Contact precautions

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Novocaine

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List of contact precaution diseases::glare:
esbl
vre
MRSA
C. diff
TB


My understanding is that wearing the yellow space suits, plastic eye glasses and n95 masks prevent us from getting infected. It is the policy of my company that after loading my patient I then take off this gear and put them in the back of the ambulance with me. Is this a huge mistake? should I keep the gear on throughout pt contact?

Is MRSA in the nares colonizing or otherwise supposed to be treated like an airborne precaution?

Does anybody have any other contact precaution diseases' I should be looking out for?
 
Uhhhhhmmmmm if you're only using contact percautions for TB, I think you may want to go and take the TB skin test...

Nevermind... You're using an N95 for contact percautions?? Why?
 
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Why you wearing an N95 in a HAZMAT suit?


FYI... N95 works far better on the infected than on the clean.
 
re

Im not quite sure im following you on this. It appears to say that your company's policy is for you to make contact and load you patient into the ambulance WHILE wearing PPE. then you take it off during transport?

If so, they really need an infection control officer with a clue. Dont take off your protective gear until your at the ED or wherever your taking the patient. then take it off in the facility and redbag it and dispose of per there policy.
 
A few months back my service transported a tb pt. We wore masks and gowns and gloves. We had to wear these till we cleaned the rig after transport.
 
Novocaine said:
List of contact precaution diseases::glare:
esbl
vre
MRSA
C. diff
TB


My understanding is that wearing the yellow space suits, plastic eye glasses and n95 masks prevent us from getting infected. It is the policy of my company that after loading my patient I then take off this gear and put them in the back of the ambulance with me. Is this a huge mistake? should I keep the gear on throughout pt contact?

Is MRSA in the nares colonizing or otherwise supposed to be treated like an airborne precaution?

Does anybody have any other contact precaution diseases' I should be looking out for?
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Correct me if I'm wrong, but it sounds as though you might be the one doing most of the driving. If that's the case, then yes. After loading the pt, you take off all of that garb and place them in a red bag before climbing up front to drive. Because if you don't, you'll just contaminate the front of the truck. Before offloading the pt, you re-don the garb. If you're the one in the back, you keep said garb donned throughout transport.

BTW, I wouldn't worry too much about all of these microscopic lifeforms unless you have a suppressed immune system. As long as you wash your hands properly, follow your company's infection control guidelines, and have a spare uniform for those "just in case" situations, you'll be fine.
 
Linuss said:
FYI... N95 works far better on the infected than on the clean.
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The infected haven't been fit tested so the mask may not be a good seal. Patients also tend to pull it off when they cough.

If you are wearing the mask, it should be your size and you have control over when you take it off.
 
 
VentMedic said:
The infected haven't been fit tested so the mask may not be a good seal. Patients also tend to pull it off when they cough.

If you are wearing the mask, it should be your size and you have control over when you take it off.
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Plus, an N95 is designed to filter in, not out. So they are not fully effective on the pt.
 
clarification

I've only had 1 tb pt in 6 months as an emt. Masks on the entire pt contact. Negative pressure roomn to rig. rig to negative pressure room.

If I encounter a contact precaution, I don the extra ppe at the pt's room. I load the pt onto the gurney. I take the ppe off, exit the patients room. I load my patient in my rig and drive or pt care to destination. Off load to pt's room where I re-don ppe and sheet my pt over again.

I feel like I may be a vector or fomite in terms of transmission of diseases because of the practices I have been taught and which are expected of me. On top of that I may be exposing myself to said diseases.
 
Roger that.

In fact, working with health care workers, you are likely to be exposed to many more TB infected peope than if you were just around the public, we get infected more often because we are around sick people.

No strap on face mask is effective at trapping a cough. A mask of any sort will help keep droplets from spreading as far.

Plus, if you transport someone in your rig whom you have to suit up for, then by that same token you have to decon your rig, no??

Sounds like they are trying to look out for the employees but maybe it is a little ,er, disjointed.

And C. difficele??
 
mycrofft said:
And C. difficele??
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C. Difficile.

That stuff can spread faster than wildfire through some NHs and hospitals. It also requires a slightly different cleaner than what we us. Unfortunately, some EMT(P)s are not always aware of that and don't take advantage of the wipes at the patient's door to wipe down their equipment. Thus, it can get spead to many different patients. Quality control and infection control, as well as cost effectiveness, are some of the reasons hospitals have their own trucks for IFT, CCT and Specialty.
 
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VentMedic said:
That you know of...

I bet you have been around more people with TB just standing in line at the supermarket than you will ever be on an ambulance.
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Very true. Being exposed and acquiring what was exposed are not necessarily the same thing.
 
Cavicide

VentMedic said:
C. Difficile.

That stuff can spread faster than wildfire through some NHs and hospitals. It also requires a slightly different cleaner than what we us. Unfortunately, some EMT(P)s are not always aware of that and don't take advantage of the wipes at the patient's door to wipe down their equipment. Thus, it can get spead to many different patients. Quality control and infection control, as well as cost effectiveness, are some of the reasons hospitals have their own trucks for IFT, CCT and Specialty.
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The service I work for has Cavicide wipes. Is cavicide not strong enough or effective against C. diff?
 
One could drape the vehicle interior with sheets prior to use

I just don't understand why we aren't all dead from all the years we just cleaned the heck out of the ambulances, but never wore gloves or masks...cough-cough....
 
mycrofft said:
I just don't understand why we aren't all dead from all the years we just cleaned the heck out of the ambulances, but never wore gloves or masks...cough-cough....
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That cough makes me think you caught the TB :P
 
Novocaine said:
The service I work for has Cavicide wipes. Is cavicide not strong enough or effective against C. diff?
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"Old-fashioned soap and water are better than antiseptic wipes and alcohol rubs in removing Clostridium difficile, according to a study by McGill University researcher Matthew Oughton, MD, presented here at the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy."

http://www.medscape.com/viewarticle/563232
 
sdemtb said:
"Old-fashioned soap and water are better than antiseptic wipes and alcohol rubs in removing Clostridium difficile, according to a study by McGill University researcher Matthew Oughton, MD, presented here at the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy."

http://www.medscape.com/viewarticle/563232
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Did you read that article and fully understand it? This is an article about comparing handwashing products and methods. Disinfecting and decomtaminating an area is very different. Also, if you want to look at methods of scrubbing hands for surgery and a NICU, you will find different techniques and products. When cleaning equipment that is going to come in contact with many patients, you want more than just some colony contacts reduced. The same for using handwashing alternatives. Alcohol Rubs are not a replacement for soap and water for every patient contact.

This article also has not had a peer review or compared with other studies. As well it is a little sketchy on methodology and sample size details.

Alcohol Rub, Antiseptic Wipes Inferior at Removing Clostridium difficile

The surface contamination study found an even greater differential in outcomes between the groups, using a measure of C difficile colony count per plate, yielding 48.8, 0.4, 0.4, 0.3, 8.0, and 37.7 units for no handwashing, warm water and plain soap, cold water and plain soap, warm water and antibacterial soap, antiseptic hand wipes, and alcohol hand rub, respectively. Dr. Oughton stated, "All of the interventions except for the alcohol hand rub decreased the colony counts by a large number."
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Dr. Boyce noted that a previous study had found alcohol hand rubs to have greater activity against C difficile than Dr. Oughton reported. He is awaiting peer review publication and further study for a more definitive resolution of the issue, he said.

Could the increased use of alcohol hand rubs, if at the expense of less handwashing, help to explain the increased outbreaks of C difficile in hospital settings? Dr. Boyce does not think so. A study at his own hospital, published in 2006, "showed that the incidence of C difficile cases did not increase over a period of 3 years, despite a 10-fold increase in the use of alcohol-based hand rubs in our facility." Other studies have found similar results.

In July 2005 the Centers for Disease Control and Prevention recommended "using only soap and water for hand hygiene when caring for patients with C. difficile–associated disease; alcohol-based hand rubs may not be as effective against spore-forming bacteria."
Click to expand...
 
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