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Inpatient Psychiatric Unit Isolation Precautions

By Kendal Lillard posted 08-25-2020 09:50 AM

  

Hi all,

I'm an inpatient Psychiatric Nurse Educator in Virginia. Our unit is a communal setting that fluidly flows without the ability to "shut down," sections without further structure changes. Here's the issue we're currently facing: We place a patient on droplet precautions when they become symptomatic (i.e.-febrile, cough, etc...). We do not have ante-rooms and are unable to hang PPE supplies on the door due to the risk of patient suicide or self harm. Our dirty linen room is in the middle of the 36 bed unit. We also are not all assigned N95 masks but wear the standard blue hospital mask with eye protection... What have you all found to be effective to decrease the risk of transmission in your units?

Sincerely,

Kendal Lillard

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Comments

Vera D'Silva
01-14-2021 05:56 PM

Also, surgical masks and goggles are mandatory regardless of the presence of a positive patient. N95 are permitted when you are caring for a covid positive patient. Do I agree with this? No. I am looking for some guidance in this forum to be able to talk to administrators about making it mandatory with goggles.

Vera D'Silva
01-14-2021 05:53 PM

Hi! I can't say we have it down to a science yet but I can share what we did this past weekend. We have a locked cart for PPE. All of our clean equipment is kept in this cart just outside of the patient room with a paper bag (our facility does not permit the use of plastic bags at this time) for soiled PPE which is carefully removed, placed in the bag and then stored in the dirty utility room until environmental services answers our page to have it picked up. We currently use a portable HEPA filter in the room as we do not have any negative pressure rooms. This requires a staff member to be assigned to watch the patient and filter using a baby monitor and they are right outside of the patient room so the equipment cart is also being monitored. When I entered the room I asked another staff member for standby assist to watch the cart as I quickly addressed the patient. When leaving the room I had the standby staff open the paper bag for me so I could carefully step out of the PPE. I then used hand sanitizer, for my hands, applied new gloves and used disinfectant wipes for any equipment or surfaces I may have touched. Its not perfect but its a plan in progress. I don't know if this helps but hopefully you can incorporate some of this into your routine.

Ivan Giannou
08-26-2020 08:08 AM

I've worked at three different places in NYC and surrounding suburbs. Only one hospital had a negative pressure single room assigned to possibly contagious patients (this was pre-COVID). The state hospital I currently work at (about 280 patients) opened a COVID unit back in late March, which has since been closed. As I imagine in every psych hospital, the biggest obstacle to preventing the infection of staff or other patients is that everyone is terrified they will be accused of violating someone's rights. Administrators set guidelines that remove all their liability while they sit safely in meeting rooms on higher floors, while the floor staff desperately try to encourage self-isolation and mask-wearing. I try to stay positive by remembering how fiercely this disease ripped through all of us (staff and patients included) back in the spring, so if anywhere has some herd immunity it should be here...