I am SO not a happy camper!

[MadisonsMomRN, BSN, RN]

At the facility I work in, we have a patient that was just diagnosed with MRSA in the sputum. The charge had to convince the doc to put him in isolation. He's been in respiratory isolation for 2 days and the doc says today that he doesnt need to be in isolation. He has NOT tested negative. The charge nurse is going over top of him to have this guy stay in isolation. This doctor is not the one taking care of him. We are risking the rest of the patients and staff of exposure.

Also, we have a case of Salmonella too. He is also not in isolation.

What is your take on this?

[EmmaG, RN]

Contact your infection control nurse. Isolation for certain conditions isn't on the whim of the doctor. It's federally mandated.

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

[MadisonsMomRN, BSN, RN]

I know... Salmonella is reportable and I know that he needs to be isolated. I am not happy because the salmonella case should have been isolated pending results. So this stuff is probably going to be everywhere.

Ugh!

[EmmaG, RN]

I know... Salmonella is reportable and I know that he needs to be isolated. I am not happy because the salmonella case should have been isolated pending results. So this stuff is probably going to be everywhere.

Ugh!

Unless the patient is incontinent or an infant/toddler in diapers, salmonella is standard precautions.

Here. I tried to find it separately on the CDC site (it's part of a 219 page report lol), but ended up having to use The Google. I'm not sure what site this link if from, but it's a copy of Appendix A of the CDC isolation guidelines that lists the infections and conditions w/the type and duration of isolation required.

http://www.md.ucl.ac.be/didac/hosp/Isolation.pdf

I carry a copy of that in my clipboard for reference.

[MadisonsMomRN, BSN, RN]

Thank you!

This guy (salmonella) is by himself and has his own toilet. I wonder who else will be affected and where it came from.

Our medical director is a trip... he thinks he MAKES the rules.

[deehaverrn]

One problem we run into ALL the time , on our high-risk obstetrics unit we have pregnant moms who all ready have issues, as well as moms with newborns in nicu, also overflow moms with their babies (when main postpartum area is full)--i maintain that just having to have two postpartum moms sharing a bathroom is terrible (how can you guarantee safety when they can both be exposed to the others blood every time they use the facility?) Then the admissions people will want to add people with abcesses or known MRSA or fevers of unknown origin when the med-surg areas are full. No matter how much handwashing or other precautions you take..its an accident waiting to happen...these newborns, especially in Nicu should be a top priority and take precedence. It used to be that we didnt have to accept these admits or transfers but now they won't take no for an answer.

[EmmaG, RN]

one problem we run into all the time , on our high-risk obstetrics unit we have pregnant moms who all ready have issues, as well as moms with newborns in nicu, also overflow moms with their babies (when main postpartum area is full)--i maintain that just having to have two postpartum moms sharing a bathroom is terrible (how can you guarantee safety when they can both be exposed to the others blood every time they use the facility?) then the admissions people will want to add people with abcesses or known mrsa or fevers of unknown origin when the med-surg areas are full. no matter how much handwashing or other precautions you take..its an accident waiting to happen...these newborns, especially in nicu should be a top priority and take precedence. it used to be that we didnt have to accept these admits or transfers but now they won't take no for an answer.

wow.

that is so very wrong; everywhere i've ever worked strictly segregates their pp patients from the general population.

geez... does your infection control nurse know of this? if the answer to your concern is something along the line of "well if you wash your hands and follow precautions there will be no problem" (what we heard re: placing infected patients next to neutropenic patients), please ask them to show you the study that shows 100% compliance among everyone who enters those rooms (staff, docs, and visitors).

[Tweety, BSN, RN]

Hospital policy overrules doctors orders. A couple of times I've dealt with this, once when it was just colonized in the nares. The other when he order AFB's in the sputum which are an automatic isolation.

The broken record routine "it's hospital policy for them to remain on isolation. Would you like to talk to Dr. ID who sits on that committee and wrote that policy?"

[Tweety, BSN, RN]

One problem we run into ALL the time , on our high-risk obstetrics unit we have pregnant moms who all ready have issues, as well as moms with newborns in nicu, also overflow moms with their babies (when main postpartum area is full)--i maintain that just having to have two postpartum moms sharing a bathroom is terrible (how can you guarantee safety when they can both be exposed to the others blood every time they use the facility?) Then the admissions people will want to add people with abcesses or known MRSA or fevers of unknown origin when the med-surg areas are full. No matter how much handwashing or other precautions you take..its an accident waiting to happen...these newborns, especially in Nicu should be a top priority and take precedence. It used to be that we didnt have to accept these admits or transfers but now they won't take no for an answer.

Very bad practice. Our gyn floor sometimes takes overflow med-surg patients, but because they also take overflow pp patients, they can't take anything whatsoever with an infection or suspected infection. They look at WBCs and temps and diagnosis and the ER and supervisors accept no for an answer every time.

[MadisonsMomRN, BSN, RN]

One problem we run into ALL the time , on our high-risk obstetrics unit we have pregnant moms who all ready have issues, as well as moms with newborns in nicu, also overflow moms with their babies (when main postpartum area is full)--i maintain that just having to have two postpartum moms sharing a bathroom is terrible (how can you guarantee safety when they can both be exposed to the others blood every time they use the facility?) Then the admissions people will want to add people with abcesses or known MRSA or fevers of unknown origin when the med-surg areas are full. No matter how much handwashing or other precautions you take..its an accident waiting to happen...these newborns, especially in Nicu should be a top priority and take precedence. It used to be that we didnt have to accept these admits or transfers but now they won't take no for an answer.

WOW! This is terrible. I can't believe they would put these PP ladies at risk like that.

[NRSKarenRN, BSN, RN]

One problem we run into ALL the time , on our high-risk obstetrics unit we have pregnant moms who all ready have issues, as well as moms with newborns in nicu, also overflow moms with their babies (when main postpartum area is full)--i maintain that just having to have two postpartum moms sharing a bathroom is terrible (how can you guarantee safety when they can both be exposed to the others blood every time they use the facility?) Then the admissions people will want to add people with abcesses or known MRSA or fevers of unknown origin when the med-surg areas are full. No matter how much handwashing or other precautions you take..its an accident waiting to happen...these newborns, especially in Nicu should be a top priority and take precedence. It used to be that we didnt have to accept these admits or transfers but now they won't take no for an answer.

Have you informed your infection control nurse of this issue??? Often they have the POWER to stop such dangerous practice....only takes ONE infection to ruin units reputation and cost $$$$ defending poor practice.

Might want to drop off this ditty to to risk management:

woman become amputee x4 after giving birth. Hospital to blame?

[deehaverrn]

We used to be able to say that something wasn't appropriate to our unit due to the possiblity of infection. Then a few years ago, a new infection control nurse maintained that as long as we used standard precautions or whatever was indicated that there was no reason for concern. Since then we get just about everything. Years ago, even pts with justifiable reasons for being on our floor such as pregnant women who were in preterm labor were kept on a med-surg floor if they had shingles for example. Now we get post op 7 days with fevers and suspected abscess. I guess its because no one sticks up for us , least of all our poor excuse for a nurse manager. And most of administration is not educated in ob issues.

Also, it used to be that all the pediatricians would come to see their newborns first, then visit sick kids on PEDS. Most of the groups still do this, but the largest one insists on seeing Peds first than the babies. I've seen how they wash (or don't) their hands. Its just not right. We did try to stop this practice, but were unsuccessful, the same as the above problem.