 hours for VS, meals, etc. There are no cameras. Pt's have their own phones in order to contact nurse if they need to. 

There are many questions that the nurses continue to ask. We are given inadequate answers or provided what we see as "the run-around." 

Firstly, men and women are housed together on the unit. Again, these patients are unsupervised for the vast majority of the day. 

Secondly, patients are co-mingling in shared rooms and a dayroom. Whether they are day 1 or 10 of isolation, they are all together. We've been told that the CDC approves of this but it seems wrong to discharge a patient as cleared when they were just standing next to/hanging out with a patient on day 1 of iso. 

Third, pt's have their own medications on the unit and are expected to comply with med on their own. We merely ask them if they have taken their meds. This has been explained to me as patients being completely independent as if they were at home, only we are providing to space for them. However, some patients do have narcotics on the unit and there's a risk of OD by themselves or other patient that may steal their meds. 

Fourth, the hospital is single-story and patients are able to leave via an emergency door which does not alarm. A number of patients have been caught leaving premises but I'm sure a far greater number have come and gone without anyone knowing. This also gives them easy access to contraband brought in from outside source. 

Fifth, patients have access to a smoking patio and are allowed to smoke (again, treated as if they were at their own home - well, except we take vitals on them, provide meds when needed if they don't have them, etc.). Nursing and admin have disagreed on whether or not we should allow smoking and have argued both sides of "well, if they were at home they could" and "In any other hospital, if you left the unit to smoke, they'd discharge you."

 

I don't even know why I numbered these as there are a dozen more issues right on the surface. I guess I hoped it would make it easier to see the big picture and maybe answer the big questions. 

 

Are we doing this whole thing wrong? Are we completely out of compliance with CDC recs? Are we being negligent? I've researched a bit on CDC recs but it can get confusing and I'm honestly overworked and overwhelmed and just needed to reach out for some guidance, ASAP. 

 

I know some at my facility really do want to help the community with this service. I'm also sure many admin are just seeing money signs every time they see COVID on a referral. 

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 43 years experience. 1,707 Posts

7 hours ago, GoAway2020 said:

 

Secondly, patients are co-mingling in shared rooms and a dayroom. Whether they are day 1 or 10 of isolation, they are all together. We've been told that the CDC approves of this but it seems wrong to discharge a patient as cleared when they were just standing next to/hanging out with a patient on day 1 of iso. 

 

This is not isolation. As soon as a new patient comes in (Day 1), then everybody who comes in contact with that person is Day 1.

GoAway2020

GoAway2020

3 Posts

12 hours ago, Kitiger said:

This is not isolation. As soon as a new patient comes in (Day 1), then everybody who comes in contact with that person is Day 1.

This is how every nurse I work with sees it. But management claims the health district/CDC approves of this. The only way I could even potentially see that is under emergency circumstances where we have literally run out of places to house everyone. 

This is somewhat the case as the county is desperate to house these individuals and we do not have the space to provide each with their own room. 

GoAway2020

GoAway2020

3 Posts

Anyone else have some insight? 

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,052 Posts

It's actually within CDC guidelines to cohort COVID positive patients, regardless of what day they are on in the course of their infection.  There's not really any reason to start their isolation period back at day one just because they are exposed to someone who has had a Covid infection for a shorter period of time.

There is a reasonable debate to be had about the transition from isolation after the 10 days of recommended isolation (20 in some cases) if they have been cohorting with Covid positive patients.  It's unlikely they can develop a new infection at that point which would necessitate lengthening their isolation period, but they can essentially be surface vectors for transmitting the virus to others, although that's much less likely than with someone who is still in the active infection phase.  Ideally they should be wearing mask for some period of time prior to leaving the cohorted unit and then continue to wear a mask in public.  

As for leaving them to continue to manage their own medications, I wouldn't push for the nursing staff to take on responsibility for their medications, that brings on a whole world of liability that I wouldn't want to take on if I were you.  

 

 

Jedrnurse, BSN, RN

Specializes in school nurse. Has 30 years experience. 2,776 Posts

On 9/6/2020 at 9:06 PM, Kitiger said:

This is not isolation. As soon as a new patient comes in (Day 1), then everybody who comes in contact with that person is Day 1.

I don't understand. This would seem to me to be the case if the patients were contacts, but these people are virus positive, aren't they?

SoCal student

SoCal student

52 Posts

5 hours ago, Jedrnurse said:

I don't understand. This would seem to me to be the case if the patients were contacts, but these people are virus positive, aren't they?

Correct.

Edited by SoCal student

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 43 years experience. 1,707 Posts

9 hours ago, Jedrnurse said:

I don't understand. This would seem to me to be the case if the patients were contacts, but these people are virus positive, aren't they?

I stand corrected. ?