Patient in Isolation...Varying Attitudes

[abundantjoy07, RN]

I've noticed varying attitudes concerning patients that are in isolation.

When I went to work with my patient this morning, they posted all the precautionary measures on the door to alert people coming into his room. The door (both doors) were wide open to his room. The nurse that I worked with thought nothing of it and we went put on gloves and went inside. From that point on I worked with him myself.

Sometimes nurses would come in with gowns and masks on. Other times they would come in with nothing on. It was not until my teacher dropped by that it was pointed out...the door must be shut. It seems like some people take isolation lightly and others don't. I was really confused about things.

When I changed his colostomy bag I (of course) wore gloves and a gown. When I went for other tasks I would wear gloves and no gown. At one point I didn't wear anything. :stone (He just wanted some coffee).

Is donning the gloves and gown a choice that is done at your own risk? Or is it a mandatory thing?

What about those patients that aren't in isolation? When you come in their room from dealing with a patient in isolation I mean? Doesn't this mean you must suit up to avoid spreading germs?

Do you have to keep gloves on to touch a isolation persons hands?

What's the bottom line? And what are the rules that Should be abided by at all costs?

[Choircat]

Depends on type of isolation and your hospital's policy. At our hospital the only time the door is shut is in airborne. The protective equipment for each type of islation is required. If you are going to come in contact with infectious body fluid yoou always wear a gown. Gloves are a given for this. To avoid spreading to the next paitnet you must follow the guidelines for the isolation and wash your hands.

[nowplayingEDRN]

Choircat just took the words right out of my mouth. Unfortunately, I find that there are still some long practicing nurses out there that have no regard for isolation and what needs to be placed on what type of isolation (ie: chickenpox that somehow manages to come into the ER as a c/o a rash and the doc said bring them in to be checked to see if it's chicken pox, which it was) It's airborn and contact isolation.....and so you would use the appropriate measures of protection as stated by the CDC and your facility.

[Altra, BSN, RN]

A missing piece of info ... was the pt. in isolation because he is infectious, or is he in protective isolation because he is immuno-compromised, for whatever reason?

Maybe this is idealistic on my part, but I find it kind of appalling that this would be taken lightly. The protocols are there for a reason, right?

[Boo439]

The hospital I work at is the same way. If someone has MRSA in a wound in their foot and I am going into their room to drop off their lunch tray, I'm not going to put on the gown, mask, etc, unless I'm afraid they're going to karate chop me in the face with their foot. I wear gloves and use anti-bacterial hand sanitizer after removing my gloves. When I change the linens, I wear a gown and gloves. Their door is usually open or closed depending on their preference. The hospital gets hot quickly and the a/c rarely works right. We end up having a patient on iso. with a room temperature of 85 degrees

If a pt. has Shingles or another air-borne illness, their door is closed at all times and I, personally, don't go in the room. I never had chicken-pox

I'm only speaking for the hospital I work at, but no one has ever said anything to us for having the door open on a contact iso. Even when JCAHO was coming through.

-Cassie

[PJMommy]

You've received good answers above and, as mentioned, it depends totally on the type of isolation. We have airborne, droplet, and contact precautions and sometimes a patient is isolated for more than one reason -- maybe they are suspected TB *and* they have MRSA in a wound.

Most commonly, what I see is MRSA contact precautions. The door doesn't need to be shut for contact precautions...at least not at our institution.

[Marie_LPN, RN, LPN, RN]

At our facility the door doesn't have to be shut for contact precautions.

And everyone is SUPPOSED to gown, glove and mask before they go into a room, but try telling the doctors that (and some of the nurses). We complained about it all the time to the supervisor, still didn't do any good.

[General E. Speaking, RN, RN]

What irks me is when you are in the room in head to toe isolation gear (as required) and in strolls the infectious disease doc without it. uh? hello? excuse me...

[RN4NICU, LPN, LVN]

Someone asked about needing to wear gloves to touch the hands of someone in isolation -- YES! Absolutely. Even if the person is in isolation for MRSA of a wound on the foot -- Do you really know for certain that the patient hasn't been touching the wound with his hands? Are you certain enough to risk the safety of yourself and your other patients?

A gown should be worn anytime you will be in close enough contact that your clothes will touch anything that belongs to the patient - you never know what the patient might have touched after touching his MRSA wound.

As far as droplet (or airborne) isolation - glove, gown, and mask -- and close the door. This is the only way to control spread of whatever it is. ANYONE that ignores isolation protocol (yes - even if it is the infectious disease physician) should be reported to the infection control department of the hospital. It is a matter of public safety, provider safety, and patient safety.