Neutropenic pt W/other isoloation pt

Hello
I work on a Surgical/Onc floor and we routinely get our fair share of VRE, C-Diff, MRSA and so forth patients. We also have those that are neutropenic. We used to have "clean" staff that would care only for the neutropenic patients along with separate equipment to check vital signs. Our patients all are in private rooms.
Our hospital has now decided that if you use universal precautions that you could care for both neutropenic pt's along with those on other types of isolation together.
I have noticed that our neutropenic patients are now coming up positive with these other isolation infections, namely C-Diff- and all of the others
I dont think that this is at all appropriate. Why?

• Handwashing dosent always get done by all staff
• Equipment isnt cleaned properly- just found out our CNA's are not cleaning equipment on those with C-Diff with soap and water- as those purple wipes used for the equipment do not kill the spores of C-Diff
• Our clothing has got to have issues with contamination- especially our shoes! We dont wear shoe coverings (do you think that would help?)
• We have these nasty curtains in the rooms that dont get routinely changed, only if they are visible soiled (eww)

I know that C-diff can be caused by abx therapy and the neutropenic are typically on strong abx. Yet still even on strong abx I havent seen as much C-diff as I do now.

The staff originally wanted to have a few rooms dedicated to those with neutropenia, when now they can be next to a row of people with these diseases that need isolation.

What does your hospital do? What do you think?
Well, our Onc and ID MDs would be flipping out and would start admitting their patients to other hopitals. We isolate our neutropenic patients alone, whether on contact precautions or not. One of our Onc MDs doesn't even like us to keep patients delivered flowers at the nurse's station; he would be apoplectic if we tried housing contact precautions with neutropenic patients. The ID MDs are a bit more pragmatic, especially when it comes to the MDROs. As long as we keep our neutropenic patients away from the ones w/ contact precautions and we wash our hands, they don't stress too much. Contact precation patient are *usually* isolated alone on our floor, but of 28 rms, 24 of them are privates anyway, so if anything, we usually end up short semi privates rather than privates anyway. Trying to play musical beds to get 2 semis in the same room w/ the same precautions would be silly.Our hospital has an infectious disease dept, which is actually part of our risk management dept. They make sure we have the correct isolation precautions in place on these types of patients and lately have been in charge of making sure those employees that didn't get the flu shot are wearing their masks. They seem *bored* to say the least, and could use something more interesting to do. Check and see if your hospital has a dept like this and bring up your concerns to them?

that is crazy! neutropenic patients are on reverse isolation! trying to keep our germs from them. if they have to share a room it should be with other neutropenic patients. anyone with mrsa or c diff would be the last patients that should be sharing rooms with neutropenic patients. those patients are in isolation as to not spread their stuff to other people. this is not a good situation for those neutropenic patients! as the nurse you should try to advocate for your patients and talk to your nurse manager about your concerns.

We have too many isolation and neutropenic patients for separate nurses to care for both. The whole point of gowning/gloving/handwashing is that you will not be spreading germs elsewhere. The evidence says this. Not washing hands and not gowning/gloving simply cannot be tolerated. We do use separate equipment. Shoe coverings are not backed by evidence as your shoe really should not be anywhere near the patient.We have plastic blinds in our rooms that get bleached between patients. Rugs/curtains have no place in a hospital setting.

Quote from frogkissingnursethat is crazy! neutropenic patients are on reverse isolation! trying to keep our germs from them. if they have to share a room it should be with other neutropenic patients. anyone with mrsa or c diff would be the last patients that should be sharing rooms with neutropenic patients. those patients are in isolation as to not spread their stuff to other people. this is not a good situation for those neutropenic patients! as the nurse you should try to advocate for your patients and talk to your nurse manager about your concerns.

Quote from rkitty198I dont think that this is at all appropriate. Why?Handwashing dosent always get done by all staffEquipment isnt cleaned properly- just found out our CNA's are not cleaning equipment on those with C-Diff with soap and water- as those purple wipes used for the equipment do not kill the spores of C-DiffOur clothing has got to have issues with contamination- especially our shoes! We dont wear shoe coverings (do you think that would help?)We have these nasty curtains in the rooms that dont get routinely changed, only if they are visible soiled (eww)

That sounds seriously dangerous for patient outcomes. Think about systemic MRSA, C Diff, VRE. Do you have nurse councils? You guys should definitely approach the administration about the serious consequences of this decision that was probably made for the sake of 'efficiency'--stupid six sigma. If you are seeing a change in patient outcomes, most likely you're right. Maybe even offer to, or try to coordinate, a clinical study that can quantify such a poor decision. While you try to make that happen, I hope you really watch out for your patients and push everyone else to do the same.

I just about DIED when I read your post!!! I was an infection control nurse and rounded at our main hospital and our sister facilities; that N E V E R would have flown. Does your facility have an infection control board? How in the name of the Flying Spaghetti Monster did anyone clear that? At that hospital we would do a bit of shuffling if we had to; occasionally a post-op would grumble at the loss of a private room, but it was not a common occurrence. We also initiated a "no scrubs out the door" policy; employees brought their street clothes with them and changed into them before going home (this because quite a few employees would be caring for MRSA/VRE/C-diff pts all day, then go pick up their kids from daycare [in their scrubs] and then head on over to Walmart [in their scrubs]). Is there any way you can go to your nurse manager over this?

I see nothing wrong with the hospital policy as stated in the OP. There is no reason, if staff are practicing proper universal precautions and using PPE appropriately, that they shouldn't be caring for more than one ISO patient, whether it's reverse ISO or not.If staff are not following proper protocol at your hospital then this needs to addressed by your infection control dept STAT. The solution isn't finding dedicated staff to care for a neutropenic patient as staffing levels rarely allow for such luxury, the solution is to educate and enforce proper infection control practices, monitor compliance and discipline those who are blatantly breaching ISO protocol.

Quote from rkitty198HelloI work on a Surgical/Onc floor and we routinely get our fair share of VRE, C-Diff, MRSA and so forth patients. We also have those that are neutropenic. We used to have "clean" staff that would care only for the neutropenic patients along with separate equipment to check vital signs. Our patients all are in private rooms.Our hospital has now decided that if you use universal precautions that you could care for both neutropenic pt's along with those on other types of isolation together.I have noticed that our neutropenic patients are now coming up positive with these other isolation infections, namely C-Diff- and all of the othersI dont think that this is at all appropriate. Why?Handwashing dosent always get done by all staffEquipment isnt cleaned properly- just found out our CNA's are not cleaning equipment on those with C-Diff with soap and water- as those purple wipes used for the equipment do not kill the spores of C-DiffOur clothing has got to have issues with contamination- especially our shoes! We dont wear shoe coverings (do you think that would help?)We have these nasty curtains in the rooms that dont get routinely changed, only if they are visible soiled (eww)I know that C-diff can be caused by abx therapy and the neutropenic are typically on strong abx. Yet still even on strong abx I havent seen as much C-diff as I do now.The staff originally wanted to have a few rooms dedicated to those with neutropenia, when now they can be next to a row of people with these diseases that need isolation. What does your hospital do? What do you think?

Ok, I get it. Totally misunderstood before, and now I can't edit. Yes, in our hospital we take care of patients that are neutropenic and other isolation patients at the same time. There doesn't seem to be much cross over from infection at all. Universal precautions cover the basic issues, and contact precautions cover the rest. We use disposable gowns on contact precaution which are kept outside those patient rooms, they are discarded when you leave the room. Signs are posted outside those patients rooms. We have the alcohol scrub on the wall between every couple of rooms, and sinks in the middle of each hallway.The issues that you cite as being the reasons why to have seperate staff are issues that should be addressed regardless. Staff not washing hands? Why not? Cleaning equpiment? Put the correct wipes on a dedicated machine and keep that machine in the isolation room. Curtains? We use blinds, and that seems like something housekeeping should address. And floors are gross, so the shoes is a non-starter. Unless you are changing shoes when you walk into the "reverse isolation" side, you are tracking nasty stuff in there anyway from outside.

the hospital I came from in Texas did have neutropenic precautions, but the hospital I work at now in another state has informed me that that Disease Control has informed them there is no such thing as reverse isolation and that standard precautions is enough. I guess it just depends on where you work ... this would be a good research project as common sense just tells me that things can be transmitted through your clothing / stethescope/ hands etc . Handwashing and alcohol gel doesnt always work 100 %, why would you not want to protect the severely immunocompromised? In a hospital of all places?

My hospital also does not split up isolation assignments. We are a med/surg/oncology floor. Our floor is split off into "pods" of 4 rooms (all our rooms are private). The other day my "pod" of 4 rooms had a c.diff pt., next door was a MDRO--urine+blood, and next door to that was neutropenic fever--wbc ~0.2. Seriously I could not make this up! I was assigned to all these pts. The point is, as other people have made, that there should not be an issue if proper isolation (or reverse isolation) procedures are in place and are being followed each and every time (not just by nursing staff-by MDs, dietary, housekeeping, PT/OT, lab, etc.). Our isolation pts. and neutropenic pts. alike have their own vital sign machine (dynamap) that stays in their room the entire stay so as not to pass infection to other pts. We use the disposable stethoscopes for the same reason. Of course gown, gloves, mask when appropriate, and HANDWASHING go without saying. The neutropenic patients: mask for all staff and visitors, no flowers/fresh fruits or veggies, handwashingx1000. We have an infectious control nurse who is seriously insane, and she does not have a problem with this. And our neutropenic patients are not getting sick.