Ice machine use in hospitals

psu_213, BSN, RN · Jul 23, 2016

So the concern seems to be, if a pt's family member sees staff directly fill a new bag from the ice machine, the family member may assume that is is OK to fill a used bag--the latter being pretty yucky. The issue I have is that IF family and visitors have access to the ice machine, I would be concerned more about other "touchings" of the ice/water machine than filling ice packs.

For example, a family member is visiting a pt. who has C. Diff. Despite proper education, they still don't always wash their hands like they should. The family member comes out, goes to the ice machine. Not realizing how it works, they touch all over the dispencer trying to get it give them ice. Now there is C. Diff all over the ice machine. That seems to me to be much more likely contamination scenario than the ice pack issue.

FWIW, the only place I've worked where the ice machine is not behind a locked door is in the ED, but we also have the chemical ice packs where you break open an inner bag, mix the content, and the chemical reaction that ensues makes the pack cold.

olcroner · Jul 23, 2016

The glaring issue here isn't about filling ice bags directly from the ice machine. The issue is a student who would argue adamantly with you. THAT's the issue I'd be addressing.
I don't have access to a particular policy right at the moment, but for forty years, the commonly used practice is to fill from a separate container -- usually a styrofoam cup but if you're really lucky, a graduate.

Thank you for your input on the proper way of filling ice bags, I agree. That's fantastic EBP. Other than flogging this student, which has crossed my mind, but not viable solution, I am addressing her stubbornness with facts. She has some experience as a CNA and she has a BS, working on her BSN, and she has developed some opinions, and spouts her misinformation freely. I am attempting to reign her in without alienating her completely, thus, my introduction of this topic. I have corrected her, privately, on another topic as well. I'm hoping she gets the point. I plan to tell her she shouldn't let her experience get in the way of her education. I am fairly new at teaching and am working on my second master's in education, this time nursing education, but I am open to suggestions here. My first instinct is the flogging, but again, not a viable solution.

Ruby Vee, BSN · Jul 23, 2016

Thank you for your input on the proper way of filling ice bags, I agree. That's fantastic EBP. Other than flogging this student, which has crossed my mind, but not viable solution, I am addressing her stubbornness with facts. She has some experience as a CNA and she has a BS, working on her BSN, and she has developed some opinions, and spouts her misinformation freely. I am attempting to reign her in without alienating her completely, thus, my introduction of this topic. I have corrected her, privately, on another topic as well. I'm hoping she gets the point. I plan to tell her she shouldn't let her experience get in the way of her education. I am fairly new at teaching and am working on my second master's in education, this time nursing education, but I am open to suggestions here. My first instinct is the flogging, but again, not a viable solution.

Flogging would be a memorable solution. I used to hate those kinds of students when I taught!

dishes, BSN, RN · Jul 23, 2016

Have you asked the students how they think ice machines can be the source of nosocomial infections? While they are answering the question, can you draw images of the chain of infection as it pertains to contaminated ice? reservoir, mode of transmission, susceptible host. This is method can be a good way to help students understand how to apply the principles of epidemiology.

verene, MSN · Jul 23, 2016

Sorry. Probably not a good idea to use sarcastic humor in text format, leaves too much for interpretation, didn't mean to seem snooty. I am checking the local hospital policy on this. I work at a Simulation Center where we teach basics of nursing. My rationale is I have witness the refilling of used ice bags directing from the ice machine. How do we stop this potentially nosocomial infection spreading practice. I say and teach don't fill any from the ice machine. My student disagrees. I'm looking for the EBP to start safe habits in my students.

Maybe have students look into potential infection risk areas? The CDC has guidelines on environmental risk factors and best practice, which I think actually includes ice machines in their guidelines. Or have students conduct an EBP search for relevant journal articles?

My program drove home the importance of infection control using the resources here: Partnering to Heal - health.gov

The video is pretty powerful.

You could use it as a starting point for discussion on infection risks and prevention.

olcroner · Jul 23, 2016

Maybe have students look into potential infection risk areas? The CDC has guidelines on environmental risk factors and best practice, which I think actually includes ice machines in their guidelines. Or have students conduct an EBP search for relevant journal articles?
My program drove home the importance of infection control using the resources here: Partnering to Heal - health.gov
The video is pretty powerful.
You could use it as a starting point for discussion on infection risks and prevention.

Excellent. I definitely will check it out, Thank you.

NotAllWhoWandeRN, ASN, RN · Jul 23, 2016

Thank you for your input on the proper way of filling ice bags, I agree. That's fantastic EBP. Other than flogging this student, which has crossed my mind, but not viable solution, I am addressing her stubbornness with facts.

I feel the need to point out that "a nursing social media post resulted in many posts by users who agree with me" is NOT evidence or evidence-based practice. It is people using knowledge and reason to come to conclusions about what they believe is less likely to create cross-contamination.

Strangers on the internet agreeing with you =/= evidence.

I agree that refilling used ice packs at a communal station isn't ideal, but I've only worked at places where the ice machine was staff access only, so the idea of a public one in a hospital kind of grosses me out anyway.

olcroner · Jul 23, 2016

I feel the need to point out that "a nursing social media post resulted in many posts by users who agree with me" is NOT evidence or evidence-based practice. It is people using knowledge and reason to come to conclusions about what they believe is less likely to create cross-contamination.
Strangers on the internet agreeing with you =/= evidence.
I agree that refilling used ice packs at a communal station isn't ideal, but I've only worked at places where the ice machine was staff access only, so the idea of a public one in a hospital kind of grosses me out anyway.

I am not planning to present these post as EBP but I have gotten several new sources and ideas of approach.

jesruf53 · Jul 23, 2016

The following has been my practice for over 40 years. Our ice dispensers are motion-sensored, so nothing has to touch. Our ice bags are disposable, so I throw away and get a new one when needed. If I re-fill a used ice bag, it is done in the patient's room only, never at the ice dispenser.

Filling NEW Ice Bags from ice dispenser:

1. Create an open funnel by punching the bottom out of a NEW, CLEAN Styrofoam cup (to be used as a funnel to fill the ice bag)

2. Attach/Fit the open bottom of the created Styrofoam cup funnel to the mouth of a NEW, CLEAN ICE BAG

3. Place the fitted Styrofoam cup funnel under the lip of the ice dispenser and proceed to fill the attached ice bag

4. Repeat above procedure when needed with a NEW, CLEAN ice bag only.

Re-Filling USED Ice Bags (to be done in patient rooms only):

1. NEVER REFILL USED/CONTAMINATED ICE BAGS AT THE ICE DISPENSER. Used ice bags should be re-filled in patient rooms only. Used ice bags should NOT be brought out of the patient's room to the ice dispenser for refills.

2. Save the created Styrofoam cup funnel in the patient's room (or create a new one) to be used for refilling the used ice bag (in the patient's room only).

3. Attach/Fit the open bottom of the created Styrofoam cup funnel to the mouth of the USED ICE BAG

4. Carry clean cups of ice or clean pitcher liner of ice to patient's room

5. Pour ice into created Styrofoam cup funnel to fill the attached USED ICE BAG.

sevensonnets · Jul 23, 2016

Thank you jesru53! A common sense tried-and-true method that has stood the test of time. I'm not too far behind you at 36 years, by the way.

LadyFree28, BSN, LPN, RN · Jul 23, 2016

The following has been my practice for over 40 years. Our ice dispensers are motion-sensored, so nothing has to touch. Our ice bags are disposable, so I throw away and get a new one when needed. If I re-fill a used ice bag, it is done in the patient's room only, never at the ice dispenser.
Filling NEW Ice Bags from ice dispenser:
1. Create an open funnel by punching the bottom out of a NEW, CLEAN Styrofoam cup (to be used as a funnel to fill the ice bag)
2. Attach/Fit the open bottom of the created Styrofoam cup funnel to the mouth of a NEW, CLEAN ICE BAG
3. Place the fitted Styrofoam cup funnel under the lip of the ice dispenser and proceed to fill the attached ice bag
4. Repeat above procedure when needed with a NEW, CLEAN ice bag only.
Re-Filling USED Ice Bags (to be done in patient rooms only):
1. NEVER REFILL USED/CONTAMINATED ICE BAGS AT THE ICE DISPENSER. Used ice bags should be re-filled in patient rooms only. Used ice bags should NOT be brought out of the patient's room to the ice dispenser for refills.
2. Save the created Styrofoam cup funnel in the patient's room (or create a new one) to be used for refilling the used ice bag (in the patient's room only).
3. Attach/Fit the open bottom of the created Styrofoam cup funnel to the mouth of the USED ICE BAG
4. Carry clean cups of ice or clean pitcher liner of ice to patient's room
5. Pour ice into created Styrofoam cup funnel to fill the attached USED ICE BAG.

Been my practice for 16 years-taught by the BEST! :up:

Been there,done that, ASN, RN · Jul 24, 2016

At first I felt you thought I was wasting everyone's time, now, you seem to be arguing my point. But the student refuses to see it that way. It's the potential of cross contamination. I find if I present the students with policy or EBP then they tend to understand better. Thank you for your tolerance as I am new to the forum. I don't like waiting 900 seconds either.

Not arguing your point, just don't want to do your work for you. You seem to have a problem with PROFESSIONALS discussing the point, but NOT your students arguing the point? Find the policy and the EPB yourself. Is THAT not what instructors are hired to do?