infection prevention
infection prevention
By Carol Calabrese , RN , BS , T-CSCT , CHESP , CIC
Isolation : Pondering the Issues
During clinical rotation I vividly recall one of my fellow classmates passing medications and walking directly into a room in which the patient was on isolation precautions .
Practicing good isolation techniques is important . We saw this especially in 2014 with the risk of Ebola in the United States . Everyone was franticly trying to re-educate their staff on donning and doffing technique of personal protective equipment ( PPE ). After the emergency was over , staff went back to their old bad habits . I have asked myself , are they old habits or did they never receive proper education ? Are we doing enough isolation education for all healthcare workers ( HCWs )?
How , where and when is education provided to HCWs in your institution ? Infection preventionists ( IPs ) struggle to provide much-needed content during hospital orientation which has gone from an hour to just 15-30 minutes . If it is not provided in general orientation , then where is it provided ? It might be in the unit / department ’ s orientation ; and if it is , who has trained the preceptors in these locations ? Are competencies performed ?
With the emphasis we place on isolation , we may not be evaluating many of the issues related to caring for patients / residents that need to be in isolation .
I ’ ve seen a wide range of infractions . Staff wearing the gown backwards , leaving a gap in the front ; staff walking out of isolation with a specimen , taking it to the nurses station to send through the pneumatic tube system ; water pitchers being filled incorrectly , dietary walking out of a contact isolation room with the menu and then faxing it to dietary at the nurses station , a respiratory therapist in full PPE at the doorway of the room typing on the computer at the mobile work station ; the whole endoscopy cart in contact precautions and a CNA doing one-to-one care in contact precautions without PPE , to name a few .
The Centers for Disease Control and Prevention ( CDC ) provides clear guidance for donning and doffing PPE , how to manage linen and to use certain disposable equipment but does not discuss other activities involved in patient care .
When a staff member is doing one-toone care , the typical expectation is that
they are wearing PPE for an eight- to12- hour shift , minus breaks . I wonder how realistic an expectation this is . A thought I have had but never implemented is to provide the HCW with hospital-provided scrubs and a lab coat . The HCW would wear the scrubs while doing one-to-one , don the lab coat when they leave the room for breaks and place it on a hook outside of the patient ’ s room upon re-entry . Naturally hand hygiene is very important prior to donning and doffing the lab coat .
Staff are encouraged to identify all supplies that need to be taken into the room to provide care , however , issues arise with items coming out .
When I trained , we were taught to have a “ buddy ” that would assist us . I went into the isolation room to collect a urine specimen . I collected the specimen and labelled it . My buddy is outside of the room with the specimen bag , holding it open for me to place the specimen into it . They then took the specimen to the nursing station to send it to the laboratory . The outside of the specimen bag is not contaminated using this process . This process can and should be applied to other items coming out of an isolation room .
Evaluating how other departments providing care to the patient in Isolation are managing items used to care for that patient is critical . A nurse or CNA can be their buddy .
Does this take some coordination ? Absolutely ; however , it also aides in reducing the risk of transmission .
Over the past few years , research has demonstrated that pathogens such as C . difficile and other multidrug-resistant organisms ( MRDOs ) are being found in non-isolation rooms .
The Centers for Disease
Control and Prevention ( CDC ) provides clear guidance for donning and doffing PPE , how to manage linen and to use certain disposable equipment but does not discuss other activities involved in patient care .”
Teska and Gauthier ( 2021 ) suggest that IPs may need to consider having environmental services ( EVS ) personnel disinfect the floors of patients on Contact Precautions . The references cited discuss the transmission of pathogens between rooms via the shoes and hands of the HCWs .
With this evidence , IPs may also want to consider adding shoe covers to the necessary PPE worn for contact precautions .
The CDC ’ s CDI TAP Assessment Tool ( 2022 ) is helpful to evaluate what is being done to minimize the risk of transmission of CDI , however , I believe this should be utilized for all MDROs .
Per the CDC ’ s report , Antibiotic Resistance Threats in the United States , 2019 , antimicrobial resistance ( AR ) report , it states that resistance is growing . Utilizing contact precautions will continue to grow as AR grows in addition to the threat of new and emerging pathogens .
As the draft 2024 transmission-based precautions guidance is released by CDC ’ s Healthcare Infection Control Practices Advisory Committee ( HICPAC ), it may be time for us to take a deeper look at isolation technique , implementing the use of additional PPE and components to environmental hygiene .
Carol Calabrese , RN , BS , T-CSCT , CHESP , CIC , is an infection prevention consultant with 30-plus years of experience . Her experience includes many settings , acute to industry with leadership background . Connect with Carol on LinkedIn : linkedin . com / in / carol-calabrese-rn-bs-t-csct-chespcic-a09bb216 and visit her website at : www . infectionpreventionconsultant . com
10 • www . healthcarehygienemagazine . com • february 2024