Tuesday 2 October 2012

Infection Control Revisited

I survived my first placement =] It went well all things considered. I was worried that I woud be rusty after my year out, or that adjusting to working from the wheelchair would be difficult, but actually it went pretty smoothly. I got some good feedback about my performance, which was a nice confidence boost with finals looming.

The downside was that I was working 8 hour days 4 days a week. I was therefore either in work, resting or asleep. I did a couple of hours of something else once a week - church or coffee with friends, but in general I was exhausted. Still, I knew that to get through this year would need me to compromise a lot in order for my degree to be finished. When I work, I will work part time and I will have some time and energy - that is what is getting me through.

Anyway! Infection control. I have never found an infection control nurse who could give me any sensible advice for those of us who need walking aids etc. So I've come up with my own.

I've already mentioned my approach to ward infection control as a stick user - my policy was to wash my hands then put a glove over the handle of my stick during a patient interaction, then dispose of the glove and wash my hands after. Plus regular wiping down of the stick handle with surface wipes. Bearing in mind that I clean my pen and stethoscope at the same time, which few doctors/students ever do, it was no bad thing.

As a wheelchair user I've been :
- carrying a small squidgy bottle of alcohol gel with me (because the gel is often at the bottom of the patient's bed or even outside the room and I contaminate my hands if I then move to the patient)
- when I need to move around the patient's bed either foot propelling, dragging myself holding onto the bed or just washing my hands again and wheeling
- gelling my hands again while I'm telling the patient what will happen next rather than as I leave (can't push myself with wet hands
- I'm hoping that on DSA I'll get a spare set of wheels to use at the hospital, which is more hygienic and that I can get push rim covers for them to help with grip as I can't wear gloves on the ward
- first thing, last thing and a couple of times in between I wipe my wheels down with surface wipes - also if there's a chance that body fluids have got on them (e.g. in resus)

I've also been wondering about how splints and tape work with bare below the elbows rules. I know that there are disposable oversleeves available for patient contact for those who need them for religious reasons, but I don't know if that would translate into covering splints. And it would be a bloody faff. Some folk have plastic spints that to a certain extent can be wiped down, but most are fastened with velcro or elastic which can't be. Some folk wear splints in spite of the rules - and in fairness bare below the elbows wasn't an evidence based introduction - it was more common sense than anything else - but I don't know anyone who has had a decent conversation about what is / isnt' acceptable. For example, I imagine one or two silver ring splints would be ok, because those could be cleaning like the plain wedding bands staff are allowed to wear - but more couldn't. Any thoughts folks?