What it means to be in an "outbreak"

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    When an outbreak of any kind is declared, what generally happens?

    I'm so sick and tired of constantly having the threat of MDROs or C.diff dinned in our (nurses) ears when no one else seems to care. It's always "Nurses, make sure you gown up and wash your hands!" and "Nurses, make sure you swab all your patients and send them to the lab before 2pm!" Meanwhile, visitors blatantly show disregard for their PPE, doctors don't wear PPE, housekeeping staff don't do follow proper cleaning procedures...the list goes on! We have reported certain individuals for not following isolation precautions but we still catch people breaking the rules. It's so, so frustrating.

    Also, the infection control department has declared an outbreak of VRE on our floor, yet the floor hasn't been closed. As a result, we keep getting new admissions, and thus, more cases. Thankfully, we've mostly managed to keep our "positive" numbers down but it has yet to go away completely. I feel like the only way we'll rid ourselves of it is to close the floor (no new admissions, no unnecessary visitors) until it's all clear. However, the hospital is so short of beds that they'll never close a whole unit down. Still, if they're so concerned about MDROs, then they should just close the unit!

    I want to complain to someone but I'm not sure even where to start...
    Joe V likes this.

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  2. 11 Comments...

  3. 4
    Quote from Aeterna
    When an outbreak of any kind is declared, what generally happens?

    I'm so sick and tired of constantly having the threat of MDROs or C.diff dinned in our (nurses) ears when no one else seems to care. .... Still, if they're so concerned about MDROs, then they should just close the unit!

    I want to complain to someone but I'm not sure even where to start...
    Mandatory reporting and public comparisons between hospitals, and the new policy of CMS to not pay hospitals for care for infections acquired while in the hospital should increase the pressure somewhat on the administrators to care about this problem.

    Well publicized examples of hospitals that have cut their infection rates dramatically put a lie to the legacy apathy that "it's just the way it is, nothing can be done about it." Patient advocacy groups may the ones to add local pressure there.

    I don't think infection control departments are very powerful in the scheme of things, compared to other interest groups.

    And people in general (patients, families, visitors) are astoundingly uninformed about infection control. More than once I've observed visitors with infants in strollers pick up a dropped pacifier off the main corridor floor and pop it back in their child's mouth.

    I hesitate to estimate what fraction of visitors don't wash their hands after visiting the heavily used public restrooms, often more poorly designed for infection control than the local Interstate rest-stop. As a society we've grown sloppy and complacent.

    From a public health point of view, in terms of MDRO's, hospitals in general are a nightmare. If all you cared about was infection control, hospitals and ICU's should all simply be shut down because they are the primary incubators and spreaders of MRDO's. But no one wants to admit that antibiotics are failing, or that untreatable TB is on the rise.

    But we don't know how to grapple in public yet with situations in which, regardless what policy we select, some people will die as a result of the choices we make. The "medical establishment" doesn't want to cope with an issue that shows the "feet of clay" and the reality that doctors are not gods, and have limits. So don't expect this issue to be dealt with without very real outside pressure and even that is hard to generate.

    In fact, society is great at putting this question out of mind. The 1918 "Spanish flu" epidemic killed more people than World War I, and was the single most important event of the day. Yet studies of recent history textbooks show that it merits at most a sentence, or no mention at all. At all levels, people just don't want to think about it.

    Public health departments have been aware of and pushing on these issues for over a century, but the response of society and the AMA to the statistics has been largely to do everything possible to squelch that voice and slash the budgets for such departments, and misportray them as "advocates of free care for underserving poor people" who need to be put out of existence.

    All that said, nurses ARE the primary line of defense of the patient, and increasing the power and influence of nursing organizations may do more than anything else to help.

    It's hard to care when no one else seems to, but that's also when it matters the most.
    ebear, elprup, Hillbilly RN, and 1 other like this.
  4. 1
    OMG! At the hospital I work at, if you're caught without your gown and gloves on in an isolation room, you could be fired on the spot!!!
    elprup likes this.
  5. 1
    You could start with your local Department of Health
    elprup likes this.
  6. 1
    Agree about the public being uninformed, but they theoretically are not doing hands-on care either. At my hospital they have a hand sanitizer dispenser at the door that serves as a good reminder. They need posters and signs everywhere too, and I don't see much of that.

    Unfortunately I have seen a lot of nurses and doctors who are still pretty lazy about gloves. That bothers me the most.
    elprup likes this.
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    And ofcourse its the nurses fault, and always will be. Its frustrating because we're not the only staff who hops from room to room. I've seen family members call from home and say Theyve caught what the patient has, then bring the illness right back after the pt gets better.
  8. 1
    Yuck, I wear gown and gloves anytime it's necessary, not just for patients but for myself. Why spread nasty germs around? But I can completely relate to where the OP is coming from. Had a lady with mrsa and c diff on vanco, family would come in, crawling babies on the floor, hugging, kissing, using the bathroom, sitting in the bed and such, etc., no handwashing, then just leave the room. So disgusting. Don't people know that bacteria and germs are real? It's not just made up for kids, people.
    nursemarion likes this.
  9. 0
    In our facility, we've been working hard toward not spreading anything that we can prevent spreading. We do a lot of hand sanitizer, hand washing, wiping down rooms between all patients, and have masks on us and all patients and family members with any URI complaints.

    I still see some providers NOT following the rules - for instance, a provider not wearing a face shield when swabbing for pertussis (we have an epidemic now), and not wearing masks with all patients who cough. Yes, I know many doctors who think they have some kind of antibacterial bubble. Everyone needs to be accountable.

    I've noticed since we have become tougher with this, we've all been less likely to catch whatever the patients bring in. Hello? It's nice not getting every other crud that comes through!

    I tell parents daily, "Please don't let your baby or young child play/crawl/lie on the floor, because some people pee or vomit on the floor." Parents are insulted that I'm saying this. Although our carpets are "cleaned" nightly, REALLY? Does this get them clean??

    Infection Control departments need more teeth. If all patient care facilities had the "fire for not using PPE (personal protective equipment)" policy, maybe employees AND MEDICAL STAFF would take this more seriously and we could cut the infection rates.
  10. 1
    There was a study done in a hospital on handwashing by employees after using the bathrooms. Doctors scored the lowest. Housekeepers scored the highest - yes, even higher than the nurses. Hmmm.
    elprup likes this.
  11. 0
    I agree it is a problem. Places I have worked, I have seen the reuse of gowns, if any, with the premise being to save the all mighty dollar. I can also understand the thinking of why medical staff do not wash and wear protective gear...because there are too many things to do in the amount of time given and they do not want to be slowed down. Alas, we know the time issue is valid but the thinking they are saving anything is incorrect. Because when they get it and spread it, everything gets 10 times worse.


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