More Than a “Concern”

We had a contact isolation patient today. This means that she has some kind of illness that can spread through physical contact. While masks aren’t strictly necessary, gloves are.

Another volunteer on-duty tonight, A., didn’t notice the bright yellow “CONTACT ISOLATION” sign on the door, which was somewhat understandable because it was partially hidden behind a pump. When I noticed A. in the patient’s room, holding her hand, touching her bedclothes and such, I cheerfully called her out into the hallway, as if I had a question.

Once we were out of view and earshot, I pointed out the CI sign – she asked me what it meant. A. has been volunteering in the ED for eight years. After a quick blink, I explained what it meant and suggested she wash thoroughly and glove up. She nodded and went to wash her hands.

Ten minutes later… she was back in the room, touching the patient and not wearing gloves! This is a woman in her 60’s who is not suffering from any sort of mental health issues. I was vexed.

One of the hall nurses and I looked at each other after looking into the room as we each walked by it. “Let me get this straight,” I said to her; “Contact isolation means, ‘do not touch anything without gloves,’ right?”

“Yup.” She gave me a “what’re you gonna do?” look and kept on walking.

There is an episode of “Scrubs” (which, as we all know, is the ultimate in hospital reality shows) that drills home why hand-washing is vital. A patient with a nasty staph infection comes in and is treated. A nurse working with the patient forgets to wash her hands and then touches the doorknob. The doorknob turns symbolically Nuclear Waste Green. Another person touches the doorknob and her hand turns green. She touches something else that someone else touches. The main character, JD, ends up touching an infected object and, soon after, touches a post-operative patient. That patient turns Nuclear Waste Green and dies.

There are infection control people in hospitals whose entire job is to lurk and to observe peoples’ habits concerning hand-washing and general standard practices protocol. I desperately wished for one of those people to walk by and observe A.

Instead, I mentioned it to a patient rep, who reported it to the LPN in charge of the volunteers. She immediately found me in the nutrition room and said, “I understand there are concerns.”

“Oh, gosh… I don’t want to get anyone in trouble… I just think someone should bring A. up to speed on Contact Isolation protocol.”
“Oh, she’s been here for eight years. She knows.”

I explained the situation.

“Well, if she gets herself sick, then she’ll learn.”
I blinked. “I’m more concerned about her transferring the contagion to other patients.” Or to me, I mentally added.

Change of subject.

[boggle]

I thought of ´┐╝marie_rex, who once nearly died because one of her providers didn’t wash her hands after using the bathroom. I thought of the “Scrubs” episode. I thought of being exposed to MRSA through random thoughtlessness on the part of a tech.

And then, selfishly, I thought of my future at this hospital. If I made A Big Deal about this, then that would put me in poor standing with this nurse. She might percolate her dissatisfaction with me to other staffers, who would side with their colleague.

I let it go.

Instead, we talked about how, three years ago, she had her job essentially yanked out from underneath her when it was decided that LPN’s aren’t qualified to treat patients in the ED. We talked about how that affected her then and what she thinks of it in retrospect.

As I was leaving, I talked to A. again myself, unable to just let it go entirely. She said she washed her hands really well and thanked me for pointing out the sign.

“But…but you went right back in there and started touching her again!” I said, somewhat incredulous but still friendly.
“Well, I wanted to finish up the conversation, and I knew I wasn’t going to touch anything.”

She was touching the patient’s bedclothes and guard rails and the patient’s arm. Maybe she wasn’t aware of it.

Staff must sanitize their hands after leaving a patient’s room. Volunteers are not so admonished. We get a 30-second primer about “common sense” and that’s that.

If it hasn’t already, this is going to bite someone squarely in the bottom. I know that people acquire infections from hospitals every day from just these sorts of instances, but I wonder if A. personally has been the cause of any of them?

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