CaliNurse

Its has been a while since I posted to this topic. I am glad to see that it is still a topic which attracts interest. At my facility we compare each and every culture and sensativity report ( the final report ) to the CDC organism list. That list will tell you which isolation is required. In respect to MDR: 1st which organism is it? 2nd where is the organism and then 3rd to play it on the safe side sometimes they will put the patient in contact isolation until the culture is negative. If more of us practice better infection control in general and gave our co-workers friendly reminders when we see them doing improper techniques we would not have so many isolation patients. Sometimes an organism like VRE or MRSA can be traced down to a piece of equipment like the accucheck !!!!! Question for anyone out there: What type of precautions does your facility recommend for the use of the accucheck machine with a patient in isolation? Happy Nursing to all... we make the world a better place :> CaliNurse

I have worked with trach patient for the last 7 years. When we get nurses who are new to the everyday aspects of trach patients I often open a spare trach up and let them fiddle around with it. You then will get the sense of how deep to go to reach the end of the trach. If you see blood that is a real sign of trauma. Are you suctioning as you go in? We have comatose patients who do not have a cough reflex and sometimes we need to go deeper. I find that my first few rounds of a 12 hours shift using my saline and suctioning clears them out. We use 1/2 & 1/2 saline and peroxide for trach care. We have never had a problem with this in the facility. However when I worked home care I did have a few kids that were sensative to it. Sometimes if there is a lot of dried secretions external to the trach we use a oral care swab for cleaning. Oh, the other thing that may help you ....... call them trach for now on. Save yourself the time and chart trach to. (Of course check your facilities abbreviation list to make sure you are using theirs :> ) It will grown on you. I wasn't used to the snot for the first year. Now it seems normal to me. Good Luck, Cali

When we work with our patients we can not see the microorganisms. We can only see the effects of the microorganisms. Bedpans once used even one time are considered soiled. You can not see microorganisms. This also applies to the urinals. The only time you don't need gloves for a bedpan is when you get it directly from central supply. Someone else posted a comment about having to get gloves from central supply in previous years. Does everyone know that your facility is required to keep gloves and mask in each room? The comment about gloves in the pocket. This is not an acceptable practice in our facility. Our scrubs are exposed to many surfaces and there is no way you can keep them as clean as in the box. Does your facility keep them in each room? With oral care I would wear gloves. I need to take the water that was rinsed with to the sink and that is an exposure to body fluids. I might not need them to to the rest but that part I do. I am also very careful about not only changing gloves but washing my hands between body systems. I think a lot of people think if they change gloves that is enough. Everytime you take your gloves off the very next thing you need to do is wash your hands. Cali

Kara, Do you really think that a bedpan full of urine is not potentially infectious????? It is highly infectious. We, as health care workers do not know what is in any blood or body fluid unless it is cultured. If there are no active signs or enough active signs the doctor will not culter. We are at high risk of transmitting and obtaining infectious organism by providing basic ADL care to our patients. Gloves are NOT 100% effective in stopping the transmission of infections, however it reduces our risk greatly. Urine is a body fluid. This is Standard Precautions. We use Standard Precautions with everyone including co-workers. I have heard of a few female nurses who obtained MRSA because they did not wash there hands or did not wash long enough. There organism site was there peri-area. Of course they wiped when they used the restroom and contaminated themselves. Please wear gloves. You put yourself at risk, you put your family at risk and believe it or not you put your co-workers at risk. To they others who state they were gloves to give injections. This is not required unless you are in an isolation room. If you are giving an injection your risk is the needle will penetrate your skin if not handled properly. A glove will not stop it from penetrating your skin. We (health care providers) often transmit infectious organism and create more work for ourselves. When you walk down the hallway and see the isolation carts some of those are created by US, and it is time consuming to put the isolation garb on and off all day long everytime you need to go into the room. We can really learn from each other. By reading this I can see why it is so difficult for me to get my older nurses to wear gloves. If "back in their day" they were not taught and encourage to wear gloves then it certainly is a case of retraining our minds to think of it. Cali

This is a good question? A patient on a vent doesn't always mean they have a closed system. There is still the existance of the natural airway. Even with a cuff you will see patients bring up secrections and need to be suctioned orally. I have seem secretions come around the outside of the trach at the stoma site. Being on a vent doesn't make it safer. It actually increases the risk of spreading infection. Each time the circuit is opened for any reason there is a risk of spreading infection. Each time staff enters the room there is a risk of spreading infection. Each time the suction canister is disposed of there is a risk of spreading infection. Each time staff DOESN'T wash there hands BEFORE leaving the room there is a risk of spreading infection. If staff leaves the room without washing theirs hands at the sink inside of the room their hands are ready to contaminate what ever they touch next. We are all so aware of what it takes to STOP the spread of infection but many of us in actuality are not practicing these steps. If you wash your hands at the sink just before leaving the room of someone if isolation and do not touch anything else in the room once you leave the room it is not on your hands anymore to spread to others. Many people are washing hands but with their bodies they are leaning or making contact with the environment in the room including the sink which is where the organisms are all present since we wash our hands there. I think the majority of us do these things without thinking. We are so pressed for time. We are busy and running around like chickens with our heads cut off. When we spread these infectious organism we only make more work for ourselves, increase lentgh of stay, increase the use or antibiotics which make these bugs learn over time to resist the antibiotics, increase the time and expense it takes to culture these patients for follow up to get them back out of isolation, increase medication administration time ...... we have to give the meds not the pharmacy staff, its a snow ball that keeps getting bigger and bigger and bigger. So the vent really doesn't make a difference. If the patient was not trached at all and was still mrsa of the sputum for us it is all the same. If you stop and think of the equipment we take in and out of the rooms during the day ..... is this equipment properly cleaned prior to being used with another patient? We can not see these organism, Life would be sooooooo much easier if we could. Cali

I often wonder if I will end up in a hospital in my life and if so if I will have the chance to be there at survey time. I always say I will make them pay for all the stupid shi* they put us through. No telling what I will do but it will be a preformance !!! The feds actually require surveyors to come on the night shift and weekends. 10% of surveys! So if they come in the door at 6:55am or 3am it counts for them. If they want to catch you they are known to come at saturday night shift 3am. Good luck, Cali

I find the comment on usage of the Dynamap machines very interesting. Does your facility have disposable isolation blood pressure cuffs? That is what we use. We have had a time keeping up with the manual gauges. They seem to get disposed of when the cuff is tossed once someone is dischardge or removed from isolation. I think if you talk to someone in Infection Control they will tell you that the staff members are not swab because you will find it colonized in the nares of the majority of staff. We have to error on the side of caution. 10 years ago we were uncomfortable with caring for someone with MRSA. Now its not such a big thing anymore. Most staff member feel that we are gong overboard. However, many people do not use the proper technique and when you go into the room a LARGE percent of the room is already contaminated. I have seen where it is spread from room to room to room. The same body systems were infected. Part of my job is survelience and education. I speak with staff in inservices and they say all the right answers. Sound very convicted in their beliefs. Last Friday I saw one of our staff members come out of a room after assisting with a bedpan and she went straight for the meal cart. I did not see any handwashing. EEEEeeeeeewwwwwWWWWW! When this person was spoken to her response was, "Oh, I didn't know you were still here!". I guess that means when certain people are present and not present her habits change. I can't figure this out. I am very tactful and respectful to my staff. I go the extra mile for them. I am always making myself available to them for clarification of what ever they feel they don't understand. I think if we all took 1 hour to follow other direct patient care givers around we would be surprised with the infection control techniques they use. Be glad if you are at a facility that isolates MRSA patients. If a patient is colonized yes they do still have the organism in their bodies. Ok, that is a reservior all we need is a mode of transmission to carry this to a susceptible host and we have a good old fashion nosocomial infection. One colonize and one active! I could go on forever. This is a subject that I deal with everyday. I hope I didn't ramble to much. This is a great opportunity to share and vent my experiences. Cali

I buy this product from Walmart. I think there is an Walmart everywhere in the U.S. The small can will cost you about $3.99 and if you buy the larger one it will cost you about $4.99. ?? The large can is about 6 times as much. I use this for my hands during those periods when my skin is so irratated and cracked open. I am not allergic to latex but very sensative. I am one who used to think the hotter the water the more bugs I was killing. I was just killing my skin. The other use is on my feet. After a good soak, rub Bag Balm on my feet and put socks on them just before bed. You wake up with the softest feet. Try it, it is very soothing. You can find it in Walmart (the larger can) by the fish/cat/dog supplies. You can find the smaller one in the cosmetic department but it will cost more. Have fun and make you feet happy !!! Cali

Julie, I can't quote Indiana law, but in California every staff member from the house keeping crew to the cook to the administrator to the nursing staff to everyone in the building MUST call APS/CPS if they suspect abuse. Actually in California for a resident in a LTCF we call the OMBUDSMAN office or 911. I have never been in an other state so I don't know if you have an OMBUDSMAN office there. But I know in California if you have a LTCF you must post the numbers for the public to have access to incase they suspect abuse. It is intending for physical abuse to Neglect to Fudiciary Abuse ( $$$ ). This summer all the LTC centers in my general area of California was sent an inservice from the Department of Justice, Office of Attorney General. It consisted of a handbook and a video. All the staff that worked in the area was required to attend. The time frame we work with is "Immediately" once we have reasonable suspicion that abuse has occured. Her reactions around him, his continuation to perform care for her that is harming her even after the nursing staff spoke to him and the doctors order was obtain to prevent him from doing it, and HIM MOVING HER FROM FACILITY TO FACILITY, and the POA - her children not having access to her these are ALL signs of possible abuse. So if this was occuring in my building it would be everyone's responsibility to report this immediately. This has been explained to us as being our LEGAL responsibility. There is nothing our administration department or anyone else in a supervisory position can do to prevent us from reporting or else they will be at risk for prosecution. I would report this right away! STAT! When it all comes out in the end you don't what to be one that is listed as "AWARE" of what was going on. Again, I can't quote Indianna law but in California if I do not report Abuse I can be find up to $1,000 and 6 months in jail or both. If the abuse results in great bodily harm or death the penalties go up to $5,000 and 1 year in jail. We are all mandated reporters! It was very clear in the package that was sent to us that facilities are not mandated INVESTIGATORS but mandated reporters. I hope this helps you. Good Luck, Cali

Nursing is like another profession in what ever country you are in. You have to have the BASIC communication skills of that country. On my unit we have about 6 hispanic nurses. They fit in like anyone else. Every facility that I have ever worked in has an "English" only rule. You must speak english in the workplace unless you are on your break, out of the clinical area or translating for a patient. I doesn't matter what the other language is. In high school and a few years in college I studied French. There is a spoken and a written language. If I ever went to France I would still be lost. But if I expected to work there I should be able to communicate in what ever profession I choose. This is why we must take the pre-req's in school before we can move on to the clinical classes. We must master the language, mathematics, etc. before we can go to the advance courses. If I lived in Mexico and wanted to be a lawyer, nurse, teacher, doctor, computer tech, etc I must first master the language. Do your friends know the options they have open to learn what they feel they are missing. There are night adult education classes. There are language cassettes to listen to at home or in the car. There is even good old college. Even the nurses that spoke english from birth still had to take a language placement test and complete classes before they enter the nursing program. Staff from other backgrounds are benificial to everyone. If I have a patient who speaks any other language including sign language I would be lost. We keep at list of translaters that we can call to help us when needed. If my co-workers speaks that language that I need help in my job is so much easier. I welcome ANYONE into nursing who wants to be here. Cali

We have a NO tolerance to abuse committed by anyone. It is reported. Occurence reports !!! Document everything, even if it is on a scratch note. Don't give up your fight. To many of us have in the past and some MDs think they are still G_D. I often think that the MDs need to have a survey team come thru their office every 3rd year when JCAHO visit us. That would really be a humbling experience for them. Bottom line to not accept abuse from a doctor. Tell him/her that this behavior is unacceptable to you. Then report it. I once had a doctor call in on the weekend and he was very short and snappy with me. He was one of the doctors that I considered part of the "team". I couldn't figure out what was up with his behavior. The next time he was in I asked him "Did I say something to offend you, or was I not understanding you?" He replied "No, I was oncall and out in the middle of no where, I got paged and my cell phone didn't work, I couldn't find a pay phone and I was frustrated". This doctor has since then behaved smug at times with my coworkers but never with me. JUST SAY NO!!!! NOT ACCEPTABLE !!!

We regard VRE extremely serious at my facility. This includes the long term care units and the acute units. We practice Contact Isolation with VRE. If you follow Standard Precautions you will be fine. I would agree with everything except the head covers and shoe covers. Because of your task I am curious - do you set up your machine in the patients room and do you clean it afterwards and what is your protocol for cleaning the machine after dialysis and what is your protocol for cleaning the machine after an isolation patient's treatment? Cali

I have been a DSD for 3 years now. I creat everything by hand because there doesn't seem to be a budget for items that are not used in the patients rooms. I enjoy writting lessons plans but don't always have the time. I am the xerox queen. Why re-invent the wheel? I like to swap and share. We all started somewhere. We all have the same focus. email me if needed .... not sure if I can help but it is nice to have another DSD to discuss issues and projects with as we are usually only one to a company. Cali

Wow, its interesting to see what others are doing in other states. MRSA - requires contact isolation. If the location is sputum YES YES YES you need a mask, gown, gloves. If it is in a wound you only need a mask when working with the wound. If it is in the urine you need a mask when working with the foley if they have one. If they are colonized they are still required to be in contact isolation until they have 3 totally negative cultures. It takes 3 negative sputum cultures to take them out of isolation. These cultures must be done after all antibiotics are completed. They also must be done 24 hours apart. Drop me an email if you have more questions. Cali