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Hi All
I was wondering if anyone had a current procedure/guideline or information that was related to patients who can use (or not use) a hydrotherapy pool specifically those patients with IDC/SPC and Stomas and was happy to share. We currently have a procedure that excludes these patients from using the pool. This is causing a large number of patients that require therapy to be excluded.
Looking forward to all responses.
Julia Carey
Clinical Nurse Consultant/ Infection Prevention and Control
Ryde Hospital & Community Health Service
Denistone Road, Eastwood NSW 2122
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Hi Julia,
See below for our pool exclusions / inclusions
Hydrotherapy pool use is not suitable for patients with:
* Acute infections (eg. cellulitis, pneumonia, fever)
* Airborne infections (eg: TB, flu, viral infections)
* Wound infections (should be considered if redness, heat, and increased swelling and pain)
* Non intact skin (open wounds) – see PHY-HPM-S06-D003
* Wound ooze following surgery
* Fever:
* clinical discretion by the ward physiotherapist and RN to be used
* may also indicate infection eg. wound infection
* Patients isolated for MRSA within the last 3 years (recommended by Dr. Ross Bradbury, Infectious Disease Consultant, SAH). Patients who have not had a positive diagnosis of MRSA in the last 3 years must first be assessed by the Infection Control Department.
* Urinary/faecal incontinence
* Unprotected menstruation – see PHY-HPM-S06-D003
* Complications or bleeding during pregnancy (APA Aquatic Physiotherapy Group)
* Urinary tract infections
* Diarrhoea and gastroenteritis (for 7 days after the symptoms have settled).
* Infectious skin conditions (eg tinea, verruca, thrush, impetigo)
* Clients with known blood borne viruses (eg Hep B, Hep C, HIV) are to be cared for using standard hydrotherapy precautions – see PHY-HPM-S06-D003
* Unstable epilepsy
* Recent CVA or TIA
* Unstable diabetes where BGL is16.0 mmol/L (recommended by Sian Bramwell, SAH Diabetes Educator).
* Neurological contra-indications (to be assessed by ward physiotherapist/ treating doctor)
* Renal or heart failure
* Undue shortness of breath
* Chest pain
* Symptomatic hypotension or labile BP
* Herpes Simplex (cold sores).
* Acute DVT (pool entry only at discretion of treating Doctor: Dr. approval required, dependent on extent and location of DVT)
* Acute Pulmonary Embolism
* Nausea/vomiting
* Confusion
* Intoxication
* Drowsiness or sedation – due to narcotics or other causes
* Some psychological/behavioural problems may be contraindicated (ward physiotherapist to assess)
* Patients with IV devices such as cannulas/porta caths/vas caths etc.
* Immersion a risk in respiratory disease where FEV1 and/or vital capacity are <35% of that of expected (Australian Physiotherapy Association (2002) – Guidelines for physiotherapists working in and/or managing Hydrotherapy Pools).2. The RN caring for the patient should assess urinary incontinence, skin conditions and patient confusion/drowsiness on an individual basis. This should be discussed with the ward physiotherapist and the NUM as to suitability for hydrotherapy.
3. Prior to pool use, it is ESSENTIAL that peri-care and occlusive dressings are attended to. Inpatients must shower on Ward before pool session. For those patients who have been primarily on bed rest, showering is not sufficient unless peri-care is attended. Patients who are menstruating must change their tampon immediately prior to entry and immediately following exit from pool.
4. Tegaderm is used to seal healthy post-surgical wounds. Areas covered must be free of body hair and sufficient material used to completely cover the wound and surrounding skin areas smoothly. Refer Protocol for Waterproof Dressings – see PHY-HPM-S10-D004
5. Patients with suprapubic catheters must have the bladder emptied just prior to hydrotherapy. The stoma must be clean and dry, and sealed with a fluid repellent dressing, which totally secures the catheter. The catheter must be secured a second time to the skin of the abdomen to minimise manipulation. A flip-flop valve or leg bag is to be used to contain urine.(Recommended by APA Aquatic Physiotherapy Group)
6. Patients with transurethral catheters must have the bladder emptied, and the catheter secured with a leg strap to minimise manipulation during therapy. A flip-flop valve or leg bag is to be used to contain urine. (Recommended by APA Aquatic Physiotherapy Group)
7. Patients with colostomies must first have the integrity of the stomal site checked by the stomal therapist (ward physio to liaise with the stomal therapist). The bag is to be changed by the RN immediately prior to the patient’s pool session. Use tight bathers/clothing or tubigrip to limit bag movement during the pool session. Care is to be taken not to bump stoma site and dislodge the bag. On returning to the ward, the colostomy bag is to be changed again by the RN (Refer Australian Physiotherapy Association (2002) – Guidelines for physiotherapists working in and/or managing Hydrotherapy Pools)
8. Patients with eczema, dermatitis, psoriasis or non-contagious skin rashes may enter the pool (unless they have open or infected areas). Where the skin condition is extensive the patient should be encouraged to wear a T-shirt over their bathers.
9. Patients undergoing chemotherapy require clearance from oncologist as to when recovered adequately to enter the pool. White cell count must have returned to acceptable levels. If still neutropenic/immunosupressed, then inappropriate to enter the pool where susceptible to infection. Pool entry is otherwise contraindicated with patients undergoing chemotherapy where:
o the patient has a port/open access/any wounds/cuts.
o For 24 – 48 hours post chemotherapy if they are incontinent or have any other “body fluid” issues (due to carcinogens associated with chemotherapy).
Recommended by APA Aquatic Physiotherapy Group
Fatigue is an issue, so start out pool work gently, progress sensibly, reassess at each session.10. Patients who have an acute fear of water are to be assessed by aquatic physiotherapist/ward physiotherapist regarding suitability of hydrotherapy. If proceeding provide reassurance and sympathetic approach, undertake careful and close handling, provide increased supervision (one on one if necessary) and avoid deep end.
11. Pregnancy: Persons should not exercise in pool (attend any Aqua classes) in 1st Trimester of pregnancy. Special Pre Natal Aqua classes are available for those in their 2nd and 3rd Trimester. Where there is bleeding, the pregnant patient should not attend the pool.
Kind regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076Hi All
I was wondering if anyone had a current procedure/guideline or information that was related to patients who can use (or not use) a hydrotherapy pool specifically those patients with IDC/SPC and Stomas and was happy to share. We currently have a procedure that excludes these patients from using the pool. This is causing a large number of patients that require therapy to be excluded.
Looking forward to all responses.
Julia Carey
Clinical Nurse Consultant/ Infection Prevention and Control
Ryde Hospital & Community Health Service
Denistone Road, Eastwood NSW 2122
julia.carey@health.nsw.gov.auThis message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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