No Prior Existing Conditions but Dead Anyway - Page 21

Channel 4 went on to quote the family further:

"Elena Panasyuk, the sister of the teen said, "He was a very timid quiet typical teenager."
It was difficult for her to talk about her little brother just two days after his death. 14-year-old Paul Nichiporuk was hospitalized for over two weeks before he passed away on Monday.
Elena says it wasn't just the H1N1 virus that killed him.
"What really killed him was MRSA, and the power of MRSA and the H1N1...the two powers combined is what hit him," she explained."

To make matters worse....... a possibly nosocomial additional infection. 2 weeks in the hospital, especially in ICU, makes it a distinctly possible nosocomial infection, which makes me wonder if the antibiotics with which this boy must have been treated, were known to work on MRSA. This brings out the Infection Control Nurse in me.

Our sole documented H1N1 death to date was also a combination of MRSA toxic shock and H1N1. The media is reporting that this child had pre-existing health problems, but the only thing other than the flu that she had was MRSA, suggesting community-acquired infection. (Our nosocomial multi-drug resistant organism rates are extremely low. At the time of her admission we had no MRSA positive patients on the unit.) She was treated with appropriate antibiotics but the combination of pathogens created a situation that resulted in complication after complication until she was removed from ECMO and died.

while i realize that some h1n1 patients can progress quickly to irreversable conditions without mrsa muddying the field, it would help the perception of nosocomial infection rates, if baseline tests for mrsa were taken upon admission to icus (when another stick isn't necessary, and there might be time to halt the synergistic process of that lethal combination).

are antivirals being used in icu withb h1n1, or are patients getting there later than 48 hours after commencement of symptoms, obviating the use of them?

We swab everyone who has been transferred from another facility, including the child I mentioned. Blood cultures were sent on admission and were positive for MRSA within a day. We monitor drug levels for many antibiotics routinely even though our lab doesn't like it when we do it, and we especially monitor them for patients on ECMO because the circuit slurps up a lot of drugs. Her vanco dose would have been therapeutic as would her linezolid and rifampin. We also have constant surveillance by our infection control department with daily visits from the IC NP. Our ECMO patients have daily blood cultures drawn from both the patient and the circuit and antimicrobials are adjusted accordingly.

Our hospital doesn't worry about the 48 hour thing. If we have a suspected influenza A they get oseltamivir within an hour of the admission orders being written.

Jan, I appreciate your full response and quality of care; and all the work you've submitted to keep us at allnurses.com, up to date! Even though I'm 70 and not gainfully employed right now, I hate to miss anything coming down, or up the pike.

Sounds like you work in Canada, as I have (eons ago). I'm so proud, seeing what you do, taking responsibility for continuing the education of all nurses.
Your health care system's anticipation of the need for ECMO is admirable, but somehow, someone dropped the ball...... does that happen frequently? I'm interested in knowing, due to the U.S. government's approaching involvement in our health care.

Thank you for your kind words. Don't apologize for trying to keep current. As long as you're learning you're living.

Now how to explain about out health care system... I know you have some knowledge of Canada and its idiosyncrasies, but I'm not sure how much you know about Alberta. It's roughly the size of Texas with a population of about 3.7 million. Most of the population is clustered in about a dozen cities. The northern third of the province has some far-flung communities with small populations, rough terrain and a forbidding climate. The middle third of the province contains most of the people and the southern third is ranchland. There are some large aboriginal communities in different parts of the province.

Health care in Canada is a federally regulated, provincially administered service. In Alberta the system has been overhauled and retooled several times. In the early 90's we went to a regional model where each of 15 regions had their own administration, their own budgets, their own priorities and their own facilities. Each region functioned independently while reporting to the minister of health and his assistants. Some regions, like Capital Health, were very successful at managing their money and resources. Others struggled t find the right balance but in general things worked. Services that weren't available locally were provided by another region; for example, trauma care for northern Alberta was provided by Capital Health and in southern Alberta by Calgary Health Region; transportation costs were picked up by the province. Capital Health had built itself into one of the most advanced and successful health regions in the country. About a year ago our government decided to restructure the system they restructured in 2003 when they reduced the number of regions from 15 to 9. This restructure took those 9 regions and made us all one big happy family. The regional administration was eliminated at great cost and an interim team put in place. The massive centralization was finalized on April 1. All the financial resources were pooled, all the human resources were now employees of Alberta Health Services and an Australian economist was hired as president and CEO. The focus shifted from clinical excellence to fiscal constraints. A serious nursing shortage was eliminated overnight by the stroke of a pen with the introduction of a vacancy management program, doublespeak for a hiring freeze. Bed closures have been announced at most major hospitals and layoffs to management and other non-clinical personnel followed. Wages are frozen and "revenue-generation" is in full flux. Virtually every decision in the province had to cross the president's desk... and he introduced a documentation-heavy process for all requests. The notion of economies of scale has value but not when it's taken to the dogmatic extreme we're seeing.

When the information coming from the southern hemisphere and Europe began pointing to an increased need for ECMO resources to treat novel H1N1, given that our hospital has a very active ECMO program, it was suggested that we increase our capacity to be ready to manage the surge. The medical director of our ECMO program filed all the required paperwork in plenty of time to have the team expanded and the equipment purchased. The paperwork then went to the critical care program director who had to think about it for a few weeks, then to the site director for another period of pondering. Then it moved on to the zone director who assessed its value before sending it on to the president for his approval. It would have arrived on his desk around the time he was on vacation in France for 2 1/2 weeks. (On the job fewer than four months and already on vacation, he wasn't too popular with the staff members who will never be senior enough to have vacation time in the summer.) When he returned he was caught up in visiting all the hospitals in the province to offer up his Koolaid. Then he flew back to Australia to attend an awards dinner in his honor. So by the time the approval was granted and the equipment ordered, it was already late summer. And there you have a recipe for ball-dropping on a grand scale.

My apologies to the other readers of this thread who have managed to work their way through this lengthy tale of woe.