RN With Contamination OCD - Please Help!

[FSZ Student Nurse, RN]

I am a new-ish RN struggling with OCD. I am trying to assess whether my hygiene habits after my shift are OCD behaviors or legitimate. I would be incredibly grateful if anyone could give their feedback on my routine!

After my shift, I go home and shower immediately. I do not prep food in the kitchen or even sit on the couch before I shower. I feel like I might have brought "something" home on my skin or scrubs and I don't want to spread germs. If I go into the kitchen for a quick drink before showering, I very carefully lean over the counters, so that my dirty scrubs don't brush the counters or dishes. If I need to sit for a minute before I shower, I sit on the floor so that I don't contaminate the sofa (Of course, I wash my hands as soon as I walk in the door from work).

Before my shower, I take a bag with me into the bathroom for my dirty scrubs. I strip my dirty scrubs into the bag, so that when I bring them to the hamper later I am not holding a bundle of dirty scrubs against my clean clothing. After my shower, I open the door and only then do I pick up the "dirty" bag of scrubs to bring to the hamper, since I don't want to touch the doorknob after touching my scrubs. I wash my hands well after dumping the bag in the hamper.... And yes, laundry days are a dreaded ordeal ?

I am very curious what others would do before they shower - would they sit on their couch? prep food or lean against counters? brush against doorknobs? hold a baby? Or even - gasp ? - go to bed without showering? (I think the last one is probably universally acknowledged as gross ?, but my perspective here might be a bit skewed).

And how do you handle your dirty scrubs?

[FolksBtrippin, BSN, RN]

When I worked in the hospital, I came home stripped down in front of the washer, put my scrubs in the washer, took a shower.

I am a moderately messy person but clean where it counts. 

If a thought-behavior pattern is bothering you, interfering with your daily life or relationships, then it might be something to address in therapy. If not, carry on.

[hppygr8ful, ASN, RN, EMT-I]

Well my husband is a germaphobe. When Covid arrived at our door He installed UV lights in the mud room. Our clothes washer and dryer are in there so I take my hospital shoes off then enter through the  back door.I strip there and throw my scrubs. Stand under the lights and make a full 360 degree turn around, Then I proceed to the shower. Once showered I put my robe on and enter the main house.

Hppy

 

[Davey Do]

Questioning one's own behavior is a good sign, FSZ. If you went about your routine thoughtlessly driven, that would be another story.

I echo FolksBtrippin's perspective "if your thought-behavior pattern is bothering you, interfering with your daily life or relationships" then it would require an intervention.

We all have our rituals, routines, superstitions, and idiosyncrasies we do which increases our feelings of safety and comfort.

Like FolksBtrippin, I am fastidious in some areas, however, I am a real slob when it cones to work I do around the house, my art, and my dress code. My medical nurse wife Belinda calls my casual dress "grunge".

Speaking of Belinda, she is not a germaphobe, even when her unit was the Covid unit. Belinda had a couple of medical procedures done about a year ago, before receiving the vaccine, had to be tested for Covid before both of them, and they came back negative.

I reiterate: Bottom line, if a behavior or pursuit does not profoundly affect your health, relationships, or work, I once again quote FolksBtrippin and say, "carry on"!

[FSZ Student Nurse, RN]

Thank you for your responses!

Unfortunately, anything germ-related does cause severe anxiety, but that doesn't necessarily mean that my behaviors in response are wrong. I am trying to figure out which compulsive actions are rooted in reality and which are just a response to obsessive thoughts.

Because of my anxiety, I actively avoid situations that "require" (in my mind) that I wash my hands. If I need to do anything "dirty", I go from clean to dirty and have built elaborate, rigid routines around avoiding "dirty" contact. Any deviations from these routines can provoke additional handwashing and severe anxiety.

I am currently working with an excellent therapist who specializes in OCD. As part of my therapy, I am exposing myself to "dirty" situations or objects and not washing my hands or cleaning surfaces afterwards.

However, work is a massive road-block to my progress in therapy, since there is a lot of legitimate handwashing and cleaning involved in hospital nursing. After my therapy session this week, I was off work for 2 days and made great progress. My hands - which are normally cracked and dry - actually looked normal for once. I went to work for one day, and I undid all my hard work. My hands are now red and raw again. I went back to washing my hands too much at home, since I was so triggered by the uncertainty of work.
 

[FSZ Student Nurse, RN]

I think if I had more clarity about which of my behaviors were absolutely neccessary to prevent transmission of infection and which behaviors were just "germ superstition", then I could allow my rational side to remain in control and avoid continuous relapses. If I knew that showering after work really protected others from unusual pathogens, then I would feel calm about it. But, I am not certain it does. 

I start thinking of all the things that I *could* be carrying home with me: MRSA, C. Diff, VRE, COVID, Ebola, leprosy ... the Plague ? (OK, I made up a few of those, but that does encapsulate the level of absurdity that my brain plays on me). 

But, what are the chances that I am actually bringing that home? How much actually gets on me when I am appropriately following IP policies? And, even if I don't follow the policies, how long do those germs reasonably remain virulent on my scrubs and skin? And, is there really all that much difference in the hospital?

While in the hospital, I can say with reasonable certainty that someone has a specific infection, but I don't know that people outside the hospital don't. Ever seen a family member of someone with explosive CDAD bring personal belongings in the room and place them on or near the patient, and then TAKE THEM HOME WITHOUT CLEANING THEM? Germs go home with patients, their family ... and healthcare workers ?

As a RN, I try to educate patients and their family members on IP policies and procedures, but so many Americans don't even wash their hands after they use the bathroom. Do we really believe that all these "cooties" are not already out in the wild? 

Does my showering ritual actually achieve anything?

[Davey Do]

Some time ago, a joke went something like this: "Did you hear my joke about Ebola?

Never mind- you probably won't get it."

I have empathy and admiration for you, FSZ for working with a therapist and proactively attempting to deal with your anxiety.

I would also encourage you to gain information on a 12 Step Emotions Anonymous Program, which helped me when I was in the throes of a depressive episode. Following the tenets of, and working, a 12 Step Program can help those of us who have difficulty dealing with our emotions.

It's been nearly 35 years since I was first introduced  to a 12 Step Program and I continue to "practice (the) principles in all (my) affairs", every day.

Having a sense of humor also helps -see my signature line.

Finally, from first hand professional experience, I have had to deal with multiple exposures to others' body fluids. I got a victim's blood in my mouth and eyes as a first responder to an MVA, and have been stuck by dirty lancets and needles.

It's not always a safe field in which we work(ED), but we need to attain a realistic perspective and not let our sometimes unfounded fears rule us.

The best to you.

 

[Tweety, BSN, RN]

I'm glad that you acknowledge you're OCD and getting help and wish you all the best.

I'm kind of on the other extreme.  I'll sanitize my work station sometimes when I think about it, I always do the "wash in and wash out" and wear gloves with patient contact and always use good infection control protocols and hand washing.  But I don't always come home and change immediately because I'm always hungry and go right to the kitchen.  I'll hang out in my scrub bottoms, socks and my t-shirt in until time to go to bed.  

I was a little more careful when it was thought covid could live for long periods on surfaces and would take off my uniform quickly and spray my shoes with Lysol.  I've long stopped doing this and have never got covid.

As far as I know it, I've never got a hospital acquired illness and haven't even been sick with a cold for years.  I really don't think if you're in reasonable health, without immune deficiencies you're going to be okay.  It can be argued if you sanitize all the good bacteria away it just makes room for harmful ones to proliferate.  Having a healthy skin microbiome is protective.  
 

 

[nursej22, MSN, RN]

My experience is similar to Tweety's. I don't believe I ever experienced a hospital acquired illness, even though I worked on a medical floor for years. Heavens, I worked before gloves were so routinely used. Most of the really bad stuff is transmitted by oral-fecal, or mucus membrane, or enters an open wound. So you need to keep your hands with their intact skin away from your eyes and your mouth, wash hands after using the restroom, before you eat and anytime they are soiled. And follow your infection prevention policies. 

Seriously, though, keeping the skin on your hands intact is as important as showering. In my opinion, the main benefit from showering is relaxation and a little aroma therapy from a nice shampoo or body wash. 

[mtmkjr, BSN]

I agree that it is good that you are recognizing that your anxieties may not be rationally based.  You've thought through the possibilities - what kind microbes are potentially going to harm you?  Through what route do they typically  infect a person?  Are healthcare workers dying or getting infections at such high rates that you need to protect yourself to that extent?

We all catastrophize over one thing or another.  Excessive fear, believing something is worse than it actually is.  For example the fear of flying when there are thousands more activities that are more likely to put you in danger. Putting things into perspective should help to reduce your anxiety over them.  If you are unable to do this, and the anxiety is interfering with your enjoyment of life, and you can't rationalize your way out of it, get a professional to help you develop some healthier though processes. 

The best defense against the typical microbes we interact with is pretty simple, hand washing, keeping cuts and scrapes clean and wearing appropriate PPE and keeping things reasonably clean.  Beyond that, you may actually be putting yourself at risk of over sanitizing, weakening your immune system.  I think that is something we will be talking about a lot more 10 years from now.

Practice healthy lifestyle.  That's the bottom line to me.  I believe exposure to common contaminates is actually necessary to our health. The human body has amazing protections built into it, and does the job for us if we let it. 

I wish you the best - hope you find the right answers

[Closed Account 12345]

My job is not even messy, and to this day, I still strip down before entering my house. Work shoes permanently stay in the garage. Work purse permanently stays in the garage. Used scrubs stay in the garage until I'm ready to wash them. I go directly to the shower and don't even greet my family until I'm clean.  

I don't think of this as an OCD routine. I think it's just good infection control.

[Emergent, RN]

I'm not a germaphobe, and I do think germaphobes are a little extreme sometimes. But, if doing these rituals helps you feel more comfortable, it's not like it's going to hurt anybody unless you are using a bunch of chemicals on your bare skin that could be absorbed into the body. Some germaphobes are not cautious enough about chemical disinfectants. There has been a huge increase in lymphomas and leukemias is due to the chemicals in our environment. So if you are cautious with the chemical disinfectants, do whatever you need for your own comfort level.