Infection Control

Christie RN2006 · Oct 26, 2007

Thats just asking for an outbreak!?! We have several different types of isolation at my hospital ranging from contact isolation (for things such as MRSA of a wound) and that type of isolation requires everyone entering the room to wear gown and gloves to TB isolation where the pt is put in a negative pressure room and everyone entering the room must wear, gown, gloves and N-95 mask.

The patients are not allowed to roam freely and if they have to be transported, we have strict rules for transporting, such as with droplet isolation, everyone transporting must wear gown, mask, etc. and the patient must have a yellow gown placed over them and a mask on. The yellow gown on the patient doesn't do much more than to tip people off to stay away.

Those in isolation on diets get their meals on a tray, but the tray is not allowed to enter the room. Everything on the tray is disposable and is to be thrown out after the patient is finished and never to leave the room again. If we have to remove something from the room it has to be cleaned throughly.

We even have special stethoscopes, thermometers, etc that stay in a patients room that is in isolation.

We had a small outbreak of MRSA at our hospital last year (3 patients) and we have really cracked down on our isolation rules since that. I don't believe that the MRSA was ever linked to staff, but still it really made us start watching how we treat our isolation rooms.

SICU Queen · Oct 26, 2007

Wow, this is pretty surprising to me. Our iso's stay very isolated, all visitors have to gown and glove, trays are disposable, etc, etc.

I'm curious as to what the long-term stats will show about your IC person's laissez faire attitude.

bill4745, RN · Oct 27, 2007

For every pt we know is contaminated, I wonder how many are that we don't know?

And wouldn't it be interesting to anonymously culture the nares of nurses, RTs, PTs, MDs, etc. in a hospital? I mentioned this to our Inf. Control RN-she said we would probably have to close down the hospital!

marmikatam125 · Oct 27, 2007

yeah!!!Right, as a student I had a pt. in isolation, I thought...ok i will gown up, put my mask and gloves. When i was done my care for this pt. i got out...wash my hands and everything. A few minutes later the Doctor goes in the room (isolation) without gloves, gown, and mask. She was touching the pt. and everything. Plus, she got out without washing her hands.!!!!!! I could not beleive what i was seeing. :smackingf i was so mad

woody62, RN · Oct 27, 2007

I'd like to pick some brains here regarding your Infection Control policies. Our Infection Control Nurse has made some changes in how we deal with people in Isolation for various reasons -MRSA, VRE, etc
She says that visitors don't need to gown or glove. Just wash their hands when they leave. When we pointed out that this may bring MRSA out into the community, not to mention spread it over our unit more, she just said she wasn't worried about the community because we didn't monitor MRSA out there.
Meal trays are left outside by dietary, nursing brings them in. That's OK - but when the pt is done, nursing has to take it out and either leave it outside the door for pickup, or if we missed pickup, we carry it to the pantry where and leave it there - sometimes on a tray rack, but more often just anywhere we can find space. Anyone using the pantry can then touch this tray that has been in an isolation room! Again she says - no big deal.
Finally, pts can leave their rooms and go about the hosptial. They just have to "wash their hands" before leaving.
Does any of this make sense to you people? Are we nurses just being overly cautious? Is this the "new" way to deal with isolation? Please tell me what your hospitals do! We are all worried that these practises will results in a massive outbreak.
Thanks!

Her attitude has some pluses and minuses. A patient, with MRSA or VSRA, should be on isolation. Anyone entering their room, depending on what is infected, should be at the minimum wearing a gloves and a gown. And their meals should be served on a throw away tray, with paper and plastic plates and forks, knives and spoons. And everyone entering and leaving the room should wash their hands.

But it has been my experience, for years, that a good number of hospital workers somehow appear to believe they don't have to do any of these precautions. I've watched lab workers enter a patient's room, bring their entire tray, drawing blood, then leaving, not washing their hands and let alone worrying about their trays. And this attitude is not restricted to employees, holding other positions, nurses and doctors seem to have similar views on what they need to do or not to do.

As for the outside world, the public needs to understand that this strain can be passed by contact, contact from mists from a person's respiratory system, contact from skin lesions, contact with just about anything capable of harboring an organism. The school systems cleaning their schools may be reassuring to the public but are of little value in preventing the spread of this organism. Hand washing, not sharing personal items, not sharing towels, are a better route to take.

Woody:balloons:

EmmaG, RN · Oct 27, 2007

Ask your infection control nurse for the research and evidence to back up her change in policy.

swee2000 · Oct 27, 2007

At the hospital I work at, every person about to enter an isolation room is supposed to don the appropriate isolation apparel. It doesn't matter if your staff, doctors(good luck in telling them to put on a gown & gloves), or family/visitors(same problem as docs). Also, before leaving the patient's room and after removing the isolation gear, everyone is required to wash their hands with soap & water...not the alcohol foam(that is outside the room anyways). As stated before, it's usually the doctors and families/visitors who are the most non-compliant with following the isolation precautions(except for the Infection Control doctors...). Alot of family members will say "I live with xxxxx and haven't gotten sick yet. So why should I have to take special precautions now?". But you just keep educating them & reinforcing it every time they come to visit.

As for the patient meal trays, our dietary dept was told that they should not enter rooms that are in isolation. Instead, they are to leave the tray outside the room and notify the patient's nurse or CNA(or, if they're not sure who it is, then the unit clerk) that the tray has arrived. Alot of the dietary personnel are good about doing this, but there are others who aren't. That's another story, though. Regarding the silverware, plates, cups, etc....patients in isolation do not get disposable items. They use the same stuff as everyone else. And when the isolation patient is done eating, their tray is placed with all the other non-isolation patient trays in the same "Return to Kitchen" cart.

If a patient in isolation needs to have a test or procedure in another dept, they are required to wash their hands before they leave the room and then put on whatever isolation apparel applies to their situation. Techinically, in these situations, the patient is supposed to wear a white disposable isolation gown. But most of the time it ends up being the yellow one. The only exceptions I can think of to this are the patients w/C-diff who are also incontinent of stool and those who are in airborne precautions(but we don't get those on my floor anyways).

As far as patients leaving their rooms to take walks in the halls or for a change of scenary, it all depends on what they're in isolation for to begin with. As I said before, if the isolation is for C-diff, the patient typically cannot leave the room for any reason, especially if their incontinent of stool. If it's for MRSA or VRE, the source of the infection must be contained; if it's in a wound, the wound must be covered and cannot be oozing, draining, etc; and the person has to wash their hands before leaving the room and then put on the appropriate isolation gear.

Now the use of specific equipment like stethoscopes, Dinamaps, etc, has been one of huge debate at my work. Our isolation carts come with a stethoscope & digital oral thermometer that are only to be used on that specific patient. There is also supposed to be a disposable BP cuff on the cart that can be connected to the sphygnomometer in the room...but a majority of the time the cuff isn't there. So then we end up using a reusable one that stays in the room for the duration of the patient's stay. When they're discharged, the cuff gets wiped down w/special cleaning solution and then left in the room for the next patient. Also, up until recently we were NOT ALLOWED to take Dinamaps, tympanic thermometers, & portable pulse Ox machines into isolation rooms. But that policy changed again and now we can use the equipment on ALL patients. However, if used in an isolation room, it also must be wiped down with the special cleaning solution before being returned to the supply room &/or used on the next patient.