Ice machine use in hospitals

sevensonnets · Jul 24, 2016

Getting ice out of a dispenser is not such a monumentally huge issue that it couldn't have been dealt with in under a minute. Now students, listen up. This is how you do it, this is what you shouldn't do. Over and none. Not worth 5 pages of discussion on AN.

RN-Doula · Jul 24, 2016

As an instructor I tell my students "We are a guest at this facility, we follow their policies. If you don't like their policies, after you graduate, get employed here and change the policies." Of course there have been a few places as an instructor, I have stepped in and shown new updated policies to the staff and had changes made. Other times I tell the students we will discuss behind closed doors, away from the staff's ears, what is taught as updated policy and what they actually see being done.

kskarzin91 · Jul 24, 2016

Our ice machines are not available to patients families. There is a key code on the door to our kitchen. And we don't use reusable pitchers only styrofoam cups that are single use only. They don't leave the patients rooms. If they need a refill the old cup is thrown away and we bring them a new on.

As far as an ice pack they are also single use. I would have no problem if a student filled a new ice pack from the ice machine. If the pack would need to be refilled we would then fill a styrofoam cup and take the cup into the room to refill the ice bag at bedside.

I have to side with the student on this one. There's no difference in filling a new pack directly or filling a cup them the ice pack. It just adds another step and honestly I believe adding steps would increase the chances of contamination. But like previous posts have stated the ice never comes in contact with the skin so really it's a pointless argument. I probably would spend time on more important teaching points with students than this.

Axgrinder · Jul 24, 2016

I like rearviewmirror's approach! Want some ice? Well, here you go, have some ice!!

Me too! I snorted so hard laughing I hurt myself! (Scared the cat too)

(I honestly haven't had such a good laugh in quite a while â€¦ thank you! I so needed that!). :) :) :)

morte, LPN, LVN · Jul 24, 2016

try contacting the infection control depts at all local hospitals, as well as that CDC link. since it does not require a lot more work, filling a used bag with cup/graduate seems a no brainer.

pedseraprn · Jul 25, 2016

How about cutting the bottom off a styrofoam cup and using it as a funnel for the ice? The funnel touches the machine. Obviously it can be re used and get gross, but might be an alternative if ok with your policy.

NurseSpeedy, ADN, LPN, RN · Jul 25, 2016

I am the instructor. So it's just because I say so.

...and how's that working for you?

While I do not find it appropriate for the student to be arguing with you as an instructor, I do think that he/she deserves to be directed by whatever the facilities policy and procedure is regarding the issue, not just what your judgement would be given the situation. Most of the places that I have worked lately have the ice machine locked away from patients/visitors. Clean is clean. Dirty is dirty. Nothing that has entered the patient's room finds itself anywhere near the ice machine (or most other places for that matter).

As a parent, I never told my child, "because I said so". It teaches the child nothing except to do what someone says because that person is in an authority role. It doesn't teach then the rationale or reason so that they understand why or why not to do something the next time...and your student is an adult paying you for a quality education. We teach nursing students to question doctors orders that are unclear or possibly dangerous, not to just do as the order says because, well, the doctor said so. That would be unsafe. The student didn't understand your reasoning. The right thing would be to have them look up the policy. However, as a nurse I would first review that policy for myself, because if not it may just bite you when she shows you her research.

paroxetina · Jul 26, 2016

For the life of my career, I have always run ice into a liner or a cup and cut out another small cup to place ice in reusable containers such as an ice pack-even initially be used it was impossible for all the ice to make the bag and I would make a mess like a toddler most of the time.
It was always stressed to prevent inadvertent cross contamination as much as possible-with the ever increasing HAIs making their way into the community, as well as the resurgence of preventable (vaccinated) infections and diseases (*cough cough* Pertussis and Mumps has returned to my community and we are up to 6 confirmed cases in the past MONTH at my facility) I try to be mindful of those possibilities. I work in a setting where our pantries are locked, and I do refill container with disposable cups to prevent cross contamination as mush as possible-even for my own container from home.
OP, explain to your student factually and professionally that we always have the ability to cross contaminate, and the best practice of health promotion is to use a system to prevent that when refilling reusable items-not just "because I said so"; it makes you look less credible as an instructor, and may affect your relationship and credibility as an instructor with this student and other students (because nursing students TALK-you know?)

This, x1000! I know that when I was a student, if I asked a professor/clinical instructor/preceptor/whatever what the rationale for his/her answer to my question was, and this person told me: "because I said so," I would infer that this person had no idea and I would not trust the answer.

olcroner · Jul 27, 2016

OK. I appreciate everybody's input. I'm am still researching this but the silver lining is this student has seen the light. I corrected her, privately, about another incorrect statement she made and was adamantly arguing. She said she had incorrect information and she appreciate me correcting her. Her attitude has improved and she is approaching her learning with more of an open mind. This was my goal. Trust me, I was highly irritated with her attitude, but this is a new generation of students and they respond differently than you and I did when we were students.

dishes, BSN, RN · Jul 27, 2016

olcroner I don't think it is necessarily a generational issue, like you I have been a nurse for 28 years and I remember a classmate arguing with the lab and clinical instructors about procedures and practices, she was convinced her prior experience as a PN meant she knew the correct way of doing everything. She had several meetings and a few threats before she realized the error of her ways.

joleneliddell · Jul 28, 2016

This info. may help:

According to the CDC and HICPAC (2014):

Microorganisms may be present in ice, ice-storage chests, and ice-making machines. The two mainsources of microorganisms in ice are the potable water from which it is made and a transferral oforganisms from hands (Table 20). Ice from contaminated ice machines has been associated with patientcolonization, blood stream infections, pulmonary and gastrointestinal illnesses, and pseudoinfections.602,603, 683, 684, 854, 855 Microorganisms in ice can secondarily contaminate clinical specimens and medicalsolutions that require cold temperatures for either transport or holding.601, 620 An outbreak of surgicalsiteinfections was interrupted when sterile ice was used in place of tap water ice to cool cardioplegiasolutions.

In a study comparing the microbial populations of hospital ice machines with organisms recovered fromice samples gathered from the community, samples from 27 hospital ice machines yielded low numbers(

See page 65

http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf

Kooky Korky, BSN, RN · Jul 28, 2016

Do you suggest flogging them into submission or trying to educated them to do the right thing?

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