Immunocompromised Loved One

[lillianbenders, ADN]

Hey!

I'm 3yrs into nursing school and also employed in an ICU but I have a semi-unique home situation that I can't find a lot of other people who relate to. My partner and I live together and he has cystic fibrosis. During clinical, I request to not have isolation patients for fear of what I could potentially bring home (especially since we have a lot of flu, pneumonia, TB, infection patients right now). So far none of my instructors have an issue with accommodating this as long as I understand that I am missing out on this potential learning opportunity. However, I still feel kind of shady and bad when I have to have other people accommodate this or when I can't assist with these patients. I know my peers are usually okay with it, but some of them do get annoyed. Most of them do not understand the extent of the consequences that an infection or illness could have if I did happen to bring it home. I come home and wash my scrubs immediately, we have sani-wipes/purple wipes in our apartment, I don't take my shoes into the apartment, etc. He wears a mask in public for the most part, wipes down most public use items, and otherwise does a lot to prevent exposure to bacteria and viruses.

I have done some research and found that healthcare providers typically do bring a lot of things home so I know it is not totally unreasonable. Does anyone else have experience with this themselves or with a coworker? Does it come off as unreasonable and extra/paranoid? Or is it normal for some people to have these restrictions (I know pregnant patients won't handle any potential exposures to harmful situations - stuff like that)?

Any input - even just an opinion - would be greatly appreciated :)

[Pepper The Cat, BSN, RN]

You do realize that there is no way you can guarantee you will not have a pt requiring isolation. The pt you took care of today may come up VRE positive tomorrow and you took care of him without isolation.

and i don’t think it is reasonable for your co-workers to constantly have to care for the isolation patients.

It sounds like you have a system to protect your partner as best you can and need to stick with that.

[MunoRN, RN]

I think you're incorrectly seeing isolation patients as the main threat to your partner with CF. Those with CF are susceptible to a wide range of pathogens, including those that you have the potential to pass on from your classmates, workmates, or just being out in public in general. At least with isolation patients there are precautions taken to avoid you becoming a vector, which isn't the case with other patients or just people in general who may pass along any number of things to your partner via you. If anything, I would argue you should prefer taking isolation patients to best avoid transmitting things to your partner.

[MountaineerFan57, BSN]

I understand your intentions with this, but I don’t think you’ll ever find a workplace that lets you not skip out on taking care of isolation patients.

[Rionoir, ADN, RN]

Just don’t touch literally anything in the hospital and you’ll be fine.

Seriously though just leave your work shoes outside, throw your scrubs straight into the washing machine when you get home and wash your hands/take a shower. The germs in isolation are everywhere.

[CommunityRNBSN, BSN, RN]

I second the comments about how being out in public is probably more dangerous. The people at the grocery store have flu and pneumonia too, unfortunately. I think you need to be diligent (and it sounds like you are!) about stripping down, leaving shoes outside, sanitize everything, etc. Staying out of isolation rooms may decrease your anxiety but I’m not sure it decreases the risk to your spouse.

[iluvivt, BSN, RN]

No it's not a realistic expectation. You may find your coworkers will begin to resent you you as well if you happen to find an unusual employer who will even grant this kind of request.Learn and use standard precautions and faithfully use excellent hand hygiene. The one thing that is hard to control is patients who just cough right in your face.I tell alert capable patients who do this to please cover their mouths then offer them a hand wipe. I agree with others, his greatest risk is just in every day living ,using shopping carts, opening doors,sitting in the doctors office, going to the movies. I have been working in bedside nursing for 38 years and not once have I got anything horrible from a patient. I am at risk for bloodborne pathogen transmission due to my constant exposure to blood and worked many years before engineered safety needles were invented. I have developed a routine I never deviate from that decreases my level of risk.

[CharleeFoxtrot, BSN, RN]

9 hours ago, Rionoir said:

Seriously though just leave your work shoes outside, throw your scrubs straight into the washing machine when you get home and wash your hands/take a shower. The germs in isolation are everywhere.

^This.

[Nunya, BSN]

I know someone with CF, actually haven't seen her since she was a little girl but we're fb friends and she has a CF FB page. While it's true that you don't really know what someone will be diagnosed with the day after you take care of them, I think it's perfectly reasonable for you to take the precautions you take. I say this because I know Jilly can be hospitalized if she gets the flu (she wears a mask certain places and the people at work know not to come near her if they're sick, and they've ALL gotten flu shots), she's been on 2 week courses of antibiotics numerous times (has a central line for this) and can actually DIE from a bad infection. She's now going to a clinic about 3 hours from home because they have a good lung transplant program, which she figures she'll eventually need. My point is, keep doing what you're doing and if people resent it and say something that's a great time to educate them, because even though I knew she had CF (because I was working with her Dad when she was diagnosed) I didn't realize how really bad it could be. I find it sad that so many here seem to think your coworkers will resent you if you never take care of isolation patients, I guess compassion for the tough situation of others really has disappeared.

[RNNPICU, BSN, RN]

OP:

I don't think requesting not to take care of isolation precautions is necessary. If you use isolation precautions appropriately, you are not placing any one at risk. The bigger risk is taking care of the general population because sometimes their isolation status can be unknown. Using isolation precautions appropriately each and every time is what would protect you the most. Just walking outside in the general public can place your partner at risk.

However... keeping your shoes outside, placing your clothes and washing after work and all of the other things you do IS what you should do.

However, I think there is a balance with isolation patients. Maybe the one with C-Diff you could have a case for, but MRSA, VRE, perhaps flu... you could. Remember, those patients are not always 1:1 and you are not passing those infections to the other immuno-compromised patients in the hospital. If that was the case, every immuno-compromised patient in the hospital would be extremely ill. Seriously, in the ICU other immuno-compromised patients do not catch the other isolation precautions and they have multiple providers whose isolation use is questionable, and they go everywhere in the hospital.

Keep your routine you have at home, make sure those who you hang out with get the flu shot, use good handwashing, and avoid overly crowded places.

Think about what type of job or place of employment you want in the future.

[SaltineQueen]

On 11/9/2019 at 2:32 PM, lillianbenders said:

(I know pregnant patients won't handle any potential exposures to harmful situations - stuff like that)?

The only thing I was told I would be excluded from when I was pregnant was varicella, which we never had anyways. I took care of MRSA, CDiff, TB...

I think you'll be hard-pressed to find an employer that will always allow you to not be assigned isolation patients. But here's the thing...you NEVER know when you may have already taken care of someone who all of a sudden turns up MRSA+ or develops CDiff. Maybe you could wear your hospital's OR scrubs and keep hospital shoes in your locker so you don't take anything like that home?

[adventure_rn, MSN, NP]

Honestly, I think that the common areas of the hospital (elevators, cafeteria, lobbies) are so much more gross than iso rooms. Patients in iso are confined to iso, with tons of precautions. However, patients on isolation have family members who come and go as they please, taking the patient's belongings to and from home, not always abiding by the isolation precautions the hospital puts into place. If your c diff patient's wife visits daily, who is to say that she'll diligently wash her hands before taking the elevator down to the cafeteria (and how often are the elevator buttons, bathroom door handles, or cafeteria tables ever disinfected...?)? Even nurses' stations can get pretty grody, since how often do people sani-wipe those work stations?

On 11/9/2019 at 2:32 PM, lillianbenders said:

(I know pregnant patients won't handle any potential exposures to harmful situations - stuff like that)?

I agree that it's unrealistic to expect never to be put in iso rooms. Even pregnant women are only restricted from a few different types of pathogens (like CMV, HSV and varicella), and their condition is time-limited. In addition, labor laws protect pregnant women against discrimination by their employers, but that wouldn't extend to significant others. Also, as others have pointed out, you often don't know a patient is sick until after the fact; it's totally possible that your patient will be put on droplet for flu after you've already provided several days worth of care without the benefit of your iso garb.

If you're super worried about it, your best bet might be to seek employment in units that are hyper-cautious about infection prevention. One that comes to mind is bone marrow transplant; their patients are severely immunocompromised, so all of those patients are on protective isolation and they take significant precautions to prevent infection. Sick family members rarely visit because they understand that an infection could kill their loved ones. NICU also tends to have relatively low infection rates, as the kids have never been outside of the hospital, and most people know enough not to visit if they're sick. OR might be another low-risk choice given the sterility considerations. Just a thought...