Question about isolation precautions...

[Dazglue, ADN, BSN, MSN, RN]

I work on a SNF within a hospital. Majority of the people are there for physical/occupational/speech therapy or wound care and antibiotic treatment. We get quite a few people on isolation. Right now, we have seven on contact precautions. When we have patients on isolation, particularly on contact & droplet precautions, therapy will come get the patients and will ambulate them around the halls and in the community gym. However, the therapists will gown up, put on gloves, and many will wear a mask during their sessions, but not the patient. I was thinking maybe the patient that was on droplet precautions would put on a mask at the least but maybe I am wrong. I asked our PCC, DON, & safety nurse and of course none of them knew the answer. As a matter of fact, my DON tried to convince me that droplet & contact precautions were the same thing. And to be honest? I'm not that surprise she doesn't know the difference. We have an awesome infection control department but they are off this weekend so hopefully I will hear back from them sometime next week. I even got somewhat chewed out by the DON because I stated I can contact an infection control nurse to get an answer. Maybe she doesn't want them to know she doesn't know....but I got a feeling they wouldn't be surprised! I was not trying to be confrontational, I just wanted to know our policy because I am sure if state questioned me and I got the answer wrong, I would be in DEEP trouble. Different facilities probably have different policies but what is the norm when isolation patients are to have therapy? Are they required to gown or mask up?

[KelRN215, BSN, RN]

A patient on droplet precautions should wear a mask when outside the room.

[Daisy_08, BSN, RN]

Like the above poster said, when on droplet the pt should wear a mask. On contact they should wash hands on their way out and not touch any surfaces. The therapist working with them wear ppe as they are going from pt to pt and therefore have an increased risk of transmitting. At least thats what my hospitals says. I think they all should have to wears ppe when they are out...

[kool-aide, RN]

In my hospital, pts on contact prec. are to wear gown and gloves before leaving g their room, and on droplet prec. are to wear a mask. Airborne prec. pts are not permitted to leave their rooms.

[nurseprnRN, BSN, RN]

When in doubt over any such issue, the CDC is your friend.

This is 225 pp, but it's all there:

http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf

This has subsections you can click on:

CDC - 2007 Isolation Precautions:Part 3 - HICPAC

This is their glossary of terms:

CDC - 2007 Isolation Precautions:Glossary - HICPAC

PS: Your DON is a fool. Of course they should be wearing masks. They're making...droplets.

These are the definitions of isolation categories:

Isolation precautions: MedlinePlus Medical Encyclopedia

solation precautions

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Isolation precautions create barriers between people and germs. They are taken to help prevent the spread of germs in the hospital.

Anybody who visits a hospital patient who has an isolation sign outside their door should stop at the nurses' station before entering the patient's room. The number of visitors and staff who enter the patient's room should be limited.

Different types of isolation precautions protect against different types of germs.

Standard Precautions

You should follow standard precautions with all patients.

When you are close to, or are handling, blood, body fluid, body tissues, mucous membranes, or areas of open skin, you must use personal protective equipment, depending on the anticipated exposure, such as:

• Gloves
  
• Mask and goggles
  
• Apron, gown, and shoe covers
  

It is also important to properly clean up afterward.

Transmission-based Precautions

Transmission-based precautions are extra steps to follow for illnesses that are caused by certain germs. Standard precautions and these extra precautions will both need to be followed. Some infections require more than one type of transmission-based precaution.

Start following transmission-based precautions when the illness is first suspected. Stop them only when the illness has been treated or ruled-out and the room has been cleaned.

Patients should stay in their rooms as much as possible while these precautions are in place. They may need to wear a mask when they leave their room.

Airborne precautionsmay be needed for germs that are so small they can float in the air and travel long distances.

• Airborne precautions help keep staff, visitors, and other patients from breathing in these germs and getting sick.
  
• These germs include chicken pox, measles, and active tuberculosis (TB).
  
• Patients who have these germs should be in a special room where the air is gently sucked out. This is called a negative pressure room.
  
• Everyone who goes into the room should put on a respirator mask that fits well before they enter the room.
  

Contact precautionsmay be needed for germs that are spread by touching.

• Everyone who enters the room who may touch the patient or objects in the room should wear a gown and gloves.
  
• These precautions help keep staff and visitors from spreading the germs after touching a patient or an object the patient has touched.
  
• Some of the germs that contact precautions protect us from areC. difficileand norovirus, and respiratory syncytial virus (RSV). These germs can cause serious infection in the intestines.
  

Droplet precautions are usedto prevent contact with mucus and other secretions from the nose and sinuses, throat, airways, and lungs.

• When a patient talks, sneezes, or coughs, droplets that contain germs can travel about 3 feet.
  
• Illnesses that require droplet precautions include influenza (flu), pertussis (whooping cough), and mumps.
  
• Everyone who goes into the room should wear a surgical mask.
  

References

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

Update Date: 2/26/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

[RNsRWe, ASN, RN]

Hooboy, your facility has some serious issues with infection control standards compliance! Droplet and contact precaution the same thing? Hardly. MASKS.

[classicdame, MSN, EdD]

this is the sort of stuff that surveyors love. I agree with koolaid -

[xoemmylouox, ASN, RN]

Wow.. It amazes me how people end up in the management positions they are in. Where is the DON's common sense?? If you have to PPE up to go in.. The patient needs to do the same before coming out!

[Underoo]

Our patients on ANY isolation are encouraged to stay in their rooms. Of course we can't make them and if they're independent some will go out to smoke or wander in the halls anyway. As far as PT goes, they do what they can in the room. If the patient has to go somewhere for testing, they wear a mask if droplet, otherwise they wear nothing special. Our techs transferring them will gown/glove up. We are initiating a "safe zone" which is an area within the doorway that you can safely enter without putting on PPE. Makes perfect sense to me and I'm excited about it. How many times have I just needed to ask a quick question and had to stop and dress up just to pop in for 30 seconds. I do have my own issues with isolation precautions, like why is it so important to be fully dressed for patient with a history of MRSA? If you don't touch them or sit on their bed, just wash your hands and be on your way. I think the majority of our society in my area probably has MRSA anyway! Then there are some people that aren't appropriate for isolation, but make me want to gown up anyway..

[Dazglue, ADN, BSN, MSN, RN]

Thanks everyone. And to the ones questioning my DON....you ever hear the saying "common sense just isn't that common"? That saying is perfect for her! She's never worked as a floor nurse a day in her life.