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Infection Control

February 8th, 2009 Leave a comment Go to comments

When I worked as an Employee Health nurse in the early 90s, I worked in close contact with the Infection control department. If an employee stuck themselves with a dirty needle, we had a needlestick policy that we followed by the book. This policy was to help protect employees from diseases such as Hepatitis B or HIV/AIDS. Also, if a patient was admitted and found later to have an infectious case of TB or meningitis, follow up for all exposed employees ensued. TB testing for everybody who had unprotected exposure to the patient was done and followed up. If the patient had Meningococcal meningitis, employees who had cared for and had unprotected exposure to that patient were offered prophylactic medicine to prevent them from getting the disease.

My major project as one of the EHS nurses was to test for TB. TB had made a comeback of sorts since the spread of HIV/AIDS. New more difficult strains of TB had emerged in part because of the vulnerability of immunocompromised HIV/AIDs patients. I was assigned the daunting task of testing every employee at my 450 bed hospital for TB with a two step testing process. It took almost 2 years to complete this task. I was also responsible for teaching TB precautions and to do TB HEPA filter mask fit testing for employees. There was a new OSHA mandate to do all of this in the nation’s hospitals. Non-compliance was not an option. Tons of money and many hours were dedicated to all of this testing, mask fitting, education and documentation. In all of my 2 years and around 4500 TB tests, I found 2 new positive TB tests in my facility. That’s right….TWO.

Now it seems to me that was a lot of hoopla for a very low number of actual TB cases. I know the importance of TB control. It is a deadly disease and there has been a reemergence of it, but compare it to MRSA.

Approximately 15% of the general population has MRSA growing in or on them. About 30 to 40% of healthcare workers has MRSA growing in them or on them. The spread of MRSA is caused by unwashed hands, contaminated equipment or furnishings, or from an infected roommate. If healthcare workers are colonized ( have MRSA in their noses but no signs of infection) then scrupulous handwashing and the use of gloves is absolutely necessary. Other things to consider are healtcare workers wearing rings or other jewelry, long hair hanging around and hovering over dressing and sterile procedures, fake or long fingernails, and wearing the same lab coat or uniform for more than one day. I don’t know any nurses who would knowingly bring disease to a patient. But, if they are not tending to their own hygeine, it is possible. Also, if a nurse becomes ill with a sneezy, ‘runny nose and eyes’ cold, they should be wearing a mask to protect patients. Better yet, they should NOT be working caring for vulnerable patients. Coughing or sneezing can spread not only a nurse’s virus but it seems that the MRSA in the nares could also be shed and spread.

Nurses are not routinely cultured for MRSA. Some say it is because there are so many of them with MRSA that there wouldn’t be any left at the bedside. I don’t believe that. I believe that nurses, because of the nature of their work, probably have a higher than normal occurance of MRSA in their noses. But, constant testing and decolonizing them isn’t the answer to the dilemma. Strictly enforced precautions and excellent sterile technique is the answer. There is a time that it is important for nurses to become decolonized and that is if they become patients themselves and vulnerable to MRSA infection in a surgical wound or if another illness makes them high risk. Also, if there is a cluster of MRSA infections in a certain department, it may be necessary for MRSA positive nurses to be decolonized. That is usually a simple procedure of putting an antibiotic cream into the nose for 5 days.

Because of hospital acquired infections, I believe it is also time to review our visitors policies in hospitals. It is difficult enough for adults to understand and use precautions. Please don’t bring small vulnerable children into the hospitals and allow them to crawl on the floors and handle equipment. The presence of bacteria is higher in the hospital than visitors know. Brief visits to patients who don’t require isolation may be appropriate, but otherwise keep babies and small children home. The sick patient’s bedside is not the place to bring small children. People in hospitals are sicker than ever and most don’t care to hear loud large parties of people visiting.

Bedside nurses will be the ones who reduce MRSA in our State’s hospitals. Maine’s Hospitals will have the mandates necessary to force them to have effective infection control policies that will reduce MRSA infections and deaths. Bedside nurses are also the ones who are closest to and care the most for and about patients. They are our protectors and advocates when we become patients. I want them to be able to decide for me and the others on my hospital ward about visitors, precautions, isolation, and other steps to protect me and other patients from Hospital acquired infections. Their decisions will also protect patients’ visitors.

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