Think of a time/situation where you or a colleague did not follow IPAC practices. Discuss the situation and the potential negative outcomes for clients related to not following the appropriate IPAC practices.
once upon a time….test test test
In instances I have seen staff using single use suture removal scissors as multi use. Which would be cleaned but not sterilized or discarded. This would be an example of improper practices related to reprocessing lab instruments, and improper practices for items that should be sterile and maintained sterile until point of use. The negative out comes of using the single use scissors multiple times would be possibly transmitting contaminated microorganisms between patients.
I have watched staff walking from room to room wearing the same pair of gloves and providing care for multiple patients.
Reply to post about wearing the same gloves patient to patient –
Changing gloves is critical to reducing any potential risks. Hand hygiene directly after is also key.
Wearing the same gloves patient to patient is risky but also not following IPAC protocols.
I have been a witness to staff using the same gloves on multiple clients or not wearing gloves and not washing their hands after or in-between providing personal care. In doing this they are potentially exposing/leaving clients susceptible to new and possibly invasive microorganisms.
I have seen as a PSW then RPN where other PSW dose not use gloves when cleaning a resident after having a BM. This person was a friend of mine, however I ad to state to her that what she did was not safe for her of the resident and any other resident that she might come on contact with. With doing this she was exposing old resident and new resident to any microorganisms that she had carried from one to the other.
One of my colleagues did not follow IPAC practices when they did not wash her stethoscope while attaining the vitals of the residents. The potential negative outcomes for the residents related to the incident could have been that they would be susceptible to whichever pathogen is potentially on the scope such as C-difficile. I remember in college when they used to refer to the stethoscope as a Staphoscope.
I was doing observational visits with a nurse who followed IPAC policies until she got to the improper use and cleaning of gloves. She double gloved and then once the procedure was complete she removed the top pair and sanitized the other pair with alcohol based hand sanitizer thinking this was a practical use not to waste extra gloves , but this does not promote proper hand hygiene and could potentially spread bacteria even more than changing gloves and doing proper hand hygiene
I have seen staff not washing/sanitizing their hands after providing care to the patient with isolation precautions due to possible C.diff. She wore the gloves in the patient’s room and then took off the gloves aftercare thinking sanitize/wash her hands was not necessary as she was wearing the gloves. In doing so, she could transmit the microorganism to other patients and staff and put the community at risk of exposure.
I have witnessed staff leaving an isolation room, removing all PPE, and then realizing they forgot something. They ran back in quick to do whatever it was they had forgotten without putting all the proper PPE back on because they were ‘just going to be a second’ and it would take too long to put all that PPE back on for something so small. This put the staff member at risk of carrying that microorganism out of the room and passing it to other staff and patients.
I have witnessed staff walking out of an isolation room with the gown still on to get something they forgot. leave it on Get it and walk back in the room with the same gown on . Staff could transmit microorganism to other residents and staff.
I have witnessed a male colleague who has been a nurse for 30+ years do patient care without wearing gloves. He has not applied gloves even while performing peri-care. He has not washed his hands between patients and then has gone on break, lunch and also went onto the computers to chart without washing his hands. By not wearing gloves and performing proper hand hygiene between tasks he would be transmitting microorganisms to other patients, staff and as well to himself and his family members.
At a previous clinic where I worked, clients would return with suture removal kits or a staple removal kit.
They were to be used one time only.
In fact the clinic staff would wash and wrap and put in sterilizer.
When instrument’s stat “For one time use” these directions should be followed
Not knowing the type of material in the instrument could it be sterilized properly??
Following the direction of the manufacture is essential when sterilizing, and not knowing the manufacture…
This will certainly spread unwanted germs if not properly done
Like a problem analysis, we should focus on the difficulties that impede following IPAC practices in different situations and provide recommendations for improvement. There is no reason for making assumptions without previous evaluations that will allow us to develop a plan of action to solve problems with professionalism.
I have noticed several times in clinical settings and health care facilities, team members, volunteers, patients, and visitors, experiencing certain doubts about if we are all compliant with the critical need of following IPAC protocols and workplace policies related to this matter. After reflecting on our current pandemic situation, I can grant that the awareness of stopping the spread of infection nowadays is alive in all of us. Consequently, I believe that we need to stop, think and evaluate each situation as a potential risk, and how we can manage and control these situations.
As an example of following appropriate IPAC practices at the workplace setting, I would like to share one of my personal experiences related to selecting aseptic techniques when performing wound care. I assisted two different expertise nurses for a dressing change procedure to the same patient in different days. One of them (nurse A) was performing clean-non touch wound care technique, and a second one (nurse B) was using a sterile field. When I was assisting nurse A, I was so impress observing how she was able to clean the wound and apply the corresponding dressing without touching the wound anytime with her gloves, contaminated supplies or any other clinical instruments that were not in the sterile dressing tray. She was explaining the rationales of her performance’s selections, and they were consistent and appropriated to keep the patient safe.
A couple of days later, nurse B was in charge to do the same clinical procedure to the same patient, and I was there again to assist her and support the patient’s needs during the performance. Nurse B brought into the room different supplies than nurse A did before, and she opted to perform the wound care sterile technique instead. At that time, I was thinking that nurse B was adopting more appropriated IPAC practice than nurse A. But, how could I know which one was performing the best practice? The patient was safe and infection control in place in both situations.
I am truly sure that the smartest decision to clarify my concerns was reviewing current literature and policies that support the decision-making process in the nursing practice. Then, I discovered that both nurses were right. They both assess the patient physical and emotionally, and evaluate the situation to achieve the best outcomes possible following the IPAC protocols.
This practice took nurse A longer than nurse B, because nurse A had the time needed to proceed slowly with no impediments that could breach infection control while we were there. In fact, another nurse was available on the floor to take care of the rest of the patients.
On the contrary, Nurse B was the only one nurse available on that shift, so to prevent from not breaching the aseptic technique she opted for being stricter in maintaining the sterile field just in case she had to touch the wound when applying the dressings. Therefore, we need to be aware that sometimes there is not a right or wrong intervention, it depends on each specific situation.
If we see staff members with the gloves on by the door of the patient’s room, are we sure that their gloves are soiled? Are we sure that someone is not maintaining adequate distance from the patient without protection when entering the room? Are they family members of the patient? Are we sure in which situation IPAC practices are breached depending on the patient’s condition? If we are not sure, I believe it should be appropriate following strict infection control precautions. Otherwise, if we are sure that specific situations require urgent interventions, we have to implement policies and recommendations for improvement to maintain the best standards of care possible.
I have witnessed colleagues perform wound care with a single pair of gloves (same pair used to remove the old dressing, and apply the new one. I have also witnessed significant errors with sterile technique (placing unsterile objects on a sterile field), I still remember watching someone pick up a dressing off the floor and apply it to the wound… Negative outcomes for both the above situations are very serious (spreading micro-organisms, potentially causing an infection).
My stories are basically the same as many here have posted, i’ve seen colleagues of mine walk out of rooms and not clean their hands. I’m almost always having to ask at least one person to change their gloves or clean their hands on shift. By not practicing proper hand hygiene we could introduce bacteria and viruses to ourselves and others, that could have detrimental impacts on our resident, especially those who are weak immunocompromised.
I observed a physician wash his gloved hands with soap and water and then continue on to the next patient after a procedure. As we all know disposable gloves are single use. Reusing disposable gloves may increase the risk of exposure to viruses as microscopic tears can develop.
I have done so as do some of my co workers is touching /adjusting my mask both with my gloves or with my hands.. both clean but I wear the mask for my whole shift . Risk of infection to myself or patient is a big concern . I am always conscious of transmission of germs
Thank you for your responses, as we can see many of you have commented on glove use, donning and doffing of personal protective equipment (PPE). What approaches have you taken when you have noticed colleagues not following IPAC practices?
. What approaches have you taken when you have noticed colleagues not following IPAC practices?
I like to ask questions in a kind manner so that there is critical thinking involved. I may need to stop the nurse before they proceed with the concerning issue in using PPE properly and review the proper procedure
For example after removing gloves to perform hand hygiene then don a new pair of gloves before continuing with the clean portion of the care
Or another example is removing gloves after care and performing had hygiene prior to opening cabinets or drawers to obtain supplies, however this should preferably be done prior to care so all supplies are available at hand and not requiring the nurse to leave the site or room helping to alleviate the need to don and doff gloves or other ppe needlessly and possibly contaminating other surfaces of opening the patient up to possible contamination
Adella, when I noticed a nurse entering a room without properly donning all required PPE based on the ISO precautions I was a little caught off guard. As a student who is quite new to the hospital I had thought that people would be more cautious, especially given everything that’s been going on with COVID.
I will admit that I did not feel comfortable as a brand new student to correct this person, but I instead asked her if there was a reason she could go in there without the PPE and if there was something I was maybe not aware of. I had hoped that this might get her to think at the very least of the example she was setting for novice nurses.
I have witnessed doctors attending to one patient then moving on to next patient without following proper hand hygiene or changing gloves. This is not following proper protocols and allows for the spread of infection.
I have witnessed doctors attending to one patient then moving on to next patient without following proper hand hygiene or changing gloves. This allows for the spread of infection.
Reply to Leslie’s post:
I have watched staff walking from room to room wearing the same pair of gloves and providing care for multiple patients.
It is critical that after every pair of gloves is worn after patient care, the gloves are removed and discarded and hand hygiene completed directly after to decrease risks of transmission to your next patient and risk to yourself . Even if wearing gloves, the risk is still there. Walking around with the same gloves is never safe for patient care and their well being.
I currently work in a setting that was doing very well with zero cases since the start of COVID-19. With this in mind, my co-workers became complacent as I noticed staff moving from one resident to another without using proper hand hygiene, PPE, and not cleaning equipment properly, for example, and numbers started to increase. It was also noticed that there was a link with staff who became infected worked with certain residents that were also infected. Only by following the proper protocols at all times, can the link in transmission of infection be broken.
I like to take an education approach to correct IPAC gaps. Often we are so busy with our work that we forget simple things… I’ve had to remind colleagues (in a very, very subtle manner if they are with clients) to change gloves, wash their hands. For issues beyond education… that has to be handled by someone above me. All I can do is speak up in that situation.
When I have noticed colleagues not following IPAC practices, I have approach them in a light friendly way to remind them of what the best practices are. Ex, changing gloves, hand hygiene, which PPE is appropriate.
Thank you everyone for your responses. Some really good responses so far and great examples of poor practice in infection control. I particularly like the comment Heather made about the staphoscope. This is a good way to consider that all the materials you use, including your PPE, is a potential contaminant for your residents/clients/patients.
I noticed a number of you mentioned that the potential consequence of these bad practices is contamination of others. In the upcoming modules I would recommend you be more specific and detailed in explaining this. For example, how would contamination occur? What implication would this have on patient safety?
Mercedes your response was very detailed and well developed. I like that you took the time to discuss your steps for correcting the matter.
Adella, when I was screening at the front entrance of my facility we had one physician in particular who would not sanitize their hands upon entry and would consistently walk into the facility without wearing a mask. I spoke to the physician which went to deaf ears so I approached their manager. I simply tried to say that it was difficult for me to ask clients entering our facility to sanitize their hands upon entry and to enforce mask wearing when our physicians/staff were not following proper procedures. The physician has gotten much better but I still see them entering now through the back door without a mask on.
Changing gloves in between residents is usually what I see. I remind them of increasing the risk of harm to the resident and themselves.
What approaches have you taken when you have noticed colleagues not following IPAC practices?
I work in a setting that has a staff mix of registered staff, UCPs, housekeeping, dietary service providers and reception. As a registered staff I role model and provide education on IPAC practices. I most often see staff failing to apply gown, glove and face shield when screening staff and visitors for Covid 19. I think this persists despite modelling and education because of “PPE fatigue.” They just tire of doing it repeatedly throughout the day. I have had to report this to my manager.
A situation that I reflected on occurred when I had realized after leaving a patient’s room following care that I had missed the sign on the patient’s door indicating contact precautions and they had recently been swabbed and were still under precautions. The concern was that my patient had used the shared bathroom with assistance and the commode was not switched to his designated commode with his name on it. The potential impact of not switching the commode was the risk of transmission as the swab results were not cleared yet and he was not considered off of precautions at that time. The risk of transmission to the patient in the next room was also a consideration as the bathroom was a shared bathroom. It was necessary to consult colleagues to problem solve and decrease the potential risk of transmission and collaborate on the best strategy to ensure patient safety and the health of both patients and any family visiting. It has made me more conscious and diligent to critically think about the impact of not following IPAC guidelines and missing a step in IPAC protocols and precautions. It is very important to be aware at all times.
A situation I can reflect on is about sterile scissors. I share an office with a colleague and we work on opposite days so we never see each other and never work together. We both work out of the same tool chest though. Often I will come in to find there is a pair of scissors opened out of sterile packaging and the scissors in the drawer amongst unopened packages of dressing supplies. I believe this colleague is using the scissors to cut sterile dressings . This practice contaminates the sterile dressing supply and is not best practice. We have ample supply of sterile scissors available and a new package should be opened for each treatment and then placed appropriately for decontamination. This current practice put the client at risk for cross contamination by use of used, contaminated (even thought there is no visible soil) scissors. This practice also may cause sterile dressings to become contaminated and therefor applying contaminated dressings to a patient, leaving them very vulnerable.
Thank you Francine.
When I notice colleagues not following IPAC practices. I remind them of increasing risk to residents, staff and themselves
One of the PSW had her face shield on top of her head during a direct care, leaving her eyes completely exposed. This improper donning of face shield could have resulted with her getting COVID and further exposing other staff member and patients. I had to reeducated her of proper donning and I had to reassign her the surge learning course on the topic.
One of the PSW had her face shield on top of her head during a direct care, leaving her eyes completely exposed. This improper donning of face shield could have resulted with her getting COVID 19 and further exposing other staff member and patients. I had to reeducated her of proper donning and I had to reassign her the surge learning courses on the topic.