What are your thoughts about this situation and hospital infections?

[zcubed]

Curious what you think...

Last week I was hospitalized because my HGB was 5.5 (I felt like crap for the last six months, and pretty close to crap for a year)

After repeat bood work, they said the neutrophils were 6. (in fact, almost everything was either high or low)

They brought in masks for everyone visiting and put a sign on door telling everyone that gloves and masks were required and the reason why.

They said that they might not be able to do the colonoscopy and endoscopy that was to be the next day if these levels persisted. The GI docs did not want to risk it.

About an hour later, a nurse comes in to draw blood; no mask though, so my father said something. She said, "no, I only have to wear a mask if I have a cold and I don't." She continued the blood draw. (she wore gloves)

My parents went to the station to say something, and the resident and another nurse also said that it was only if there person was ill. When they protested, the resident than said, "Oh, she must have..."

No less than twenty minutes later, a woman storms in and says, "Another patient is coming..." and begins to fix the other bed.

So I said, "Is that patient going to wear a mask...I have a restriction." Oh, and then she looked at the sign that apparently no one bothers to read.

It turns out the the one test was apparently a lab error, but the thing is that it troubles me is that no one bothers to read the sign or if they do, they don't care. When I was hospitalized last week, it was exactly ten years since my ARDS hospitalization. And in general, my immune system is pretty shot since ARDS (I have a low IgG and IgA) and in the last many years, I read many, many articles about hospital acquired infections. I myself had pseudonomas back then in my trach.

I should say that while these two did not read or ignored the signs, everyone else who was in the room during this time followed the rules. And the hosptal room had two signs posted to families stressing the importance of hand washing to decrease the possibility of infection to patients.

Just curious what those of you in the profession think. Thanks for your thoughts, Eileen

[ceecel.dee, MSN, RN]

There are differing schools of thought on protective isolation.

Our old oncologist had routine standing orders for his cancer/chemo patient's isolation standards based on their blood counts (from good handwashing only to full glove, gown and masking for all entering).

Our new oncologist does not believe in protective isolation. He believes that if we are all conscientiously using universal precautions, that that is enough. At most, it is the patient themself that would wear a mask when leaving the room (though this is not ordered by the doc, but may be offered by a nurse that finds it hard not to protect that patient the old fashioned way).

[zcubed]

There are differing schools of thought on protective isolation.

Our old oncologist had routine standing orders for his cancer/chemo patient's isolation standards based on their blood counts (from good handwashing only to full glove, gown and masking for all entering).

Our new oncologist does not believe in protective isolation. He believes that if we are all conscientiously using universal precautions, that that is enough. At most, it is the patient themself that would wear a mask when leaving the room (though this is not ordered by the doc, but may be offered by a nurse that finds it hard not to protect that patient the old fashioned way).

I understand different schools of thought. That was not my beef. My concern was that obviously my docs felt that these precautions were necessary, and in so doing, they posted a huge sign on my door. The fact that for whatever reason they thought this was necessary, having this sign on my door did not matter (it was not read by at least two staff), nor did bringing this to the attention of at least one nurse seem to matter. There was no ambiguity in the sign posted and the directions on it.

I have nothing but adoration for nurses, who were instrumental in saving my life ten years ago. But in this day and age where there is more research about these issues and my own doctors felt this was the way to proceed for me, this is what I have an issue with.

[Tweety, BSN, RN]

To play devil's advocate here, neutropenic isolation doesn't mean everyone in who walks in has to wear a mask.

Maybe there's more information on the CDC website, but here is some information.

Avoid contact with people exposed to infectious diseases (like chicken pox, shingles, flu, colds) and caution with children in day care or school environments. This includes you! If you have a cough or runny nose--don't take care of this patient. And a mask does not help--it just concentrates your germs in one spot on the mask!

Avoid people recently vaccinated with live vaccines for 30 days

Flu shots are not recommended. Not because they will hurt the patient--but because they won't be effective with the immune system this low...

Good "pulmonary toilet" (coughing and deep breathing--ambulation)

Institute "neutropenic precautions". This is just a reminder to do good handwashing and keep people away that could increase the patient's risk of infection. If they have to go somewhere (like radiology) then they can wear a mask to give them some protection from all the bugs floating around the medical world. If they are neutropenic at home--they need to avoid crowds and don't eat off the salad bar! (Just imagine all those people hanging over the salad bar, sneezing as they go, little fingers rubbing runny little noses and then sticking their hands into the cherry tomatoes...)

You no longer need to place them in "reverse isolation" and cover yourself or their visitors with masks, gowns, gloves...

But the policies may be different in different hopsitals. If there was a sign on the door "WEAR A MASK" then this person didn't follow policy. If it said "Neutropenic precautions" or "I'm at risk for infections", then this person was doing the right thing.

Best wishes for a speedy recovery.

"

[NancyJo]

Isolation precautions do vary from one facitlity to another. At my hopital all who are placed in Neutropenic Isolation are placed in a private room, door must remain closed and all who enter must wear gloves and a mask.

[zcubed]

To play devil's advocate here, neutropenic isolation doesn't mean everyone in who walks in has to wear a mask.

Maybe there's more information on the CDC website, but here is some information.

Avoid contact with people exposed to infectious diseases (like chicken pox, shingles, flu, colds) and caution with children in day care or school environments. This includes you! If you have a cough or runny nose--don't take care of this patient. And a mask does not help--it just concentrates your germs in one spot on the mask!

Avoid people recently vaccinated with live vaccines for 30 days

Flu shots are not recommended. Not because they will hurt the patient--but because they won't be effective with the immune system this low...

Good "pulmonary toilet" (coughing and deep breathing--ambulation)

Institute "neutropenic precautions". This is just a reminder to do good handwashing and keep people away that could increase the patient's risk of infection. If they have to go somewhere (like radiology) then they can wear a mask to give them some protection from all the bugs floating around the medical world. If they are neutropenic at home--they need to avoid crowds and don't eat off the salad bar! (Just imagine all those people hanging over the salad bar, sneezing as they go, little fingers rubbing runny little noses and then sticking their hands into the cherry tomatoes...)

You no longer need to place them in "reverse isolation" and cover yourself or their visitors with masks, gowns, gloves...

But the policies may be different in different hopsitals. If there was a sign on the door "WEAR A MASK" then this person didn't follow policy. If it said "Neutropenic precautions" or "I'm at risk for infections", then this person was doing the right thing.

Best wishes for a speedy recovery.

"

Thank you for the good wishes! My hemoglobin is holding steady at 11.6. The differential is normal. I will get there.

I should have stated that the note was quite explicit. It mentioned Neutropenic, mask, gloves, and also stated that anyone who had cold, flu, flu shot (in the last month, I believe) I think a couple other things, could not enter.

I only looked at the sign to see if it was so innocuous so as to be easily ignored. A few of my friends who work at this hospital were not thrilled to hear this.

[Tweety, BSN, RN]

Thank you for the good wishes! My hemoglobin is holding steady at 11.6. The differential is normal. I will get there.

I should have stated that the note was quite explicit. It mentioned Neutropenic, mask, gloves, and also stated that anyone who had cold, flu, flu shot (in the last month, I believe) I think a couple other things, could not enter.

I only looked at the sign to see if it was so innocuous so as to be easily ignored. A few of my friends who work at this hospital were not thrilled to hear this.

You have the right to be upset that they weren't following policy. I'm sure you wanted to take them outside and say "DUH, can't you read".