Dear, dear friends. We all hate being "under the man". I get it. But goodness. Let's face it. Protective gear is a rule because it is so very necessary. If you are ever fearing a back spray, please, wear the gear to protect your ever-absorbing skin and EYES. We touch some of the most unruly things in our profession. In the longest run on sentence I would love to share with you some of my icky-stickiest: maggots in the feet, wounds to the bone, explosive clostridium difficile, excessive lice that took over a week to treat (HEAD TO TOE), tunneling wounds in the peri-area that exceeded 8 inches in depth, infected boils bigger than golf balls, dehisced abdominal surgical sites (staples flew across the room), goopy tracheostomies that hadn't been cleaned in so long they were almost cemented in place, shingles galore, meningitis with fevers of 104, tuberculosis with projectile sputum that was yellow/green, anything sputum (makes me cringe), explosive bloody diarrhea, Mount Vesuvius-like blood spurts when inserting an airway while in a code, removing feeding devices thus spurting bile, etc, etc, etc.
Did you turn a little green yet? If you're a nurse, I am sure the answer is no. For me, sputum always makes me a bit (more like a LOT) nauseated, and sometimes uncontrollably gaggy. Funny and so not funny all at the same time. It's kind of embarrassing. I'm always afraid it will make my patient feel bad (in any way shape or form). Moral of the story above is that PPE is not just a GREAT choice when dealing with our usual: MRSA, VRE, Cdiff, Meningitis, Tuberculosis, Shingles, etc. Any time you are coming into contact with flaking skin, excessive wound drainage, foot care, you name it, WEAR SOMETHING TO COVER YOURSELF.
We all know that Cdiff has legs. The spores have legs people. It attaches to things and it clings on for dear life. Do you not realize that this advanced bug has the ability to live on surfaces for extended periods of time unless it's given a proper clean? Seriously. If you can't imagine anything else, imagine these microscopic critters sticking to you, your hands, your clothes and shoes. Now think of what you touch. Your face, phone, private parts (you gotta pee at some point), say you pick your nose for that stubborn boogey, or capture a stray eyelash, or even chew a nail.. Yum yum, nom nom, right? Wrong. Disgusting. Hospitals are cesspools. May I remind you that everyone is sick? (That or asking for Aunt Dilaula, but that's a different issue).
It is OVERLY tedious to gown up, remove, gown up, remove, and go from room to room. I guarantee that your neutropenic patient who is crazy sick (or may even have cancer) greatly appreciates your attention to detail when washing your hands in between patients. It's easy to get cavalier when moving fast, rushing or just thinking that hand sanitizer will do the job. If I could give you a sad face/awkward frown, I totally would right now. The thing is that we all know this is necessary, an issue, and a PIA, but we have to do it. Personally, when I get home and hug my love, I don't want to pass someone else's poo to his lovely person. It's rude. And it's just down-right gross.
What do we do then? Comply comply comply. Wash your hands. Comply some more. We are a profession that washes our hands before and after using the bathroom. It's just the way we need to conduct ourselves. I personally don't want to go to the bathroom and take care of MY business after putting a suppository up someone else's end. Just saying. Your poo-poo platter doesn't need to be on my platter. Okay okay. Enough puns.
Things are becoming more and more resistant to antibiotics. When in doubt, don the yellow gown (or whatever color your hospital PPE is). When there are creepy crawling things that are jumping, break out the hazmat and have no shame. I've worn hazmat and I felt so so SOOOOOO blessed. I did NOT want to bring that ju-ju home with me. I love my job, but I don't have to love the bugs involved.
What can be a controlled infection can turn to sepsis quickly. Be aware and seriously, just wash your stinking hands! I will never forget how horrified I was when palpating an abdomen that I didn't know had a tunneled wound down to the patient's infected stomach appliance from bariatric surgery. Let's just say that warm puss from someone's insides on your bare hands is enough to make you want to autoclave your body for the rest of the shift.
Believe me when I say that I love wounds and wound care. I find it fascinating. But when I'm assisting on an Unna boot and physical therapy is blasting off dead skin with their crazy machine, I'm covered with PPE head to toe. Because as rewarding as it is to heal wounds and assist in curing the sick, I'd rather not have your skin flakes in my hair (thank you very much).
There have been times when a culture has come back and I wasn't sure if the patient needed contact precautions or not. The navigator for that is literally a phone call away. If night shift can't get ahold of someone who knows for sure then a 'cheat sheet' needs to be made. For you and your safety, always err on the side of caution.
Two last things to keep germs at bay... REMOVE your shoes before getting in the car. If I had a dollar for every time I stepped in poop, pee, vomit, spit, blood, or found those things clinging happily to my shoes, I would have paid for all of your school loans and probably paid off your mortgage (you're welcome). Leave those nasty buggers in the TRUNK of your car in a box. It is NOT necessary for those shoes to see the light of day besides fluorescent lights at your job, and then the brief walk to your car. You don't wear shoes in the house? Good for you. I don't either, but! Wearing work shoes home with first driving, then leaving them wherever you do and then driving the next day while (you're off) in your awesome civilian kicks, heading to a friends house and walking into their door... You're welcome. Whatever grime was on your work shoes, can make a lovely imprint on your car's pedals and excitedly await another shoe to make close friends with. It's truly that simple.
Lastly, my dear dear germ-ED family, our scrubs. Our scrubs. They need their own planet. If there was a laundromat in space, we'd need it for frequent use. Since that is not (yet) a possibility (let's go NASA!) we have to wash our scary things at home. Rule number one. I don't care how much you paid for those super cute/stylish/comfy Grey's Anatomy scrubs (they are my favorite too), if you get excessive bodily fluids on it. Trash it. End of story. Buh-bye! I had Cdiff pooped down my leg once. I bought the scrubs the DAY BEFORE. Guess where they went? BIOHAZARD. OR scrubs the rest of my shift, for the win! Rule number two. Scrubs need to be cleaned on HIGH heat and washed separately from the rest of your gear. Think about it.. Wash your washcloths with your scrubs. Later on, wash your face, bum, etc with that washcloth... I don't think I need to elaborate more. I make my own detergent and use essential oils for their antimicrobial properties in my fabric softener. Then I do an empty cycle behind my scrub laundry to clean out the machine. Do what you need to do friends, the bugs we deal with daily are serious.
Unfortunately, the germs we work with, deal with, fight with, all deserve respect beyond what we've been giving them. I'm sure we are all walking around carrying something or with some antibodies of some sort... But for me, I'd rather win than have to deal with MRSA boils, or Cdiff diarrhea.. Personally, I'd also like to refrain from nursing my own tuberculosis.
We need to have compassion for our patients. Not the germs.
