We have a very needy patient on our unit. They have been there for over a week. They also happen to be in isolation. The issue our staff has been having is. The daughter who refuses to wear any isolation gown, nor will make her school age children wear isolation gowns when visiting granny.
So my co-worker approaches me, and asks do you have any ideas on how we can get the family to comply? So we talk about it for awhile, meanwhile the patient's call light goes go. I follow with the patient's nurse to go help her, as it takes two people to turn her or assist her into the bathroom.
As we are in the patient's room with our gowns and gloves on. In walks the daughter and grand daughters. I look up and matter of factly say. You need to have gowns and gloves on . Daughter say, no I won't do it .Meanwhile her children are whining they also do not want to put gowns on either. To which I reply reminding them of hospital policy etc. Her reply " My husband is head of Trauma Services here and I don't have to"
cool, and god knows this impresses me to no end.
I look her dead in the eye and say. " I have one at home just like him and I do not get to break the rules either. "
So for one day she complied, now she is back to no gowns no gloves. A part of me wanted to call her husband requesting him to talk with his wife,as none of us has seen him on the unit to discuss this with him. Then I thought heck, not my battleground.
my vent is,, who in the heck does she think she is.... I have seen this attitude with some of the older wives, I had hoped younger wives had some self esteem beyond what their husband's did for a living.
We don't make visitors wear isolation gowns in isolation rooms. The gowns and gloves are to product the other patients from getting whatever condition the patient has, be it MRSA or VRE or whatever. If they've been seeing this person outside the hospital, odds are they were more exposed to the condition there.
I know that things are a bit different on your type of unit, but on most, everyone in the room is supposed to follow the precautions. If the infection was hospital acquired (cause unfortunately, that happens) or they are like the vast number of family members who come out of the woodwork when the grandma they hadn't seen in years was in ICU, they weren't already exposed and need to be protected themselves. That, in addition to the need to keep them from transmitting the bugs to the community via poor handwashing and whatnot is why my hospital requires everyone in an isolation room follow the standards. If family refused to gown up, they were refused visitation, it was a HUGE infection control issue.
I'll have to check with our infection control people on what evidence they're using to support our policy. I was under the impression it's common to only expect staff to gown and glove. There's nothing in the hospital that isn't in the community already. That's why we have so much vre on my floor. We routinely screen for it and 1/3 of people come in with it.
We're a bone marrow transplant unit, and with the exception of VRE, have quite low rates of things that will get you put on precautions. We've had 3 cases of c. diff in the last 2 months, and one of those came from another hospital with it. We've had two cases of MRSA in the last 6 months.
We don't let people "lean" on the nurses station, they're not going to transmit anything just walking down the hall, and we disinfect surfaces like counters and the nurses' stations qshift.
Yes, that's really our policy.
So your C.Diff patients aren't on isolation precautions? Ours are on contact isolation and we have bleach wipes at the bedside. Isolation signs posted and family gown and glove to visit.
We test all on admit with a nasal swab for MRSA and if + modified contact isolation.
The gowns prevent the staff that's going from room to room and having close contact with the patients from passing germs around. Since the family is only seeing one patient, they don't risk this.
But they do run the risk of contaminating the public areas of the hospital.
I'm all for strict enforcement. We in America are far too lax in our infection-control policies and/or their enforcement which helps explain why our rates of MRSA are so staggeringly high compared to countries like Sweden and Holland.
We're a bone marrow transplant unit, and with the exception of VRE, have quite low rates of things that will get you put on precautions. We've had 3 cases of c. diff in the last 2 months, and one of those came from another hospital with it. We've had two cases of MRSA in the last 6 months.
We don't let people "lean" on the nurses station, they're not going to transmit anything just walking down the hall, and we disinfect surfaces like counters and the nurses' stations qshift.
Yes, that's really our policy.
Well, perhaps because we see much higher incidences of both community-acquired and facility-acquired infections we're much stricter on the subject.
Perhaps, too, people don't "lean" on your nurses' station (I imagine we'd all have to draw pictures to show one another what our own look like!), but they do certainly stop there, hand things to the staff, pick up a pen to write with, etc etc. And they DO transmit those germs walking down the hall: ever seen people brushing up against everything in the room, then leaning on a wall to talk to someone (yep, people lean and brush everywhere)? They touch elevator buttons and EVERY SURFACE between their germy loved one and the parking lot.
Of course, people in the community do the same thing, and therefore we have such a need for public education where handwashing is concerned. But if we don't enforce it in our healthcare facilities, how on earth are we going to stem the tide?
MRSA and VRE are transmittable from every bodily fluid. C-diff is common enough in the general community, but when someone is already compromised (hospitalized) it can become life-threatening. We do everything we can to keep the c-diff patients' germs from spreading throughout the hospital, and if visitors are going to visit an infected patient, you can bet your butt they are gowning and gloving.
If hospital policy is gown and gloves I would be very leery of allowing them in the room without them regardless of who her husband is. This can put the hospital at tremendous liability if they get ill. They will of course blame it on the nurses, etc. for still giving them access.
I'd get a paper trail going on this immediately. Make your superiors aware immediately if you haven't already. I'd be going up the food chain and asking them how you should be dealing with this so it doesn't come back to haunt any of you.
Specializes in CVICU, Burns, Trauma, BMT, Infection control.
I would document the heck out of it for when hoity toity and the kids come down with festering sores.
Visitors should wear isolation to prevent transmitting resistant organisms to others in the hospital and the community. Do you have an infection control nurse who you can talk to? Have you talked to your Nurse Manager about this?
It bothered me more that the children were able to see that rules did not apply to them, only to others.
My ugly twin would love to go into the room and work with the patient without a gown and gloves on and see how the daughter feels about that..
To answer anyone, as she is not my patient, and in a room the fartherest away from the nursing station. At this point except for my one dealing with Mrs. Doctor.
It is most likely that patient is colonized stage. Our hospital policy whether any of us likes it or not is. Once MRSA has been isolated, a patient coming into our system there after for 5 years will be put into isolation with contact precautions.
The amount of MRSA in our area is huge, much of it at this time is community acquired.
With the advent of Medicare now not paying for anything which is hospital acquired I see as one of the main reason we have the policies we have in regards to this.
jmgrn65, RN
1,344 Posts
Umm VRE is passed not only thru the stool, if it is in the sputum then it is passed airborne, in the blood then via the blood and so forth.