No, we do not take the procedure cart into an isolation room. Take in only what you think you will need, and bring nothing back out. And I clean out the basket on the Site Rite. Then, afterward I clean the machine from top to bottom!
We "gown" our Site Rites with the extra large isolation gowns that we have available and wear ourselves. The neck goes around the pole over the top of the keyboard and then is tied around the "waist". Probes etc are then cleaned before the gown comes off. We don't have the luxury of extra work space so we need our carts. We use 2 gowns opened up full to cover our carts and put the necessary supplies on top before we enter the room. The cart is never up against the bed and stays several feet away. It only organizes the things we need for our tray that becomes our sterile field. We prepare our sterile field, drape the patient and then bring the sterile field up to the draped, prepared pt. Every thing is well covered. The cart is wiped down as we leave the room as an extra precaution. Our infectious disease doctors have approved this procedure and in the 7 years I have been practicing and actually established this method we have not had a single infection related to insertions and that before maximum barrier precautions which is now standard.
I think the only exception I would make to this would be if I were placing a PICC on a patient in a room with droplet precautions. Then I would make the extra effort to find additional trays to take into the room. Some days it is hard enough to find one tray to become our sterile field. We have tried to get the floors to dedicate a tray to procedures and the tray shortly disappears.
If anyone has any literature/research on best practice, I am up to working harder on this.
I think best practices would be to keep carts out of any isolation room, but you would still have to take in the US machine. The only thing I would question is getting your process approved by infectious disease physicians. In my experience these physicians do not truly understand about infection control and prevention. I have seen them take multiple patient charts into isolation rooms!! So I would only work with an infection control nurse or an epidemiologist on this issue. RE your zero infection risk with PICC insertion - that is great. But I would be looking for another type of infection - your cart being the vector to carry the infection in the patient in isolation to the next patient. That would be what my concern would be. If you are using an acceptable type of disinfectant wipe to clean everything before it goes to another patient, that would definitely help. But again, I would check with the infection control nurse, known called infection preventionists on what is an acceptable disinfectant wipe. There are certain criteria for those solutions. Lynn
Thank you Lynn for your input. Our Infection Preventionist is also in on this and the committee of all of them approved how we handle this. They meet regularly. We use the appropriate wipes/spray for the type of contact isolation the patient is on. We are germophobes. I scrub before and after each patient as I don't know who touched my equipment as I move about between PICCs and gather things before I go into a room. Even for patients that are not on contact isolation I cover the front of my Site Rite with a clean bed pad as it gets up against the side of the bedrails. I have seen some nasty bedrails and do not want that touching my equipment. I do not want to spread anything anywhere. On top of that we regularly break everything down and scrub every nook and cranny with the approved bleach solution.
Our group of Infectious Disease Doctors are very careful. I have not noted any of what you mention with our group. But then we have electronic charting so there is no need to carry charts around. But they are always washing/alcohol rubbing their hands. I have no complaints.
No, we do not take the procedure cart into an isolation room. Take in only what you think you will need, and bring nothing back out. And I clean out the basket on the Site Rite. Then, afterward I clean the machine from top to bottom!
Bobbi Martin, RN
Archbold Medical Center
We "gown" our Site Rites with the extra large isolation gowns that we have available and wear ourselves. The neck goes around the pole over the top of the keyboard and then is tied around the "waist". Probes etc are then cleaned before the gown comes off. We don't have the luxury of extra work space so we need our carts. We use 2 gowns opened up full to cover our carts and put the necessary supplies on top before we enter the room. The cart is never up against the bed and stays several feet away. It only organizes the things we need for our tray that becomes our sterile field. We prepare our sterile field, drape the patient and then bring the sterile field up to the draped, prepared pt. Every thing is well covered. The cart is wiped down as we leave the room as an extra precaution. Our infectious disease doctors have approved this procedure and in the 7 years I have been practicing and actually established this method we have not had a single infection related to insertions and that before maximum barrier precautions which is now standard.
I think the only exception I would make to this would be if I were placing a PICC on a patient in a room with droplet precautions. Then I would make the extra effort to find additional trays to take into the room. Some days it is hard enough to find one tray to become our sterile field. We have tried to get the floors to dedicate a tray to procedures and the tray shortly disappears.
If anyone has any literature/research on best practice, I am up to working harder on this.
Thanks all.
Mary Penn RN Vascular Access Team
St Charles MO
I think best practices would be to keep carts out of any isolation room, but you would still have to take in the US machine. The only thing I would question is getting your process approved by infectious disease physicians. In my experience these physicians do not truly understand about infection control and prevention. I have seen them take multiple patient charts into isolation rooms!! So I would only work with an infection control nurse or an epidemiologist on this issue. RE your zero infection risk with PICC insertion - that is great. But I would be looking for another type of infection - your cart being the vector to carry the infection in the patient in isolation to the next patient. That would be what my concern would be. If you are using an acceptable type of disinfectant wipe to clean everything before it goes to another patient, that would definitely help. But again, I would check with the infection control nurse, known called infection preventionists on what is an acceptable disinfectant wipe. There are certain criteria for those solutions. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn for your input. Our Infection Preventionist is also in on this and the committee of all of them approved how we handle this. They meet regularly. We use the appropriate wipes/spray for the type of contact isolation the patient is on. We are germophobes. I scrub before and after each patient as I don't know who touched my equipment as I move about between PICCs and gather things before I go into a room. Even for patients that are not on contact isolation I cover the front of my Site Rite with a clean bed pad as it gets up against the side of the bedrails. I have seen some nasty bedrails and do not want that touching my equipment. I do not want to spread anything anywhere. On top of that we regularly break everything down and scrub every nook and cranny with the approved bleach solution.
Our group of Infectious Disease Doctors are very careful. I have not noted any of what you mention with our group. But then we have electronic charting so there is no need to carry charts around. But they are always washing/alcohol rubbing their hands. I have no complaints.
Thanks for your help
Mary Penn RN Vascular Access Team
St Charles MO