Universal Precautions

by Robert J. Lanz, LCSW

There isn’t a human bodily fluid that I haven’t been subjected to at one point or another in the ER. Well there is one, buts that’s only because the nurse warned me before I went into the patient’s room that he had been masturbating like a caged monkey since his arrival.  I guess that is part of my job, to consider all things into the mix of my psychological assessment. Masturbation is normal at home but not at the hospital, but you probably already knew that. What you probably didn’t know is that it is not uncommon for us to have that happen. It could be a schizophrenic with delusions, a developmentally disabled guy just enjoying another day with his hand in his pants, oblivious to the niceties of public behavior. It could even be a bored guy intoxicated with methamphetamine. I’m sure at some point I may have actually seen a bored, meth intoxicated, developmentally disabled schizophrenic working his own program as if he was at home in the dark with Pamela Anderson on his mind.

In this case, I observed “universal precautions” same as if the patient had hepatitis or TB or some other communicable disease. That means I gowned up and gloved up and masked up and put on safety glasses over my bifocals and with a deftness I didn’t realize I still had, managed to dodge the bullet so to speak. I don’t recall this coming up during the hiring process, my deftness I mean.  Some folks might have turned down a gig with such requirements and as I grew older on the job I realized there would come a day when I might actually not be deft enough to dodge the bullet, in whatever form it arrived in. That’s what “universal precautions” are all about.

The docs and nurses wear scrubs and if something gets on their clothes they can just go into the back and change into something fresh and they are good to go. Some are slick enough to do it in such a way that no one even knows they took a hit.

The social worker has a dress code, sort of. Upstairs where dress codes and such are more observed, the male social workers are supposed to wear sport coats and ties so they look “professional”.  It gets a little confusing at times because half the patients especially the older ones think any old white guy with a tie must be a physician. Downstairs, and the ER is always in the downstairs part of the hospital, no one thinks much about the dress code. With all those bodily fluids flying around, the all too frequent altercations involving drunks and psychotics and personal comfort itself preclude getting “dressed up” in any way.

In an altercation, a necktie becomes a convenient handle for the opposition. A sport coat would end up having more germs than a lab specimen from a festering butt wound. Hell, there were some nights when I think I should have just showed up for work in my surfing wetsuit and then stopped at the quarter car wash on the way home for a good hose down. On more than one occasion I had to dip into the stash of homeless clothes when my own have suffered the indignity of blood, or urine, or vomit or, well, you get the picture. You can’t observe universal precautions all the time.

Fortunately for me, I’m the one that usually does the thrift store shopping for the homeless clothes so I generally pick a few items that will fit me, just in case.  Like most guys my age, I’m not big into shopping but since I’ve taken up the responsibility of clothing the homeless I have actually become more fashion conscious.

Hmmm, that sounds pretty twisted. No wonder I never wanted to work upstairs. They only have to use universal precautions when someone actually has a communicable disease…

Dividing line

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About robertjlanz

Author and health care professional.
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