Concern about Infection Control

  1. I'd like to ask a question of you experienced nurses out there. Last semester in clinicals I was asked to collect a stool sample for a patient I had been assigned to. It was my first rotation and only the second patient I had. Anyway, I took the proper precaution -- wore the gloves, handwashing, etc., and collected the sample. Two weeks later, when I was assigned to this patient again, I found that she had been placed in contact precautions because she had C-Diff (that's what I was collecting the sample for.) I was outraged that i was not told of this because there are of course extra precautions to take when dealing with something like this. (C-Diff is extremely contagious). In any case, being that I have two small children at home, my worst fear is picking something up and bringing it home to my kids. I am concerned with the fact that you don't always know what you are walking into and it's a very vulnerable position to be in as a nurse. I am wondering if you other nurses share my fear, and how do you handle it? Thanks so much!
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    About mommyrn

    Joined: Jan '02; Posts: 15; Likes: 2
    Full time nursing student.


  3. by   Cubby
  4. by   mommyrn
    Sheila -- thank you for the reply. Let me ask you all -- do you don gloves as soon as you walk into the room and wash hands? What about your steth and bp cuff -- how do you disinfect those to the point where it's safe to bring them home? I use alcohol swabs and such, but what about the actual cuff? What about changing linens for a client with no obvious threat (no feces, urine, sputum, etc.)...As a nursing student, I want to know what it's like in the real world. I am trying to boost my immune system the best I can, but ironically, being in school is so stressful, I think my immune system is shot! How do you all keep your systems in top shape aside from vitamins and the obvious? Any hints, words of wisdom are greatly appreciated! Thanks!
  5. by   Jenny P
    The most important thing you can do to protect yourself is wash your hands for a minimum of 15 seconds (sing "Twinkle twinkle little star" all the way through), dry them thoroughly, and keep your skin intact. The friction of washing your hands is as important as the soap and water.
    Why are you (as a student) taking your own BP cuff into patient rooms? We have BP cuffs at each bedside in my facility and they are washed after each discharge for infection control.
    Your stethescope chestpiece can be vigorously wiped off with alcohol wipes between each patient.
    For my own piece of mind, I never bring my stethescope or work shoes home; I have a locker at work that I keep those things in to assure myself that I'm not bringing home something to my family. As a student, I understand you don't have that priveledge, but you can keep your things in a gym bag in the trunk of your car (or whatever else you can think of that will work in your situation).
    I used to shower just before I went to work; but since my husband has M.S. and is very immunosuppressed, I come home from work and shower and get the dirty uniforms in the clothes chute right away. And I do the laundry, not him.
    Be very aware of what is clean and "dirty" when at work. I feel safe with MY following of universal precautions, but not always with other peoples' ways of doing them. I only glove when I am ready to do actual patient cares; our institution says that vinyl gloves are only good for about 20 minutes, so wearing them all of the time while in a patients room may be more hazardous than wearing them when you NEED to wear them.
    You can still touch patients with your ungloved hands; sometimes the patient needs to feel a human touch to feel better. You don't have to go overboard on stressing out over cleanliness and disinfecting things, after all, do you gown and glove when your kids' friends are over and you need to wash their faces after PB&J sandwiches?
    I was taught to put dirty linen into the dirty pillowcase when changing a bed. I don't always do it, sometimes it's easier to put it in the dirty linen hamper. I have been trying to break a bad habbit I developed over the years- throwing dirty linen on the floor. That is how C. diff spores are spread. Do I make beds with gloves on? No. I hate to try to make beds wearing gloves (I do it when a pt. is in isolation) though. Basically, use your head.
  6. by   WashYaHands

    wash your hands (with friction and often). When you get home, immediately remove your uniform and take a shower. Might want to keep your shoes in the garage or away from where little ones might come in contact with them.
    Since you are a student, you will be asked to perform tasks. Make it a habit to ask why...why am I taking this stool sample, what are we testing this for? (Actually, they should have told you this).
    When handling linens, keep them as far away from your body as possible. If it makes you more comfortable, wear gloves when changing linens it's better to be safe than sorry.
    Did I mention to wash your hands?

  7. by   mommyrn
    Hi everyone. Thanks for the replies. We have been taught the 15 second handwashing, holding linens away from the body, etc. No, I don't believe gloves should be worn all the time. I never used to store my shoes out of the house -- now I will. During my first rotation in a nursing home, we were shocked to find out that NONE of the soap dispensers even had soap in them (hence, noone was washing their hands) we came in there and filled them and the aids actually laughed at how much we washed our hands. They didn't even wash between patients! It's so alarming.

    Now -- we were told to bring our OWN equipment to clinicals so we don't have to keep running to the cart to get the equipment. I had a problem with this from the beginning-- but you know, as a first year student, you do what you are told. Maybe I'll stop that practice? Maybe I'll leave the cuff at home and just use the steth. It's gross thinking about what I could have brought home!

    I look forward to keeping in touch with all of you and thank you so much for the advice. I find that I won't get the REAl low down in school -- it's going to come from other nurses.

    Love you all!
  8. by   LilgirlRN
    Treat everyone like they have something and wash your hands. Shoe covers are good too, most every unit has some..keep your shoes nice too I keep lotion in my pocket, I get the kind that has the bacterocide in it when I think about it. Stay out of pt's faces especially if they are admitted with an undiagnosed respiratory ailment. Wouldn't hurt to keep some clean clothes with you, just in case.
    Last edit by LilgirlRN on Jan 8, '02
  9. by   mommyrn
    See now, this is where it gets sticky. When we go to clinicals with our instructor, we are assigned our patients, and off we go. I have never thought of asking for shoe protectors because I never saw any other nurses wearing them. do you think these shoe covers should be worn all the time or only for certain situations? What about you all wear them every time you enter a patient's room? Do you all get titers to make sure that your immunizations took and are active? I will be going for that before we start this semester. Thanks again for the input!
  10. by   semstr
    hi there,

    I am always surprised by the fact that you all (or most of you) have to buy and wash your workingclothes by yourself.
    Here (not just in Austria, but in Germany, the Benelux , France, Greece and I do think in GB too) you get your stuff from the hospital and they do the washing too.

    In fact, we forbid our students to wear their "uniforms" from and to work, because of hygienic standards.

    Of course, the space to change from casual into workinggear is provided too, with lockers and showers etc.

    We have 10 changes, dresses or trousers with thirts or blouses, you can pick what you want, when you start working, then you get a number inside your stuff and just throw it in the "dirty-bin", 3-4 days later you can pick them up again.

    In some hospitals private uniforms are allowed too, but most of them don't.
    It is also, easier on the patients and their families to recognize RN's and students. (RN's wear white trousers with white/blue pinstriped blouses or dresses and the students have allover blue blouses or dresses.)

    The shoes are not provided, but we do encourage students to buy an extra pair of "workingshoes", which most of them do.

    Take care, Renee
  11. by   mommyrn
    Hi Renee. Thanks for the reply. We have to buy plain white pants and tops, and the ugliest blue smock you ever saw with a big patch stating that we're nursing students. It's so embarrasing! We buy everything -- our shoes, bp cuffs -- everything. It would be nice if we were provided them. It seems to make more sense for us to take the clothing off before leaving the clinical area -- maybe I'll suggest that to the Dept. Chairperson this semester.

    Thanks so much for the info everyone! Keep it coming!
  12. by   Aussienurse2
    And you guys pay how much to do your degree??? Seems to me that education pays better than they're telling us!! I put my uniform straight into a bucket of napisan as soon as I walk in the door then hot foot it to the bathroom for a long, hot shower. I wash everything in hot, hot water and the kidliwinks don't touch me untill I've so.
  13. by   boggle
    Hi Mommyrn

    Glad you are asking lots of questions! I agree with eveyone's posts about washing your hands!!!!!!!

    Also check out the CDC's new data on effectiveness of the liquid hand sanitizers. Their findings show these as more effective in reducing spread of microorganisms than handwashing in many cases. Expect to see them more and more in the clinical setting!

    Review, remember, and PRACTICE your Basics of Infection Control. Standard Precautions apply to everyone, everywhere! Remember your links in the "chain of infection".

    As for gowns, shoecovers, masks, all the time gloves -- that's going overboard in most cases. Think it through. Ask yourself, "Do I need a barrier here? Will I be touching with my hands (or clothing) any blood, body fluid, secretions, excretions, non-intact skin, mucous membranes or items contaminated with any of those substances?" If so, use a barrier.

    A patient with C-dif who is not incontinent is treated like any other patient. We glove for specimen collection, gather and hold linens away from our body for EVERYONE!

    Yes change your clothes when you get home. Keep ALL outside shoes away from children. Practice and teach your kids to practice good hygiene all the time.

    Do your best to keep healthy too- eat right, sleep ( oh forget sleep, you're a nursing student:chuckle :chuckle ), and get your flu shot!

    Mostly, make your decisions based on good science, not on panic.
    Keep using your common sense, critical thinking skills!!!

    .......And welcome to nursing too!! Best of luck to you in school.
  14. by   adrienurse
    Practice basic universal precautions all the time, and you should be okay. Next time you are asked to collect a sample, find out why first, then there will be no surpizes. Always ask why you are doing something before you do it -- this is a good policy to have.

    P.S. I like to sing the oscar meyer weiner song when I wash my hands.
    Last edit by adrienurse on Jul 2, '02