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RE: C Diff - 2/21/2011 12:19:10 PM   
angelikaJ


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quote:

ORIGINAL: barelynangel

YES you should report the situation, you are caring for the elderly and setting the whole home up for a lawsuit by your negligence especially in NOT reporting same.  I don't care if it costs you your job -- you did something stupid in not reporting it right away and you are continuing to put elderly people you work with in danger by not reporting it and taking precautions and getting checked out. 

Its little negligences like this because you are more worried about yourself than those people in your care, that cause unnecessary harm. 

Take responsibility for your own actions and report the situation and take the consequences of your actions.  Yes, it may have been making due, it may have been a decision you made on the fly and didn't mean harm, but not reporting it while knowing that you could very well contract same because of your actions is negligence and irresponsible and i am speaking of your actions of not reporting it.

Yes you made a mistake not finding gloves or calling to see if someone can get you some.  That wasn't your negligence, your negligence was not reporting the situation at all.


angel


She did report to her manager the following morning that she could not find gloves in the house.
At that point, depending on the agency's specific policy of what did or did not constitute an "emergency" she may or may not have done the right thing that night.
Hopefully policy has been revised to provide for such a contingency. I am certain dfb has now adjusted her own habits and will keep a stash of gloves with her personal things (since she does not have a car).

In the location that I worked in, even if 2 staff had been on, on the over-night shift there were staffing ratios that had to be maintained and one staff leaving never would have been an option. In addition to that, the nearest all-night drug store was 20 miles away. I also would not have been able to call another nearby house and ask them to simply send someone to buzz me over a box.

She had no knowledge that the client had a communicable disease. That was not discovered until that person was in the hospital. That is why following "universal precautions" is always so important, we never know with absolute certainty that someone does not have something we could catch or spread on to others.

The agency is at fault for not providing the proper safety equiptment as determined under OSHA regulation. The staff members who were on the shifts before her, were responsible in not making certain there was an adequate supply of gloves on hand for the next shifts.

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RE: C Diff - 2/21/2011 1:08:33 PM   
sweetsub1957


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quote:

ORIGINAL: angelikaJ
The agency is at fault for not providing the proper safety equiptment as determined under OSHA regulation. The staff members who were on the shifts before her, were responsible in not making certain there was an adequate supply of gloves on hand for the next shifts.

This.

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RE: C Diff - 2/21/2011 3:40:07 PM   
IrishMist


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quote:

ORIGINAL: sweetsub1957


quote:

ORIGINAL: angelikaJ
The agency is at fault for not providing the proper safety equiptment as determined under OSHA regulation. The staff members who were on the shifts before her, were responsible in not making certain there was an adequate supply of gloves on hand for the next shifts.

This.

I will agree that the agency is indeed at fault..however, I can not excuse DBG for her lapse in judgement in not using percautions. It's not only to stop the spread of diseases from patient to patient but also to stop the spread from care giver to patient, and so on.

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RE: C Diff - 2/21/2011 4:14:28 PM   
maybemaybenot


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I really think people are being extrememly hard on DFB, sorry I do. She had an error in judgement. Yes, it *may*, repeat * may *, have a consequence, but  it is extremely small. We don't even know if she touched the feces, let alone got some in an open sore on her hands/arm.  It's very hard for a healthy person to contract it and her chances of having spread it to another resident are slim to none, as she scrubbed her hands and arms after changing the resident diaper. She isn't Typhoid Mary here. She isn't a irresponsible, negligent person, as a result of her mistake either, IMO. It's C Diff for goodness sake, not hepatitis or HIV. Yes, I know it * could * have been but it's not, thank goodness for her.

There is an old saying I learned when I first got out of nursing school : "Nurses eat their young " and sadly some are doing just that. She said she didn't know what C Diff was, she said the employer did not provide adequate PPE, she said the infection was not known at the time. I suspect if she had known the residents waste was contaminated she would not have acted with her bare hands.  And, btw,  washing your hands with soap and H2Oshould always be done after caring for a patient with C Diff, even when wearing gloves as soap and H2O kill the spores and antimicrobial foams/gels do not. So altho she did not know it, her actions were the most appropriate given the situation. I also suspect she learned a huge, very hard lesson. The girl is concerned, she's scared she may have contacted a disease she doesn't know much about or spread it to some one else. Perhaps a little empathy and education is more appropriate than a battering ?

I seriously doubt she would get fired for this situation. I cannot imagine it, after 30+ years in the nursing field, I really just don't see it amounting to a termination situation. Inservice and education, * perhaps * a warning, but I think that is a bit over the top too, since the company she works for actually IS negligent. They did not suppy the appropriate equipment needed to perform her job. DFB could be a real A Hole and report it to OSHA or DPH. But I don't think that's what she's looking for, I think she was looking for guidance and got a scolding.

I think some of you need to really take a good hard look at yourselves and ask yourself if you have ever broken universal precautions. I will raise my hand and say, Yes, I have. It's not my practice and it's not my habit, I don't even use that antimicrobial gel/wash. I use soap and H2O. But there has been that rare emergency situation when I reacted quickly. And I find it hard to fathom that anyone who has been in the field more than a few years or has worked outside of a very very controlled area hasn't, on at least one occasion, " slipped up ". I know I have felt worse and beat myself more than anyone could on the couple of occasions it has happened and I am grateful I had supportive co workers and managers.

                 mbmbn

< Message edited by maybemaybenot -- 2/21/2011 4:21:29 PM >

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RE: C Diff - 2/21/2011 5:03:30 PM   
angelikaJ


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quote:

ORIGINAL: IrishMist


quote:

ORIGINAL: sweetsub1957


quote:

ORIGINAL: angelikaJ
The agency is at fault for not providing the proper safety equiptment as determined under OSHA regulation. The staff members who were on the shifts before her, were responsible in not making certain there was an adequate supply of gloves on hand for the next shifts.

This.

I will agree that the agency is indeed at fault..however, I can not excuse DBG for her lapse in judgement in not using percautions. It's not only to stop the spread of diseases from patient to patient but also to stop the spread from care giver to patient, and so on.


She states that gloves were not in the house.
Was she to stop providing personal care?

Was that person who had a rash supposed to lay in a dirty depends?
In my state that would have been grounds for an investigation for criminal abuse and neglect by the Disabled Person's Protection Commission and immediate dismissal.

Her agency was at fault for not following OSHA policy. Her manager was at fault for not making certain adequate supplies were ordered/on hand. Her co-workers were at fault for not remedying the issue before it left her short in the middle of the night.

As someone who worked in both home health care for 10 years and in residential group homes for another 10, I will state that circumstances have come up in which my adherance to universal precautions was not 100%. In the fluid-borne/blood bourne pathogen classes I was taught, we were actually told that at some point if we encountered that we were to do exactly what dfb did: to wash our hands thoroughly with soap and water as soon as possible. I will also state that I never ignored universal precautions out of laziness or because I could not be bothered. It was always due to unforseen circumstances beyond my control. I too, have had people who have helped me after the fact.
The important thing is not that she screwed up at this point, but how will this incident change her behavior (making certain gloves will be something she carries) and alter the agency's policy and practices in the future.




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RE: C Diff - 2/21/2011 5:10:30 PM   
sirsholly


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quote:

Its little negligences like this because you are more worried about yourself than those people in your care, that cause unnecessary harm.


Whoa...that is uncalled for. The op did not know the patient was positive for CDiff and states she washed her hands well when done with the patients care.

Contrary to your opinion i would say DFB was NOT worried more about herself then her patients. If that was the case, she could have left the mans care to the next shift who had gloves.



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RE: C Diff - 2/21/2011 5:23:28 PM   
sirsholly


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quote:

ORIGINAL: defiantbadgirl

I screwed up by not calling the manager in the middle of the night. The fact that I never heard of C Diff is no excuse.


You were not yet aware the man had CDiff when this occurred. Can you imagine the flack you would have received for waking the manager in the middle of the night? Universal precautions be damned...she would have been pissed and might have taken it out on you.

I am in the medical field. Whereas i have never worked in a setting such as you describe, i have had to make judgment calls that were not always by the book. Never did i knowingly put anyone at risk, and i do not think you did either. For the record...i couldnt see myself calling the night manager either.
quote:


Reporting it will probably get me fired and then I will have no income and a messed up employment record.
Correct me if i am wrong...but you DID in fact report it, though not formally?
Did you not alert the next shift that the house was out of gloves? That should tell the management that you worked without gloves. The patient was diagnosed with CDiff upon admission to the hospital, which means you dealt with a CDiff positive patient with no gloves.

Can they not put two and two together?


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RE: C Diff - 2/21/2011 5:45:01 PM   
sweetsub1957


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quote:

ORIGINAL: maybemaybenot
There is an old saying I learned when I first got out of nursing school : "Nurses eat their young " and sadly some are doing just that.

And that saying is still around. Were it me in the OP's situation, I think I would have looked around for plastic grocery bags to put over my hands before "doing the job." But if nothing's available....what to DO? You're damned if you do and damned if you don't.

~sweetsub~

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RE: C Diff - 2/22/2011 12:36:41 AM   
CalifChick


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quote:

ORIGINAL: maybemaybenot

I really think people are being extrememly hard on DFB, sorry I do. She had an error in judgement.


Perhaps it's the long, long, longggggggggggggggg history of bad judgment that makes sympathy a bit hard to come by around here.

Cali



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RE: C Diff - 2/22/2011 1:16:03 AM   
tazzygirl


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quote:

There is an old saying I learned when I first got out of nursing school : "Nurses eat their young " and sadly some are doing just that.


Took you till after you got out of nursing school to realize that? I had to deal with some tough cookies before I got out of nursing school. Had one who stated "I really hate fucking nursing students"... to which I replied... "Must be mighty damn nice to be born with RN behind your name, huh." My nursing instructor chewed me out in front of the "RN" then praised me in class... lol... I adore Ms Strickland!

quote:

she said the infection was not known at the time.


This is one big point. However, she also should know that she may also have to deal with hepatitis, e-coli... the list is way too long. I commend her for her dedication...But, in order to look after her patients, not to mention her family, she needs to look after herself first.

quote:

I seriously doubt she would get fired for this situation.


She would not. A reprimand, perhaps. But not a firing offense, if its the first time. What is a firing offense is not reporting the incident at all. Reporting does not require a call in the middle of the night... it does require a well documented notation... most places have forms for incident reports.

quote:

I think some of you need to really take a good hard look at yourselves and ask yourself if you have ever broken universal precautions. I will raise my hand and say, Yes, I have.


I have too. Had my hand shoved up insode a delivering woman, no gloves, because of a prolasped cord. Cant tell you how many babies I have "caught" while not wearing gloves. You deal, you clean, you discuss, and you move on. I even went through three needle sticks, one after an aids patient... talk about a nerve-wracking experience!! But all was reported.



< Message edited by tazzygirl -- 2/22/2011 1:17:59 AM >

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RE: C Diff - 2/22/2011 2:36:39 AM   
DeviantlyD


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quote:

ORIGINAL: defiantbadgirl

Does anyone know if C Diff can be absorbed through the skin?


No it cannot be absorbed through the skin. If you have a cut, even a microscopic one, it has the potential of gaining access via that opening.

As others have said here, Clostridium difficile is usually not a concern unless one is immunocompromised. The fact you washed immediately aftwards, was, as others had also mentioned, a good thing.

No offense to Termyn8or, but his advice was horrible. I would strongly discourage you from heeding it.

I understand how you must feel right now. Not knowing if you've put yourself at serious risk is very scary. If you are healthy, and given the fact you cleaned yourself well afterwards, I think your chances of contracting it are probably very small indeed. And you do have the advantage of knowing you were exposed to this. If you suddenly find yourself with diarrhea or some other gastrointestinal issues, you can provide your physician with this information and he/she would likely start you on antibiotics. Good luck and let us know how you are doing!

Edited to add:

Someone else offered a link. This one is quite thorough also. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html

< Message edited by DeviantlyD -- 2/22/2011 2:40:11 AM >

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RE: C Diff - 2/22/2011 2:39:45 AM   
tazzygirl


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Joined: 10/12/2007
Status: offline 		One other avenue is the hand to eye, nose or mouth. Which is why handwashing is so extremely important.

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Duchess of Dissent 1
Dont judge me because I sin differently than you.
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RE: C Diff - 2/22/2011 10:43:15 AM   
defiantbadgirl


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quote:

ORIGINAL: angelikaJ


She states that gloves were not in the house.
Was she to stop providing personal care?

Was that person who had a rash supposed to lay in a dirty depends?
In my state that would have been grounds for an investigation for criminal abuse and neglect by the Disabled Person's Protection Commission and immediate dismissal.

Her agency was at fault for not following OSHA policy. Her manager was at fault for not making certain adequate supplies were ordered/on hand. Her co-workers were at fault for not remedying the issue before it left her short in the middle of the night.




It's also true in my state that refusing to provide care (leaving a client with a diaper rash in a dirty diaper all night) is neglect. I have now spoken to someone in upper management and was told that nobody was likely to bring gloves in the middle of the night. Given the situation and my mistake of not having my own box of gloves in my car, I did the only thing I could at the time.


And I was at fault for not having my own box of gloves in my car. I accept 100% responsibility for that. For some strange reason, some people on here think I never accept responsibility for anything. Yet I've seen plenty of other threads where someone didn't accept responsibility and the same people who usually insult me never called them on it. I could become like them so I would fit in, but I get no pleasure from spewing insults at others. Like you and a few others, I prefer kindness. Still, we are in the minority I think.



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RE: C Diff - 2/22/2011 12:32:30 PM   
littlewonder


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Status: offline 		The others may not have been called on because they did not continuously come on here with complaints and mistakes they've made.

It's like the boy who cried wolf...cry wolf too many times and people tend to see you as less than competent.

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RE: C Diff - 2/22/2011 2:09:16 PM   
maybemaybenot


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quote:

ORIGINAL: tazzygirl

quote:

There is an old saying I learned when I first got out of nursing school : "Nurses eat their young " and sadly some are doing just that.


Took you till after you got out of nursing school to realize that?


LOL,  Yanno.
I never heard the phrase it until I was out of nursing school. I think I was pretty lucky, cuz I don't remember experiencing it personally. I went to a Hospital School of Nursing and it was a teaching hospital. So overall the staff were really good to us. A few jack asses, but nothing like what you experienced. I went straight to work there out of school at 19, and stayed there until I was almost 30.

I was out of school,  probably,  a couple of years, when I called a student nurse " fucking stupid ". Not to her face, but in conversation to a co worker. That's when my co worker * politely * < not  > dressed me down good and told me about eating our young.

I had my own Ms. Strickland... Mrs. Keaveney. God, she was tough on me publically, but she was always there for me back in the classroom. <I was a bit mouthy. Kinda like yourself. >

          mbmbn

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RE: C Diff - 2/22/2011 3:15:32 PM   
angelikaJ


Posts: 8641
Joined: 6/22/2007
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quote:

ORIGINAL: defiantbadgirl


quote:

ORIGINAL: angelikaJ


She states that gloves were not in the house.
Was she to stop providing personal care?

Was that person who had a rash supposed to lay in a dirty depends?
In my state that would have been grounds for an investigation for criminal abuse and neglect by the Disabled Person's Protection Commission and immediate dismissal.

Her agency was at fault for not following OSHA policy. Her manager was at fault for not making certain adequate supplies were ordered/on hand. Her co-workers were at fault for not remedying the issue before it left her short in the middle of the night.




It's also true in my state that refusing to provide care (leaving a client with a diaper rash in a dirty diaper all night) is neglect. I have now spoken to someone in upper management and was told that nobody was likely to bring gloves in the middle of the night. Given the situation and my mistake of not having my own box of gloves in my car, I did the only thing I could at the time.


And I was at fault for not having my own box of gloves in my car. I accept 100% responsibility for that. For some strange reason, some people on here think I never accept responsibility for anything. Yet I've seen plenty of other threads where someone didn't accept responsibility and the same people who usually insult me never called them on it. I could become like them so I would fit in, but I get no pleasure from spewing insults at others. Like you and a few others, I prefer kindness. Still, we are in the minority I think.




Your not having a box of gloves in the car was an oversight. I am sure it is one you are unlikely to repeat. Management again is at fault for not making certain there were adequate supplies on hand. It is as fundemental as making certain that all residents' medications are ordered and picked up or delivered and in stock. In addition, the previous shift's staff should have been paying attention to the glove situation while they were on shift since they likely owuld have been in a position to do something about it.

I find it odd that this is the first time you have ever heard of C Diff. As I mentioned, I too worked in residential and first heard about it in 2004...but actually it was 2005.

Of course, my question was to IM and now I am wondering how she thinks you were negligent with following universal precautions when it has now been stated to you that no one would have brought you gloves anyway.
(Of course that is always an easy thing for upper-management to say: they aren't the ones who are forced into breaking universal precautions, nor are they the ones who deal with the personal health consequences.)
I have worked in a residential group home with sometimes as many as 4 staff on, and none of us were in the regular habit of carrying gloves in our car... but I was in the regular habit of forwarding money to petty cash to buy some. Eventually I just took over keeping a watch on the glove supply and letting the pm know when more needed to be ordered.

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RE: C Diff - 2/22/2011 4:23:08 PM   
defiantbadgirl


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quote:

ORIGINAL: angelikaJ


Of course, my question was to IM and now I am wondering how she thinks you were negligent with following universal precautions when it has now been stated to you that no one would have brought you gloves anyway.



As far as she and some other posters on the forums are concerned, I'm always negligent on absolutely everything simply because I'm me. Some people get off on inflicting nonconsentual verbal abuse and they jump at the chance to use the collarme forums to do it. I've noticed that I as well as several other regular posters are often targets. When targets attempt to defend themselves, they're accused of never accepting responsibility. When they complain, they're labeled whiners. Often, the only way targets can stop insults from others is to insult themselves.


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RE: C Diff - 2/22/2011 7:10:36 PM   
sirsholly


Posts: 42360
Joined: 9/7/2007
From: Quietville
Status: offline 		Just an FYI...carrying gloves in the car is a good idea, but the extreme temperatures in the car will cause the latex to become brittle and unusable...and it doesnt take long for this to happen..

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RE: C Diff - 2/22/2011 7:54:24 PM   
CalifChick


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From: California
Status: offline 		So what are your SOPs for supplies?  Are you supposed to check gloves, adult diapers, etc., at the start of your shift before the last shift leaves?  Is the outgoing shift supposed to check?  Is someone supposed to check every morning?  If there is no SOP, then one would think that someone who does not want this to happen to them again would strongly suggest the implementation of one.

Cali





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RE: C Diff - 2/22/2011 8:55:05 PM   
tazzygirl


Posts: 37833
Joined: 10/12/2007
Status: offline 		~FR

I cant help but think the gloves in the car angle wouldnt have helped. Would you leave a client in vomit and poop while running out to your car?

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
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Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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Profile   Post #: 40
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