Putting a mask on a spitter

[NotFlo]

The situation is a dementia pt. in a LTC facility. Pt. is a peach much of the time but when pt. gets in a bad mood pt spits. Pt. has spit on multiple staff members, primarily CNAs (because it's usually during care/changing/repositioning/bathing that pt. gets upset) and also has been observed spitting on spouse.

Some CNAs decide that an appropriate intervention for this behavior is applying a mas over pts. mouth (standard surgical face mask). Pt. is unable to remove this mask on own so it blocks the spit.

So, is this abuse, an appropriate intervention, somewhere in between? There is disagreement among higher-ups about what should be done about this situation and what, if any, consequences the CNAs should face. Any opinions?

[CNL2B]

In acute care, this is generally considered an appropriate intervention among staff although I'm not sure of management's opinion. Usually we only have to deal with this for a finite amount of time, however (eventually, patient gets discharged.) Surgical masks don't hurt the patient and most of the time in an acute delirium-type episode the patient doesn't remember having it on.

In LTC if it is the patient's home environment (essentially) I think it would probably be more appropriate for the staff to put on a mask or face shield, or whatever they felt comfortable with as PPE. Don't know what the poor demented LOL will think of that though ... staff coming at her in weird masks.

[netglow, ASN, RN]

Well, here is a situation in which if the facility provided the CNA's with disposable face shields eg used in trauma/bloody surgeries, they would be able to be protected from the patient. The patient could be left to spit away. Question is whether the management deems staff worth the expense, or if management just feels like punishing.

[robinbird]

I had a patient in behavioral restraints in the ER who was a spitter. After the first loogie-launch he was placed in a mask whenever we were in the room.

[heartnursing]

I dont see how this is abuse at all....

Are the staff (CNAs) suppose to just stand there while they get spit on? and then have spit all over them to then only care for other residents with spit on their scrubs?? Even if the staff wore a mask it would still get on their scrubs.... thats gross

I would not tolerate anyone spitting on me.. the surgical mask is not going to hurt the pt.. and im sure if the pt did not have dementia they would not want to be in a room where they have spit all over (bed linens, floor etc)

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

There's a lot to be said for avoiding body fluid exposure here. No mask could cause a lot of medical expenses to workmens comp for the employees. I doubt management would like that. Wish I could think of a better solution, but I think you're doing the right thing.

[VivaLasViejas, ASN, RN]

This could indeed be considered abuse! The patient is in a nursing home, and putting a mask on her that she can't remove violates her dignity and her rights. I could see the State walking in and having a field day with that one.

I know it's pain in the rear, but if the staff wants to protect themselves from body-fluid exposure they will need to gown and mask themselves rather than the patient.

[DanC]

After many years in large trauma center it is my thought that all spitters are hypoxic and need oxygen del. by mask.

[Silverla]

I work in long term care and I remember the fist time someone spit in my face, I was p***** and deeply hurt.Still, I wouldn't put a mask on a resident, I would wear one with a face shield, and a gown. That being said, please don't punish the CNAs, If it is decided that putting the mask on the resident is inappropriate. Make the policy clear to everyone, then have consequences for non-compliance.

[Neveranurseagain, RN]

This could indeed be considered abuse! The patient is in a nursing home, and putting a mask on her that she can't remove violates her dignity and her rights. I could see the State walking in and having a field day with that one.

I know it's pain in the rear, but if the staff wants to protect themselves from body-fluid exposure they will need to gown and mask themselves rather than the patient.

What about the rights of the CNA's not to be spit on and treated this way? Is this not abuse of the CNA to have to stand there and let a pt spit on them? Even with a gown, the spit soaks thru onto your skin, and a mask doesn't protect your hair.

[VivaLasViejas, ASN, RN]

What about the rights of the CNA's not to be spit on and treated this way? Is this not abuse of the CNA to have to stand there and let a pt spit on them? Even with a gown, the spit soaks thru onto your skin, and a mask doesn't protect your hair.

Of course it is.......but you must not have worked in long-term care before, or you'd know that the State couldn't care less about the CNAs (or the nurses, for that matter). The only rights they're concerned with are those of the residents, not the staff. Being hit, kicked, swung at, spit on, cursed at, hair pulled etc. is part of everyday life in LTC; we merely learn to duck and dodge the blows.

[Scrubby]

Of course it is.......but you must not have worked in long-term care before, or you'd know that the State couldn't care less about the CNAs (or the nurses, for that matter). The only rights they're concerned with are those of the residents, not the staff. Being hit, kicked, swung at, spit on, cursed at, hair pulled etc. is part of everyday life in LTC; we merely learn to duck and dodge the blows.

And it's this type of 'oh well it's just the way it is' attitude that allows the abuse to continue.

I don't disagree that putting the mask on is inappropriate- there could be safety concerns. I agree that personal protective equipment is the way to go, such as visors, hair nets etc.