Neutropenic pt W/other isoloation pt

[rkitty198]

Hello

I work on a Surgical/Onc floor and we routinely get our fair share of VRE, C-Diff, MRSA and so forth patients. We also have those that are neutropenic. We used to have "clean" staff that would care only for the neutropenic patients along with separate equipment to check vital signs. Our patients all are in private rooms.

Our hospital has now decided that if you use universal precautions that you could care for both neutropenic pt's along with those on other types of isolation together.

I have noticed that our neutropenic patients are now coming up positive with these other isolation infections, namely C-Diff- and all of the others

I dont think that this is at all appropriate. Why?

• Handwashing dosent always get done by all staff
  
• Equipment isnt cleaned properly- just found out our CNA's are not cleaning equipment on those with C-Diff with soap and water- as those purple wipes used for the equipment do not kill the spores of C-Diff
  
• Our clothing has got to have issues with contamination- especially our shoes! We dont wear shoe coverings (do you think that would help?)
  
• We have these nasty curtains in the rooms that dont get routinely changed, only if they are visible soiled (eww)
  

I know that C-diff can be caused by abx therapy and the neutropenic are typically on strong abx. Yet still even on strong abx I havent seen as much C-diff as I do now.

The staff originally wanted to have a few rooms dedicated to those with neutropenia, when now they can be next to a row of people with these diseases that need isolation.

What does your hospital do? What do you think?

[eegrnbsn]

My hospital also does not split up isolation assignments. We are a med/surg/oncology floor. Our floor is split off into "pods" of 4 rooms (all our rooms are private). The other day my "pod" of 4 rooms had a c.diff pt., next door was a MDRO--urine+blood, and next door to that was neutropenic fever--wbc ~0.2. Seriously I could not make this up! I was assigned to all these pts. The point is, as other people have made, that there should not be an issue if proper isolation (or reverse isolation) procedures are in place and are being followed each and every time (not just by nursing staff-by MDs, dietary, housekeeping, PT/OT, lab, etc.). Our isolation pts. and neutropenic pts. alike have their own vital sign machine (dynamap) that stays in their room the entire stay so as not to pass infection to other pts. We use the disposable stethoscopes for the same reason. Of course gown, gloves, mask when appropriate, and HANDWASHING go without saying. The neutropenic patients: mask for all staff and visitors, no flowers/fresh fruits or veggies, handwashingx1000. We have an infectious control nurse who is seriously insane, and she does not have a problem with this. And our neutropenic patients are not getting sick.

[rkitty198, BSN, RN]

Crux-

You get me :) I may not have described it right. All rooms are private rooms. No sharing, however, I am bothered by 811 (c-diff) 812 (vre) 813 (neutropenia) 814 (c-diff)- as an example.

• We do not have separate Dynamaps for these patients they all share
  
• We use for example, a cardiac chair which a c-diff patient may get feces on and then clean lightly with a wipe that isnt designated for that spore, then wheel it into another patients room (neutropenic). Even if you have a patient with MRSA, which the wipes work on, does the CNA or RN really clean it from top to bottom?
  
• Same thing with the transfer boards- those are filthy, not cleaned properly and then brought to a compromised patient
  
• Curtains (fabric)
  

Crystal-

I agree, if you can prevent the transmission of these diseases why not separate nurses.

My issue is not necessarily with a "clean" Nurse for these patients. If we are expected to have both isolation and reverse isolation patients give us the wipes, the equipment to deal with it.

If I go to my manager she will yell in her loud voice and say "we are already taking care of it" and then do nothing about it.

I want to go to our Oncologists

Our infection disease people are the ones who make the rules where I am at, so I think it may make waves of negativity if I go there...I guess who cares when it comes to patient safety.

I guess I want to make sure I have an arguement here before I go to them and raise these issues.

[Quark09]

Our infection disease people are the ones who make the rules where I am at, so I think it may make waves of negativity if I go there...I guess who cares when it comes to patient safety.

I guess I want to make sure I have an arguement here before I go to them and raise these issues.

This is where I'm a bit dumbfounded. I, too, read your original post and thought these patients were sharing a room; that was my mistake. I also understand that due to staffing issues, etc you can't necessarily have a "clean" nurse on a given day. However I don't think your infection control people are figuring in the human factor regarding these patients... namely, that employees are not using standard precautions, not cleaning shared equipment, and not properly gloving, shielding, etc.

In the facilities I've worked in, shoe covers were the norm when you were going to be doing care on a patient in isolation (unless it was strictly contact; pt had MRSA in a wound only, etc). We all know what can get tracked around on the floors in a pt room *shudder*... then you walk into another room, attend to your next patient, walk out, and a few minutes later she drops her eyeglasses/box of tissues/a piece of hard candy...

We have an infectious control nurse who is seriously insane, and she does not have a problem with this. And our neutropenic patients are not getting sick.

I like her already!!

[Penelope_Pitstop, BSN, RN]

I think the big issue here is that staff is not being compliant with Universal Precautions. Even if a nurse only has "clean" patients or "dirty" patients, if he or she is not washing hands...well, germs are going to spread!

One hospital I know of does not allow any isolation patients on the oncology floor. They go to a medical ward.