patients with infectious diseases part 2
Chris Horton
Description
Collection
Title:
patients with infectious diseases part 2
Creator:
Chris Horton
Date:
4/1/2008
Text:
Chris,
It's important to know what kind of infectious disease your dealing with so
that you may understand the hospitals insistence on sterilization. As far as
TLSO's and adjustments, if the issue is trimlines they should be preset at
time of measurement so that you don't have to bring it back to the lab. Also
if you use a blade knife and a plastic deburring tool you can avoid bring
the orthosis back to your lab. For patients who have this level of infection
I usually have the TLSO fabricated with a removable lining so that it can be
cleaned or disposed of and replaced. As far as tools that are used for
adjustments, I try to use Chicago screws for straps and any scissors , screw
drivers allen wrenches etc. are all metal so that the hospital can sterilize
them. Or I get really cheap ones that can be thrown out. If the patient is
in this type of maximum isolation what is there diagnosis requiring a TLSO.
Sometimes an custom fitted multi-panel TLSO which requires less adjustment
and easier application and cleaning is appropriate for this patient. In
addition be sure that the person measuring this patient takes all the
required precautions so that they do not inadvertently bring the bug back
to the facility. Sometimes when dealing with isolation patients it is even
better to use the intercom or phone and have someone write down the
measurements so that you do not take anything out of the isolation room.
Hope this helps, there are guidelines that are available from the CDC when
dealing with very contagious bugs. You might want to go to there web site
or email them for specific information. They have been very cooperative with
me in the past.
All the best,
Carey Glass CPO FAAOP
20% bleach w/ water in a spray bottle.
If your TLSO is made of 3/16 or thinner polyethylene, you can heat it with a heat gun without touching it, and then cut off what you don't want with a sturdy pair of shears. They can then sterilize the shears for you. Carry some moleskin to cover any jagged or rough edges.
Buen suerte,
Matt Daniels, CP
Chris,
The TLSO is going to be worn over a T-Shirt. Explain to them that it will not be against the skin so there is no risk of infection. Mark your adjustments and take the brace back to the office. Do not do the work there; that way you are not dragging contaminated tools into the hospital.. After the adjustments wipe it down, and spray it off so no plastic lint is on the jacket. Again, let them know the TLSO is fitted over the T-Shirt, and the T-shirt is over the sterile dressings; just like a post-op BK. That should solve the problems.
Rick F./cpo
Hello Chris,
I have not come across such a strict rule on equipment sterilization.
The first thing that comes to mind is how do the DME companies that
provide the hospital with CPMs, beds, commodes, etc. clean and sterilize
their equipment? I know that CPMs are reusable from patient to patient,
but you can't put the CPM into an autoclave?
Just some thoughts and good luck in your situation.
Steven Chu, CPO
Hi:
You are over-thinking the problem. Have the hospital sterilize the brace and then you only have to make the adjustments. They can gas sterilize. It's their rule, make them do the work that they want/need to be done. It's the patient who is infected, not you or your equipment. As for measurements, use a throw away tape measure.
On the other hand, maybe the hospital can provide a barrier between the patient his TLSO. If a gown is good enough for you, isn't it good enough for the patient? After all, he'll only wear the TLSO for short periods, at least for a while.
Certainly, as a last resort for a hard nosed hospital, they can always repurchase as necessary.
Jim Fenton,L.P.O.
Miami
Tell them you are happy to comply, BUT, you must then charge them for
the destroyed equipment. They are being unreasonable? Do they make you
destroy or sterilize the clothes you wear into room, under the gown,
does all their staff likewise use dedicated clothes in room and have a
sterile room to change into your sterile clothes. Is the patient truely
infectious with a deadly infection (Eboli, Dung Fever, etc) or is it a
case of MRSA? Let them tell you how to proceed. If they buy you the
new tools leave the contaminated in the room for future adjustments. I
do all TLSO adjustments in room, haven't had to return an orthosis to
office in several years. They can keep old tools when patient discharged.
Just a thought.
Morris Gallo, LPO
If that is the case then cast the patient. You can do cast changes and use the hospital cast saw and tools,
Mike Dodd
Wow, sounds serious. I would make a new one just to protect me and my
staff.
I will be very interested in the responses. For a meaningful response,
the question should be asked of a Infectious Diseases specialist who actually
knows what P&Os do. Many years ago, the hospital accreditation group cited our P&O department for discarding plaster impressions in the garbage can rather than in the
red Infectious Disease bags. Once we got a ID MD to take a look and he
realized that we routinely cast over a new plastic garbage bag, he wrote an opinion
and the whole problem went away. It's very likely that simply making a garbage bag sleeveless vest for this guy is all that would be needed. If nothing ever touches his skin and the garbage bag is left in the room, then you're probably completely safe.
--John
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Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
It's important to know what kind of infectious disease your dealing with so
that you may understand the hospitals insistence on sterilization. As far as
TLSO's and adjustments, if the issue is trimlines they should be preset at
time of measurement so that you don't have to bring it back to the lab. Also
if you use a blade knife and a plastic deburring tool you can avoid bring
the orthosis back to your lab. For patients who have this level of infection
I usually have the TLSO fabricated with a removable lining so that it can be
cleaned or disposed of and replaced. As far as tools that are used for
adjustments, I try to use Chicago screws for straps and any scissors , screw
drivers allen wrenches etc. are all metal so that the hospital can sterilize
them. Or I get really cheap ones that can be thrown out. If the patient is
in this type of maximum isolation what is there diagnosis requiring a TLSO.
Sometimes an custom fitted multi-panel TLSO which requires less adjustment
and easier application and cleaning is appropriate for this patient. In
addition be sure that the person measuring this patient takes all the
required precautions so that they do not inadvertently bring the bug back
to the facility. Sometimes when dealing with isolation patients it is even
better to use the intercom or phone and have someone write down the
measurements so that you do not take anything out of the isolation room.
Hope this helps, there are guidelines that are available from the CDC when
dealing with very contagious bugs. You might want to go to there web site
or email them for specific information. They have been very cooperative with
me in the past.
All the best,
Carey Glass CPO FAAOP
20% bleach w/ water in a spray bottle.
If your TLSO is made of 3/16 or thinner polyethylene, you can heat it with a heat gun without touching it, and then cut off what you don't want with a sturdy pair of shears. They can then sterilize the shears for you. Carry some moleskin to cover any jagged or rough edges.
Buen suerte,
Matt Daniels, CP
Chris,
The TLSO is going to be worn over a T-Shirt. Explain to them that it will not be against the skin so there is no risk of infection. Mark your adjustments and take the brace back to the office. Do not do the work there; that way you are not dragging contaminated tools into the hospital.. After the adjustments wipe it down, and spray it off so no plastic lint is on the jacket. Again, let them know the TLSO is fitted over the T-Shirt, and the T-shirt is over the sterile dressings; just like a post-op BK. That should solve the problems.
Rick F./cpo
Hello Chris,
I have not come across such a strict rule on equipment sterilization.
The first thing that comes to mind is how do the DME companies that
provide the hospital with CPMs, beds, commodes, etc. clean and sterilize
their equipment? I know that CPMs are reusable from patient to patient,
but you can't put the CPM into an autoclave?
Just some thoughts and good luck in your situation.
Steven Chu, CPO
Hi:
You are over-thinking the problem. Have the hospital sterilize the brace and then you only have to make the adjustments. They can gas sterilize. It's their rule, make them do the work that they want/need to be done. It's the patient who is infected, not you or your equipment. As for measurements, use a throw away tape measure.
On the other hand, maybe the hospital can provide a barrier between the patient his TLSO. If a gown is good enough for you, isn't it good enough for the patient? After all, he'll only wear the TLSO for short periods, at least for a while.
Certainly, as a last resort for a hard nosed hospital, they can always repurchase as necessary.
Jim Fenton,L.P.O.
Miami
Tell them you are happy to comply, BUT, you must then charge them for
the destroyed equipment. They are being unreasonable? Do they make you
destroy or sterilize the clothes you wear into room, under the gown,
does all their staff likewise use dedicated clothes in room and have a
sterile room to change into your sterile clothes. Is the patient truely
infectious with a deadly infection (Eboli, Dung Fever, etc) or is it a
case of MRSA? Let them tell you how to proceed. If they buy you the
new tools leave the contaminated in the room for future adjustments. I
do all TLSO adjustments in room, haven't had to return an orthosis to
office in several years. They can keep old tools when patient discharged.
Just a thought.
Morris Gallo, LPO
If that is the case then cast the patient. You can do cast changes and use the hospital cast saw and tools,
Mike Dodd
Wow, sounds serious. I would make a new one just to protect me and my
staff.
I will be very interested in the responses. For a meaningful response,
the question should be asked of a Infectious Diseases specialist who actually
knows what P&Os do. Many years ago, the hospital accreditation group cited our P&O department for discarding plaster impressions in the garbage can rather than in the
red Infectious Disease bags. Once we got a ID MD to take a look and he
realized that we routinely cast over a new plastic garbage bag, he wrote an opinion
and the whole problem went away. It's very likely that simply making a garbage bag sleeveless vest for this guy is all that would be needed. If nothing ever touches his skin and the garbage bag is left in the room, then you're probably completely safe.
--John
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Chris Horton, “patients with infectious diseases part 2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/229224.
