Universal Precautions

[The Noob]

thought i would put this here, because i truly want all feedback i can get before i meet with doc next week to discuss.

question: if you are in-center, what, if any, precautions do the EMS, transport or (if you have them come in) Prison guards use/do for entrance to your Hemo unit?

i really want all the feedback i can get. good/bad/ugly/indifferent..

[cattlekid]

The EMS and transport folks usually wear gloves but that's it.  I haven't seen prison guards yet, we are not the closest facility to the county jail.

Patient visitors are rarely allowed, but the few times I have seen a visitor, they are not required to wear any PPE.

[The Noob]

thank you, please others chime in. i want to be well read next week. i am searching net and here for other articles as well. i would think gloves would be the least thing to ask.

[jbeany]

When I was in-center, the rare times EMS came in, they were wearing gloves - but that's SOP for treating any patient.  No precautions were taken for anyone else - visitors, social worker, admins, etc.  I wasn't in-center for the giant flu epidemic, so not sure if that changed then.  When I stopped in this summer to visit, post-transplant, it was the same.  I just walked in the door and walked into the treatment area to say hello to everyone, patients and staff alike.

[The Noob]

wow. i'm stumped for words.

[Poppylicious]

My experience (from the few occasions I've gone to haemoD with Blokey) is much the same as jbeany's.  Standard practice for ambulance and ward staff to wear gloves but nobody else (including the Hospital Transport chaps) has to take any precautions, apart from signs encouraging the use of the alcohol rub.  Blokey does haemoD at a big, very busy, training hospital in the UK though, and I have no idea if this experience is standard throughout all UK hospitals.

[Hemodoc]

Universal precautions are for protection of health care workers from patients, not so much to protect patients from health care workers that I believe was part of the opening post's question. In addition, health care workers are notoriously bad at washing their hands and changing gloves in between patients. Not much good news on that front I am afraid.

[jbeany]

Yup, if you are wondering why your clinic staff seems so confused by you wanting more precautions - it's because it's not standard of care pretty much anywhere.  And part of that is always going to be the expense of masking, gloving and gowning every person who walks in.  But they could at least require everyone who walks in the door to use hand sanitizer, don't you think?

I'm now a VRE carrier.  (That's Vanco(antibiotic)-Resistant Enterro-something-I-can't-spell) It raises the risk of abdominal wound infections and cause some rotten side effects like diarrhea. It's transmitted by bodily fluids.  Everyone has a bit of the regular version on them, but the antibiotic resistant version is nearly impossible to get rid of.  I shockingly  caught it while I was in the hospital for 2 months with an open abdominal wound post transplant.  It no longer puts me at risk, but it puts every other patient at risk, so I always get a private room (which is the best part) and all the staff must glove, gown and mask when they come in to prevent spreading it to other patients.  They are horrible at it.  I'm constantly reminding them to gown and glove up, and if they walk in without, I'm also reminding them to scrub up on the way out if they touched anything at all.

But - none of the cleaning staff gowns up.  Neither do any of the food service people.  Or the admin or financial people.  They all come in, shift stuff around that I have been handling, and skip right back out to go do the same in the next room.  Gee, wonder why I got it?  Oh, and I can go for a walk whenever I want around the hallways, too - and sneeze where and when I please!

It's all just so logical, isn't it? 

[sullidog]

In my old unit drivers are not aloud in the clinic and have to wait in the waiting room unless the patient requires their assistants. Social workers and anyone besides the patient that comes on the floor has to ware a goun. I'm not sure about my new unit as I just started there.

[Lindia]

At my hubbys unit,  they require that any visitors on the floor - wash hands and put on a gown.   The dietician gowns up,  the head RN doesn't - its sort of a mixed bag.  The techs are good at wearing gloves, and changing them often.

[The Noob]

thank you all for chiming in. looks like there is controversy on this issue depending where/who treats.

Hemodoc: i was always taught that taking universal precautions was for my safety, but also the patient.
what about transferring between patients?

what we were taught in many CEU classes put on by our 911 company, was to don the gloves, but didn't need masks unless there was suspect of body fluids/airborne. we were also expected to wipe the equipment and cot down after each patient.

i guess what i'm asking is, if this is not standard practice anymore, why have sign on door of unit not allowing anyone to come and go?

one of our support group members and myself will meet with the doc tomorrow with these questions. my bet is he will side with us at least in the area of wearing gloves.

hey! if nothing else, someone is listening to us. will be back to report! thanks all of you!

[Riki]

At my unit everyone (patients, staff, visitors) to clean their hands with hand sanitizer when coming in and leaving.  EMS transports generally wear gloves.  The fellows that transport me and a few other patients don't generally go into the treatment area unless their assistance is needed.  They are a disability transport service, but sometimes they do stretcher calls when the EMS's are too busy.  They use hand sanitizers as well, and sometimes keep some in the vans.

The nurses wear gloves, masks, and safety glasses when putting people on, and taking them off.  I'm thinking that's more for their protection than ours.  Sheets and pillow cases are changed, and chairs, pillows, bedside tables and machines are all wiped down between patients.  If an IV pump is needed, it's also wiped down after each use.  The scale and the thermometre are also wiped down after each patient

Our hospital was VRE free until a few years ago.  It's still MRSA free, I think, but that could change as well.

[Zach]

Universal precautions are for protection of health care workers from patients, not so much to protect patients from health care workers that I believe was part of the opening post's question. In addition, health care workers are notoriously bad at washing their hands and changing gloves in between patients. Not much good news on that front I am afraid.

We used to abide by the term, "aseptic technique" as the protection for the patients.
I don't hear the term much these days. Sad.

[The Noob]

you know, in almost 2 years of this, my DH has not had so much as a cold. However, what he had instead was MSRA, CDiff, Gramm Negative/positive, Staph. This was due i believe because of the lack of the aseptic technique.

now they are pushing all the vaccines on him, telling him he must get them for a transplant.
in years past both of us had the hep-c series more than once, and never converted. he had a bad adverse reaction to the flu shot at one time and was out of work for weeks.

we don't decline TB and Tetanus, but have done so on the others. the TX clinic says it is not mandatory for flu/pneumonia vaccines, clinic insistent. 

what do i tell him? one area he is concerned is the PRA count going up if he does? does anyone know? right now his count is 6.
i almost figure being in that setting he will probably pick up these viruses anyway, and make his own antibodies.

i am struggling here. i'm sorry to vent. there is just so much he and i don't know and what info we can get.

the TX clinic told me yesterday they still have not read the kidney scans. and they have no scheduled date to do this. reason being, the docs want at least 6 to read at one time. so this could go on and on. the nurse did say she is trying to get it scheduled anyway. he has had 4 scans, all normal.

he has a matched healthy cleared living donor who lives one mile from the transplant clinic, and who is still adamant about donating. however, he can't get the donor nurse to call him back in over 2 months.

why do i have the feeling that all these issues come down to a checkbook or insurance card?

[Hemodoc]

thank you all for chiming in. looks like there is controversy on this issue depending where/who treats.

Hemodoc: i was always taught that taking universal precautions was for my safety, but also the patient.
what about transferring between patients?

what we were taught in many CEU classes put on by our 911 company, was to don the gloves, but didn't need masks unless there was suspect of body fluids/airborne. we were also expected to wipe the equipment and cot down after each patient.

i guess what i'm asking is, if this is not standard practice anymore, why have sign on door of unit not allowing anyone to come and go?

one of our support group members and myself will meet with the doc tomorrow with these questions. my bet is he will side with us at least in the area of wearing gloves.

hey! if nothing else, someone is listening to us. will be back to report! thanks all of you!

Universal precautions came into being over the HIV epidemic and the assumption that all blood and body fluids are contaminated. In such, there are certain standard precautions that all health care workers assume in their daily chores such as starting IVs, placing catheters, giving medications with syringes, etc.

Putting up signs on doors and masking and putting on a gown is a different situation associated with isolation of known case of resistant bacteria or virulent virus. In the dialysis unit, all patients with Hepatitis B serology are isolated from the general dialysis population. I wish that they also included Hepatitis C patients as well since that is another epidemic amongst dialysis patients, but that is not the standard.

With isolation, there are different levels depending on the type of pathogen involved. Some are only contact isolation, some have respirator precautions and some are a combination of contact and respiratory precautions. In this instance, the patient has no mask or gown and all that come into the room must gown, mask and not bring their own stethoscope or BP monitors. Leaving the room is an outer room where the contaminated items are disposed.

For patients with TB and other serious respiratory pathogens, you add negative air pressure and frequent air exchanges to the equation.

There is a different type of isolation called Reverse Isolation for patients that have immune disorders that occur from disease or from consequences of chemotherapy for example. In this situation, the patient will have a low microbial diet with no yogurt,  no salads or other items with known high bacterial content. Staff that enter the room where mask, gloves and gowns to protect the patient.

However, the universal precautions used in the dialysis unit are for protection of the staff. The protection to the patient is changing gloves and hand washing in between each patient. In this situation, we are the contaminated subjects, not the staff, or at least in theory. However, we know that most of the infections in a dialysis unit are ultimately nosocomial in nature. In other words, caused by poor aseptic technique as Zach noted above. So, while universal precautions are meant to protect the staff and in such secondarily prevent nosocomial transmission to other patients, it is poorly practiced in dialysis units.

[jeannea]

I don't believe that what your transplant clinic is doing has anything to do with money. We all go through tests to be permitted on the transplant list. And you have to be listed, even if it's for a month, even if you have a living donor. Most of us getting a transplant are on Medicare and don't have a lot of money.

[The Noob]

HemoDoc: thank you for laying that out for me. that was very kind and patient. i think i understand now. it was drilled into us working in healthcare so much, we just expected it to be the same here.
this must be hard on you being a doctor and a patient as well. its been a rough transition for my DH, though i constantly remind him that he is still the man he was before, though now some hurdles, if that makes sense.
we have patients at the clinic with multiple myeloma and various other ailments. my heart goes out to them.
i had a discussion with the receptionist once, who puts the bulletin boards up. i suggested to her that instead of putting pics of the patients as babies, and then as adults sitting in a dialysis chair, why not post a pic of them in their heyday? i don't know that i'd want to be remembered sitting in a dialysis chair. 


jannea, i often ponder why you seem to bite back at me when i post things. i am simply stating my feelings, thoughts and opinions. i don't believe either you or I can be experts on what hospital policy and administrators motives may sometimes be. please if you would, soften your response if possible? we are all fighting this battle together and need to be as kind to one another as we can. 
after reading through OKarols news articles and the hundreds of posts/experiences on such, its obvious not everyone holds the same opinion about this.

[jeannea]

I'm not biting back. I am disagreeing. I think you're the one biting at me. I find it strange some of your viewpoints. But I thought I was allowed to offer another viewpoint. If you only want to hear from people who agree with you, then just say that. I have had a transplant from a living donor and now I am on the list again so I do know about transplants. But if you don't want to hear other people's ideas then good luck. Your life will be harder.

And if you read other threads you will see other times people disagreed without freaking out.