Infection Control and/or staff safety for infectious bacteria?

[gastronurse2]

After more than 15 years as a surgery nurse, I recently transferred to our Endo department for a Charge position. wow-what a difference in culture and process. (Those of you in Endo know what I mean). I have a great team of nurses and they all do a great job in patient care, but what concerns me is the lack of infection prevention processes like I was used to in surgery. When I was in the OR, there were countless steps to make sure nothing (infectious) came in or out of our department or suites. We were constantly meeting with our IC for any post surgical infections or complications, and were always looking to improve our process and protocols for our patients and staff. I even became the "IC Department Lead" under our new initiatives, and found myself looking at my job and department differently, not just handwashing, but in the overall process flow of supplies, staff, equipment, patients, etc.

My first year in endo was like a culture shock. Dont get me wrong, the staff is great and we have a great team. But being in the room after so many years in surgery, its no wonder we have bugs like c. diff and e.coli all over the hospital. When I was more in an IC role, I was very aware that bacteria like c.diff, VRE, e.coli, intestinal parasites, etc. all came from stool or GI secretions. Now, I work in a department where we see "debris" during every procedure and its amazing that we pay so little attention to what happens after the patient goes to recovery. When the doc leave the room and the patient is moved to PACU, I often see in the light the "debris" from the procedure we just did. We joke about the splatters on the sheets and rails, and I have tried to bring this up but our culture seem so complacent, and I often hear about our "zero infection rate" in our department. But i have to think that, since we share a PACU (somewhat) with our OR, we need to change our practices to "keep it in the room", like we would if a patient is in isolation up on the floor. Believe me, Im not a shy or quiet person, but I can't seem to get anywhere with my concerns, but this practice defies everything I have learned about Infection control, isolation, and transmission sources and vectors. We did a case on a patient last week for R/O c. diff, and found out 2 days later the cultures were positive- great time to find out after they went through our PACU and back up to their room on the same gurney we did the procedure on, just like any other patient that came down for a procedure.

I'll bet our IC would shutter if she saw that, but unlike surgery, she is only in endo about once or twice a year, usually reviewing rerpocessing logs and guidelines, but has never looked or commented on our procedure flow, like we did in surgery.

Does anyone else run into the same thing, or have a similar concerns about what we or our colleagues are exposed to in PACU or transport?

Thanks for any feedback.

[heron, ASN, RN]

A tough nut, I think. Does your staff have any ideas? Do they even see the issue yet? You may get better response from them than from your hospital admins who are also seeing more money spent on cleaning and liability issues.

[gastronurse2]

Heron-Thanks for your reply to my rant. The simple answer to your question is no- i dont even think they see what is right in front of them. Ive talked to a couple of more experienced (like myself), and they seem to see it, but seem to write it off as just part of the job. Most get that they need to protect themselves (never would get caught without a gown), but then what happens when the patient is moved to PACU? I know from past experiences I look at our P&P in more detail, as we did in a more asceptic environment, but I think one of the biggest challenges of infection control is putting all the pieces together and seeing the whole picture from start to finish.

We have a colleague (42 y/o single mom- recently out for 3 months due to c. diff). In our department meeting, it seemed all written off to the fact she was on ZPack a few months earlier for a URI, but all I have read and know would confirm that it takes BOTH an exposure to a bacteria (C. diff is fecal-oral) and then the addition of an antibiotic that causes C. Diff to present. All of the focus was on the ZPack and not the fact that she was likely exposed from a patient and it cant be tracked back to exposure. We just quit looking after we see an antibiotic hx. Thats kind of the mentaility I get when i try to bring it up.

[heron, ASN, RN]

I guess I'm confused ... who's the "we" doing the dismissing? Your staff, the IC dept or hospital administration?

If it's the staff, seems to me that you have pretty respectable experience in good infection control to be able to inservice them and it seems definitely part of your job as mgr to do just that. An approach that emphasizes your worries about staff safety might improve their receptivity. You clearly have great respect for your staff and I suspect they know it, so it might be doable.

If it's infection control or hospital admin., it seems that OSHA and risk management might have some useful tools for getting their attention.

I'm not a manager ... don't have the temperament or the skill set. I'm speaking strictly as a worker bee, so take it for what it's worth.

[gastronurse2]

Sorry for the confusion- the we is "Our Department" as a whole. My greatest obstacle is my Director who doesn't get it, and won't spend a penny, especially for anything other that the basics required to meet OSHA and JCAHO survey. As a whole, our hospital did pretty well in our last survey, but in our department all they really looked at was reprecessing procedures and compliance and presence of OSHA PPE. Because nothing is ever mentioned in surveys, and she touts our "low infection rates" (for our endo patients), Im up against a brick wall on making any changes. I see it, but it takes upper level support to make changes in what I see, as it would mean a new way of doing things to make the process safer for our docs, ourselves, and our patients hospital wide.

[heron, ASN, RN]

Still, an increased awareness among your staff might result in some simple changes that could make a difference. I'd pick a few brains in IC to see if there's simple ways to get verifiable information about what's really going on. If we're supposed to be using evidence-based practice, then the first step is to collect data. Design your own study ... and meanwhile, get your nurses and techs thinking about ways to keep your area cleaner.

ETA: It seems like your admins are having a knee jerk response by denying that there's a problem ... it's in their short-term best interest to avoid rocking anyone's boat. Don't have a clue what you can do about that.