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Raising the Bar in Rehab

Isolation

Published August 13, 2009 11:48 AM by Lisa West
In the acute-care hospital setting, words like MRSA, VRE and C-diff run wild.  Many patients are in isolation, and many require specific sanitizations prior to and following patient interaction.  Droplet isolation is, for the sake of argument, fairly easy to accommodate with a facemask.  Contact isolation, however, requires significant planning on behalf of the therapist. 

For a given patient in contact isolation, I gather all possible materials I may need; clean sheets, gown, slideboard, walker, and place it outside the room.  I poke my head into the patient's room to verify they are willing to work with therapy, because the process of sanitizing is time-consuming, and not an efficient use of time for a patient who may likely refuse therapy.  Then I glove, gown, and enter the room.  (I won't get into the basal temperature changes my body experiences with all this PPE.) 

The most laborious aspect of patients in isolation is the lengthy process of obtaining permission from infection control for the patient to ambulate in the halls.  First, I must talk with the RN to see if the patient is actively stooling, or if a wound is draining, etc.  Then, I call infection control and relay the current status from the RN and ask for any restrictions the patient has regarding community ambulation.  This information is then documented in three places- the current PT note, the "sticky note" on the computer documentation for other health care providers, and the paper chart. 

It's easy to see why many therapists avoid this lengthy process and simply ambulate patients in their hospital rooms.  In addition to all the other tedious parts of PT, isolation precautions add even more time to patient care. 

What is your hospital's policy for infection control?  What do you normally do? 

1 comments

Very good post, Lisa.

There is certainly a trade off: time versus productivity, infection control versus not allowing a patient to reach their functional potential...and let's not forget about the social isolation.  It's a well documented fact that the more "work" a patient is, the less likely they are to receive contact during the day...because it's a deterrent to the provider.  

At our facility, of course, we use the PPE. However, we are allowed to ambulate patients in the halls as long as we are both wearing PPE...the patient included. So, when I enter a room, I also bring with me a gown, gloves and mask (if needed) for the patient as well.

Christie ,, August 13, 2009 9:35 PM

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