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Hi Kavita,
Thank you, a very tricky situation.
Hoping to start up some considerations and discussion.
Consider: Could PPE represent risk and induce staff concerns? Note: PPE is at the bottom of the hierarchy of controls – putting in other measures first may reduce the risk and minimise the use of PPE – hence reducing staff concerns and heightening willingness to work.
See: https://www.safetyandquality.gov.au/sites/default/files/2022-05/using_the_hierarchy_of_controls_in_conjunction_with_infection_prevention_and_-_fact_sheet.pdf
Also: Risk assessing in home care: https://www.agedcarequality.gov.au/sites/default/files/media/quality-and-safety-in-home-services-5-key-areas_0.pdf
MRSA:
Consider where the MRSA is located and how the transmission risk may be contained. i.e. is it in a wound that can be covered – removing transmission risk for staff. Where a wound is covered transmission PPE is not required (only standard precautions), potentially reducing the concerns and fear of staff from transmission. RN/Wound Specialist attending to wound management wear contact precaution (gloves/gown) to attend dressing only.
If the transmission risk cannot be contained i.e. multiple breaks in the skin (with MRSA present) caused by skin condition/scratching, then the cause of the skin condition would need to be treated in the first instance as contact precaution PPE would be required here due to indirect and direct contact transmission. Once the skin condition is healed, the risk is removed and the need for transmission PPE – again as a domino effect, remove the need for transmission PPE and reduce staff concerns/fear.
Shingles:
Pregnant women can not care for a person with Shingles. Only staff that have had the chicken pox vaccine or who have had chicken pox (acquired immunity) should be caring for a person with shingles. 1st lines of defence.
Again, consider looking at when PPE needs to be worn against the risk of transmission. The risks come from the ooze from the pustule sites – potentially contact and airborne transmission; if the pustules have not burst or have scabbed/healed there is no risk. Hence transmission PPE is not required, only standard precautions. (If a person is diagnosed early and on an antiviral for the virus, they are more likely to heal faster.)
If a person has localised shingles on the torso the area can usually be covered with a dry, waterproof dressing and clothes to protect the area – transmission PPE is not required, only standard precautions. Contact precaution PPE (gloves/gown) is only required when the area is exposed – i.e. showering.
Where transmission PPE is not required, it may reduce the concerns and fear of staff and increase willingness to work.
Note: Disseminated shingles = on multiple sites on the body, including the face, is not easy to cover and transmission risk is higher. Here staff should wear contact and airborne (respiratory) precautions with a PFR and eye protection, until all blisters have crusted/healed over.
See the Aged Care Guide pg 80 + pg 82:
https://www.safetyandquality.gov.au/sites/default/files/2024-08/The-Aged-Care-Infection-Prevention-and-Control-Guide.pdf
Regards Carrie