Was reprimanded for wearing gloves while working with a patient

[amillion3147]

I'm not a nurse but a physical therapist working in what I may add a very unsanitary nursing home. The staff is very neglectful with regards to patient care. The nursing assistants do not toilet residents on a regular basis so often residents are sitting in soiled briefs for hours or they have on two briefs because the staff don't want to change them. This presents as a skin and hygiene issue. Two weeks ago bed bugs were found crawling around a pts bed and infested their wheelchair. I could go on but I digress. Anything you can think of many of the pts have from Mrsa, cdiff, HIV etc. I got reprimanded not once but twice for ambulating residents in the hallway wearing gloves while doing my job. These pts of course had active infections. My defense is that I have a responsibility to adhere to universal precautions as I don't wish to get sick. My health is my primary concern and protecting the health of residents as well. Often in the midst of working with a pt is enough to make them void. I was told that it was a dignity issue. How when I am working with sick people? Why should I have to throw caution to the wind here? It's hard to get many of these pts to simply wash their hands. I observe people actively digging around in their own briefs. Any advice on how to proceed now?

[june2009]

I am currently work in a SNF and am appalled by what I read by OP. There is absolutely no excuse not to report the abuse that is taking place at this facility. If I found any one of my residents double-briefed or sitting in excrement the person responsible would be immediately repremanded and investigated for neglect.

[laKrugRN]

When in doubt..WEAR GLOVES! Wow. You were just being smart and safe. This place sounds awful and the state needs to be involved.

[SongofaNurse]

I would wear gloves. It is not a waste of supplies if you are using it to protect yourself. PROTECTING yourself is important. I would report it. And for the person who responded saying it is unlikely you wash your hands according to protocol. How do they know? I know one of the things I am big on is HANDWASHING! Always protect yourself! And of course wearing gloves you are protecting yourself and the patient.

[LightMyFire]

C-diff? MRSA? These diagnoses require the use of PPE and proper hand hygiene. Encourage the pts to also wash their hands before leaving the room. While I work at a hospital, our policy is to have those in iso to have clean linens on the WC, wash their hands before leaving the room, and refrain from touching anything while out if the room. These people may feel better if they were able to wash their hands hands once in a while and may not be offered the opportunity very often.

[rnforforty]

This would come in under the Elder Justice Rule signed by Congress in 2010. This states you are obligated to report such neglect to the State or law enforcement if it is resulting in physical harm.

[BrittL&D]

Report them!

[Cheyenne RN,BSHS]

Universal precautions are basically barrier precautions. Our PT/OT is not allowed to wear gloves in the hall either but we still have infection control guidelines for patients when outside of their room. Any open wounds must be covered with a clean and dry dressing, the patient is to have on a clean hospital gown over their own gown/robe, and they must clean their hands with a hospital approved hygiene product when they leave their room. (gel, foam, or soap and water as per facility policy). The clean gown will provide your barrier. Keep a pair of gloves in your pocket in case you have to handle any body fluids while ambulating the person.

If the patient is incontinent and soiled request that the patients nurse or assistant change them and any wet/soiled clothing. (If this is a problem at any facility talk with your director or department head about a policy so that this is understood up front with facilities.) It is inappropriate for the patient as well as HCW to be walking down the hall or to PT/OT in wet briefs that smell. That is a dignity and IC issue.

If a patient has a problem "digging for gold" in their briefs or diaper during the time PT/OT is working with them then it may not be appropriate to work with that person out of their room or in Physical Therapy. An isolation gown would be more appropriate then if contamination with body fluids is a high potential. Some patients with dementia do have habits that can cause contamination.

If the patient is coughing or it is flu season it would be better to remain in their room for Physical therapy to avoid spreading the infection. We require patients with respiratory infections or on Droplet Precautions to wear a surgical mask while out of the room. Hope this helps and make you feel more protected.

[ocean.baby]

Sounds like administration or corporate needs to get busy. One thing I ask is that you don't jump to conclusions that the nursing staff isn't doing all they can do. Now you work there so you know who is doing what. However, I know some facilities work so short handed that nursing staff can run their behinds off and never be able to give adequate care. The reason they don't quit is that they are too worried about what will happen to the residents.