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Don't take needless risks if patient needs isolation
Noncompliance with isolation precautions can be extremely dangerous for ED nurses, but in fact, this situation is surprisingly common, according to Diane Hochstetler, RN, BSN, CEN, clinical practice specialist for the ED at Goshen (IN) General Hospital.
"The ED serves as the gateway to the hospital, which leads to the unknown of what staff and other patients are exposed to," Hochstetler says.
Noncompliance in Goshen's ED came to light during a recent outbreak of Clostridium difficile (C. difficile) in the community. "Our nursing colleagues reported seeing breaks in isolation practices," says Hochstetler. "There was also an increase in the number of patients with C. difficile in the inpatient population, which caused concern for the ED."
First, isolation precautions and the reason for these were reviewed with staff. "This exercise provided a baseline of knowledge before the next phase of instruction," says LeeAnn Matson, RN, shift coordinator for Goshen's ED. [The competency checklist used by ED nurses is included. For assistance, contact customer service at (800) 688-2421 or email@example.com.]
Next, ED-specific scenarios covered contact, droplet, and airborne infection risks, with a particular focus on C. difficile. One scenario involved a 76-year-old man presenting to triage from a long-term care facility with the complaint of diarrhea for two days.
In an ED treatment room, a polymer lotion that glows under a black light was applied to the side rails, sink, counter edges, computer, patient blood tubes, urine specimen cup, and intravenous (IV) supplies. Working with a simulated patient, ED nurses were asked to:
Afterward, ED nurses removed their gown and gloves and washed their hands. Before they left the room, a black light was used to reveal any contaminant on the nurses' hands and clothing.
"The presence of the polymer was discussed, with suggestions for improving techniques to prevent transfer of organisms," says Matson. "Compliance has improved significantly."
Some of Goshen's ED nurses admitted that they weren't clear on why isolation procedures were necessary, and they even questioned the department's inclusion/exclusion criteria. This situation gave Hochstetler the opportunity to explain that these precautions protect the nurses and their families, as well as others.
"Also, it was pointed out that once the patient receives a medical screening, the C. difficile assessment scoring tool is used, and proper tests are returned, the patient may be removed from isolation," she says.
For more information on improving compliance with isolation precautions, contact:
Prevent contamination from commode contents
The task of removing commode contents from the room of a patient in contact isolation "can put many at risk," warns Diane Hochstetler, RN, BSN, CEN, clinical practice specialist for the ED at Goshen (IN) General Hospital.
Here is the ED's practice:
Spent zero dollars to create simulated patient
Diane Hochstetler, RN, BSN, CEN, clinical practice specialist for the ED at Goshen (IN) General Hospital, reports that her ED nurses created a simulated patient named Mertle, for no cost at all.
"She shows up for a spontaneous mock code, becomes a neutropenic patient, presents with tuberculosis risk, and sometimes even is an elderly hypoglycemic patient," she says. "The possibilities are endless!"
The dummy is put together with three pillows, two towels, tape, two rubber gloves, a round paper face, patient gown, and name band. One pillow with the round face taped to it serves as the head. The other two pillows are laid lengthwise below the head to make her body. The two towels are folded, rolled and taped to form the arms, with the rubber gloves placed on the ends for hands.
"The folds in the towels serve as good places to place mock intravenous lines. We use coffee stir sticks," says Hochstetler. "Mertle visits our department on a moment's notice and brings a smile to my colleagues' faces. This past Halloween, she even gained a $1 Dolly Parton wig!"