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CASE STUDY

CASE STUDY

E.L. is a 68-year-old woman admitted to the hospital from a skilled nursing facility with an exacerbation of chronic bronchitis. Within a few days, E.L. began having multiple bouts of diarrhea daily. Infection with Clostridium difficile was suspected and the patient was placed in Contact Plus Precautions isolation. Stool sample testing confirmed C difficile infection and the patient was immediately started on fidaxomicin. Today, the physical therapist was treating another patient on the same floor as E.L. When the therapist could not locate a front-wheeled walker on the floor, he asked the physical therapy aide to find one. The aide recalled that E.L. had a walker in her room and decided to borrow this walker so that the therapist could use it for his other patient. When the aide entered the patient’s room helpfully presenting the borrowed walker, the therapist requested that the aide immediately return the walker to E.L.’s room without allowing it to touch any surfaces along the way and to wash her hands with soap and water afterward.

REHABILITATION FOCUS

This chapter is divided into two distinct sections. The first includes miscellaneous antimicrobials not discussed in Chapter 27, including those specific for treating lower urinary tract infections. The second section discusses antiseptics, disinfectants, sterilants, and preservatives. Figure 30-1 outlines the categories and specific agents included in this chapter.

FIGURE 30-1

Agents are divided into miscellaneous antimicrobials, those specific for urinary infections, disinfectants and antiseptics, sterilants, and preservatives. Example drugs or agents are listed under each major category.

Like all healthcare workers, physical therapists follow standard precautions with all patients regardless of their infection status. These practices include hand hygiene before and after contact with each patient and hand drying with clean one-use towels (if washing with soap and water) and wearing appropriate personal protective equipment (PPE) when treating patients with whom there is potential to contact blood, mucous membranes, or other body fluids. If a specific diagnosis of a transmissible infection has been made, therapists follow facility guidelines regarding additional precautions that need to be taken based on how the infection is transmitted.

In outpatient and inpatient practice settings, physical therapists use therapy-related equipment (eg, gait belts, crutches, manual therapy tools) to treat multiple patients. Thus, it is of utmost importance to ensure that this equipment does not become an infection reservoir or transport vehicle. Therapists must know how to appropriately disinfect treatment tables and multiple-patient use equipment to avoid the potential transfer of pathogens from one patient to another.

Disinfection procedures are chosen based upon the frequency of encountering specific pathogens. In hospital and other inpatient settings, infection control departments typically dictate the disinfectants and procedures to be used. In outpatient clinics, physical therapists are responsible for choosing suitable products ...

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