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By Lanette L. Rhodes RN, BS, PA, CNOR; Denise G. Nesselrodt RN, MSN, CIC; Sandy Massey RN, BSN; and John H. Armstrong, MD
As bacterial antibiotic resistance increases, there is an increased need for hospital isolation compliance. Bulky isolation supplies of gowns, masks, and gloves are often located in patients' rooms, hall isolation carts, and boxes; these inconvenient supply locations clutter hallways of healthcare facilities and pose fire, logistic, and regulatory problems.
To prevent nosocomial transmission of resistant bacteria, healthcare workers need convenient access to personal protective equipment. If the equipment is dispersed and difficult to locate, the healthcare worker will either forgo using the equipment or waste valuable patient care time searching for supplies.
Through team work and creative problem solving, our hospital resolved this hallway storage problem.
During a recent hospital inspection by the state fire inspector, the Winchester Medical Center safety and security director was informed that the hospital was in violation of the fire code by storing isolation supplies in the hall, outside the patients' rooms.
Supplies were stored in carts outside the patient rooms because there was inadequate storage space in the nurse server. The safety and security director informed the Infection Control Committee of the fire inspector and JCAHO interpretation of the fire code. Isolation carts would no longer be allowed outside patients' rooms. Fire Prevention states that the hallway must be free from all obstructions.
Three members of the Infection Control Committee, two Infection Control Practitioners and a director of patient services investigated alternatives to the current methods of storing isolation supplies. Local businesses were contacted and an Internet search was conducted to find a door-hanging storage unit for supplies. We were looking for a "shoe-storage" type unit with pockets of varying sizes. No infection control-specific storage unit was commercially available.
On Sept. 17, 1999, Denise Nesselrodt RN, Sandy Massey, RN, and Lanette Rhodes, RN, met to discuss further options. Due to space limitations, the proposed hanging storage unit could not be more than 19 inches wide, needed to contain items for patients on isolation, and required variable pocket sizes to accommodate isolation gowns, face masks, regulated medical waste bags and tags, stethoscopes, and thermometers.
We obtained a linen sheet, cut the bag to our dimensions, and pinned and stapled pockets to our measurements. Our first prototype storage caddy contained four pockets: two pockets for isolation gowns, one pocket fitted for masks, and one pocket each for regulated medical waste bags, linen isolation tags, and waterless hand cleaner. The caddy can be folded with the items secured in the pockets. The folded bag can be secured with a loop and ties.
Reinforced eyelets are placed at the top of the hanging storage container. The eyelets allow the bag to hang from the outside of the patient door.
This prototype was taken to our sewing department, stitched, and then taken to the director of environmental services.
The prototype was sent to an upholsterer, as were five revised models. Winchester Medical Center laundry services are outsourced. The department head of our Central Supply Department requested that the product be cleaned with an approved hospital disinfectant to eliminate the need for the caddy to leave the hospital. The "Caddy Committee" chose a yellow nylon product that could be chemically disinfected. Unfortunately, the nylon caddy did not meet fire regulations.
Naugahyde was considered as an alternative material but was too bulky. A lightweight and conveniently woven fire-retardant material that can be chemically cleaned, was finally selected.
Christmas wreath hangers were used to secure the bag to the door. The heavy-duty hangers held the weight of the caddy and its contents and allowed the door to close securely.
A local merchant estimated that each isolation caddy would cost approximately $40, and on May 26, 2000, the first 10 isolation supply caddies were delivered. They are now used for storage of isolation supplies for patients in contact and enteric isolation.
The Infection Control Department provided caddy education to all hospital employees. Caddy acceptance is high and nurses, physicians, and ancillary staff have said the caddy convenience made isolation practice easier. Recently, the rehabilitation unit and long-term care facility affiliated with our health system has expressed interest in using the isolation caddy for patients on contact and enteric isolation.
The Infection Control Department conducted a point prevalence study to validate that isolation supplies are not stored in the hallways and isolation caddies are adequately supplied with inventory. The point prevalence study indicated that hallway storage has been eliminated and isolation supplies are readily available.
Hopefully, our storage solution will encourage isolation compliance, thus aiding in the prevention of the spread of antibiotic resistance.
To our knowledge, the isolation caddy is a new and unique device for supply storage.
Lanette L. Rhodes, RN, CNOR, BSPA, is an infection control practitioner at Winchester Medical Center in Winchester, Virginia. Denise G. Nesselrodt, RN, MSN, CIC, is an infection control coordinator at Winchester Medical Center. Sandy Massey, RN, BSN, is director of patient services at Winchester Medical Center. John H. Armstrong, MD, is certified in internal medicine and infectious disease with Selma Medical Associates and chairman of the infection control committee at Winchester Medical Center.For a complete list of references click here