It's Airborne: Contact Precautions Will Not Stop This Superbug

ctrimarchi, BSN, RN

C. Diff, MRSA and VRE are just a few of the diseases hospitals have taken specific measures to reduce cross contamination. These diseases have serious side effects and can further complicate an immune-compromised patient's chance of improvement. Evidence based practice has given staff protocols to reduce the chance of spreading these diseases and research has given antibiotics to assist in the treatment of someone already infected.

But what about the disease that is more viral than any other? The disease that spreads like wildfire via the "Butterfly Effect" infecting the staff, patients and visitors? The disease that does not have an incubation period, is airborne and can be just as detrimental to patient outcomes as MRSA? What is this new superbug you ask? Attitude. There are two types known: Attitudinous vulgarious (A. vulgarious), or "bad attitude" and Attitudinous optimisticous (A. optimisticous) or "good attitude." In either version there are multiple variations, degrees of infection and can be hospital or community acquired.

Attitude spreads like wildfire no matter how many gloves, gowns or masks you have on. Have you ever walked into a patient's room, and no matter how bad they feel, when you greet them with a smile and a pleasant attitude, they can't help but smile also? BAM - you have just become part of the epidemic - someone caught your good attitude, if only for a moment.

A. vulgarious appears to spread faster than A. optimisticous however both go 'viral' and affect the entire milieu of the floor. Who among us has not been yelled at during a typical day at work, more often than not, simply because someone else was having bad day? How did this affect you? Instant bad attitude? This attitude can spread quickly unless a conscious effort is taken to combat it. Many do not realize they have been infected until it's too late and have further spread the virus as well. We as nurses have more frequent contact with patients, visitors and other hospital staff and therefore have a higher chance of cross-contamination than, for example, a doctor. Although we can be infected by a doctor, we can then spread it to the transportation staff, who then infects the MRI staff, who then infects the nurse on another floor, so on and so forth, and now it has gone hospital wide.

Unfortunately, there are no labs or diagnostics that can be done to see if someone has been infected or with which version they may have and once you are infected, you are a carrier for life. Only thru assessment and observation can staff determine which version may be present. Legally, nurses cannot be held liable for infecting someone with A. optimisticous however a legal opinion on the transmission of A. vulgarious is still pending.[ii]

What can you do? The old adage lead by example comes to mind. Ellis holds five MEE standards, one of which is Attitude. This encompasses six values: be positive; promote forward thinking; recognize problems as opportunities for improvement; do not make excuses or blame others; leave personal business and problems at home and collaborate when problem solving.

I try to be positive from the moment I step out of the car on my way to start my shift until I exit those double sliding glass doors to the parking garage when my shift is over (cue background music of angels singing and rays of sunlight shining down). Often on my way to the floor I pass people in the hall who have obviously not had the best of days but with the quick flash of a smile and a friendly 'Hi', they can't help but return the gesture.

I like to think I promote forward thinking and recognize problems as opportunities for improvement. Some of the spread of A. vulgarious on the floor is attributed to staff-to-staff contact. If someone attempts to infect me I may briefly suffer some symptoms, however remind myself that I need to keep moving forward and that hanging on to that virus only distracts from the job at hand. I try to remind myself and others that it does no one any good to stay in a bad mood from an event that may have happened earlier. Inhale, exhale and move on. Problems are always opportunities for improvement and discussing them with other staff members can open your eyes to a solution you may not have come to on your own. I find my co-workers great resources professionally and personally and value their input and opinions.

I try not to make excuses or blame others, which can be a difficult task if infected with A. vulgarious. I try not to spread my bad day to others however no one is perfect and this can be more challenging than it sounds. I make a conscious effort to go into each room as if it were my first for that day, leaving behind what may have happened in the staff lounge, at the nurses' station or in the previous room. It is important to remember though that if someone has a Stage 4 infection of A. vulgarious they may not feel any relief no matter what interventions you employ. At this point it is important not to blame them, but to remember that everyone is going through their own issues; treat them with respect, an open ear and be a sounding board. Sometimes the only intervention required is the openness of another to listen to the infected. Often I collaborate with others when it is the patient that is infected to obtain their thoughts and points of view on how to best treat the patient. Other staff may know the patient better than I and already have some coping strategies they have employed. They may know that "Larry," who is unable to control his bladder and bowels, gets angry when he is incontinent and this can upset him for the entire shift. Therefore, a concerted effort is made to get Larry to the commode frequently. When this effort is successful he is happy the entire shift and much more pleasant to be around.

Lastly, I try to leave personal business and problems at home - Lord knows there are enough at work to go around!

Notes

Centers for Medicare and Medicaid will no longer reimburse for hospital-acquired A. vulgarious.

[ii] Scrooge v. Polyanna, 24B N.Y. Niner.

It's Airborne: Contact Precautions Will Not Stop This Superbug

About ctrimarchi, BSN, RN

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