Nursing Orientation

All staff AND visitors should follow the precautions listed on the sign All PPE (personal protective equipment) should be on prior to entering the room and staff/visitors should not leave the room until PPE is removed and hand hygiene performed Gowns should be placed around the neck and tied at the waist for full protection – do not leave waist ties undone and enter the room!! Reusable equipment such as blood pressure cuff, stethoscope and thermometer should be left in the room for subsequent use PPE that is not saturated should be placed in the trash. Saturated PPE should be placed in a biohazard bag

This procedure should be kept as clean as possible Avoid touching the patient, dressings, skin etc prior to giving medications If a medication is dropped on the floor it should be discarded and replaced.

Dietary will deliver trays to patients in CONTACT precautions only. They will not deliver trays to patients in any other type of isolation.

PICC line dressing changes are done by the PICC team and should be done weekly or as needed if soiled or integrity is compromised. Other central lines are not done by the PICC team and should be monitored by nursing to ensure they are changed regularly. Always use hand hygiene and scrub the hub! Evaluate catheter insertion site daily for tenderness, redness, drainage etc.

What is the number one way to prevent catheter associated UTI? – Don’t put a foley in!! What is the second best way to prevent catheter associated UTI? – Take the foley out!! Indications for a foley catheter are: Strict I&O in Critically Ill patients Urinary retention or bladder outlet obstruction Perioperative for selected procedures (should be evaluated on post op day #2 – dc foley or physicians order for why it is still needed) To assist in healing of open sacral or perineal wounds (stage 3 or 4 decubs) in incontinent patients Prolonged immobilization (traumatic injuries such as hip fracture or spinal cord injury) To improve comfort for end of life care

Studies have shown that patients who have a foley catheter for greater than 2 days are 21% more likely to develop a UTI. Patients who have a foley for 2 weeks are 50% more likely to develop UTI Patients are 100% more likely to develop UTI if they have a foley in for 4 weeks We are looking at starting a nurse driven foley removal protocol to help with removing the catheter earlier.

Our policy states that the foley should be cleansed with soap and water daily. Avoid putting the cloth back into dirty bath water and repeat rinsing – washcloth should be new and clean Some studies suggest the bath basin may be a source of contamination Use a STATLOCK!! – studies show as much as a 45% reduction in UTI in patients with a STATLOCK. (the thought is that it prevents in and out movement which causes transmission) Keep catheter and tubing below the level of the bladder

If readmitted within 12 months of positive culture, the patient will remain in isolation with no additional testing If readmitted at greater than 12 months from positive culture, we will obtain cultures to check for the resistant organism by: Culturing the original site of infection or Doing a nasal swab to check for colonized MRSA Doing a rectal swab to check for colonized VRE

Patient’s with diarrhea (3 or more stools per 24 hour period) without an identifiable cause should be placed in private room in Special Contact Precautions and stool sent to lab to check for Cdiff Patient’s who are positive for Cdiff will not be removed from isolation during that admission – there is no need for repeat testing (with exception of extended stay hospitalization and then IC will consult with Dr. Geha regarding removal of isolation) Patient’s readmitted with a history of Cdiff do not need to be placed in isolation unless they are having diarrhea on readmission or are still being treated for a recent Cdiff episode.

Call us for any questions or concerns Vicki Sherwood or Lindsey VanSandt – find us on CNET or on the 5 th floor across from staff elevators!! Also on CNET Isolation Quick Reference log – right hand side of main page