Need some infection control scenarios

TazziRN, RN · Feb 22, 2007

Nobody?

C'mon, guys, help me out! I don't see a whole lot of IF problems in the ER.

AnnieOaklyRN, BSN, RN, EMT-P · Feb 23, 2007

Ok here goes, I am a nursing student who did a day in the ICU and here is the story, not sure if it is what your looking for, but here goes.

Elderly gentleman came in on 2/1 for a colectomy. Got the normal preop workup and prep including an peripheral IV. The patient seemed to be recovering fine as far as the colectomy, but while on med surg he began showing signs of heart failure with pitting edema developing over a couple of days. The patients IV site had also showed signs of infection with errythemia and developement of a lesion at the site which was cultured with a return of MRSA. The IV was removed and the patients MRSA treated. A PICC was then inserted for antibiotic therapy. Over a span of 3-4 days the patients pedal edema worsened and he became increasingly short of breath. A med surg nurse assessed him at change of shift and noticed he was pale, diapheretic and dyspneic secondary to congestive heart failure. The patients primary phsycian consulted a cardiologist who ordered an echo which revealed a blown out mitral valve secondary to growth of MRSA on the valve. The patient was transferred to the ICU (where I was doing a clinical day). He was obviuosly short of breath and looked like crap. NTG was initiated and he was given IVP lasix. The patietn was prepped for the cath lab for Aortic Balloon pump insertion and for central line insertion (the PICC was single lumen, so they needed more accesss). The patient improved with the balloon pump and was sceduled to be transferred to tertiary care facility the next day for a valve replacement. Unfortunatly I do not know whether he lived or not, but this is a perfect example of why it is important to clean the skin prior to peripheral IV insertion and to keep the site clean.

Hope this is something you were looking for. It was a good experience for me as a nursing student.

Swtooth

flashpoint · Feb 23, 2007

Hi Taz! Not sure if this is quite what you are looking for but...

Recently a nurse tried to call in sick. She had been awake all night with diarrhea and vomiting. The DON informed her that since there was no one to cover her shift, she had a choice of coming in or being terminated. She chose to work. Two weeks later, 13 of 23 residents were sick with emesis and diarrhea. The charge nurse on duty that weekend, made the decision to quarantine all of the residents to their rooms. By Monday morning, everyone was symptom free and the adminstrator chose to lift the quarantine. By Friday, 21 of 23 residents were again sick with diarrhea and vomiting. All but the five staff members who covered the first weekend also ended up with the same symptoms. The five that didn't get sick washed their hands after every resident contact, used alcohol based hand gel several times throughout the day, and used an antibacterial hand lotion. They also had family members bring them clean clothes and washed their uniforms at the facility instead of wearing them home. The charge nurse that weekend bought pizza and hamburgers for everyone to assure that everyone was eating during their shift. The cook that was on that weekend made extra breakfast for everyone on staff and left juice for the staff, which the charge nurse made everyone drink. The weekend staff went home from work, ate a healthy supper (or breakfast) and went to bed early. A good indication that plenty of rest, a healthy diet, and good handwashing make a difference.

A gentleman who was well known to the hospital came in for pain management for pancreatitis. The nurse who was inserting his IV dropped the alcohol prep on the floor, picked it up, and continued to swab his wrist where the IV was to be inserted. The man ended up with e-coli and staph a in his site.

:)

TazziRN, RN · Feb 23, 2007

Exactly what I need, thanks guys!!!!

caroladybelle, BSN, RN · Feb 23, 2007

Trach patient was admitted to the MS floor. Pt has end stage cancer, and an obvious URI. Coughing up nasty looking sputum. Died in less than 24 hours.

Approximately 8-10 days later, a large number of staff come down with symptoms of serious upper respiratory illness. Several have serious problems shaking the illness. All treated by varying MDs/clinics until connection was made. CDC become involved. All of us had handled the same pt - and the MD that admitted the pt KNEW the pt was infected with resistant infection, but never told the staff, because he didn't think precautions were all that "necessary".

Those treated early w/two ABX regimens, including augmentin, recovered relatively quickly. Those of us that were not (including myself - allergic) ended up sick as dogs and had to go through numerous regimens, and in some cases, IV ABX. All recovered.

Interesting note: One of the meds used to treat my URI was a drug called Omniflox. It had been on the market for about 6 weeks, around the time I was sick. It passed all FDA testing, only to kill or cause liver failure in quite a few patients...enough to get it pulled from the market. It did get rid of my resistant URI, but I had to be called back in for liver tests.

caroladybelle, BSN, RN · Feb 23, 2007

Second case:

Seven surgical patients, all of whom were operated on during a period of ten days, came down with the same resistant infection. One surgeon was involved as primary or assisting in all of them. All staff that handled the patients were tested for MRSA and were negative. Said surgeon refused testing, lost his privileges at the facility and moved to another state. CDC again was involved. The patients all survived. While some did have some risk factors due to poor compliance with post op care restrictions, the cases did stop after the surgeon left. I do not know whether the PTB got him to be eventially tested or stop operating.

caliotter3 · Feb 23, 2007

You would have to fill in a lot on this scenario:

Vent dependent adult male pt who lives at home. Utilizes "in line" suction catheters that he prefers over the regular suction catheters. Insurance payor (medicaid) refuses to pay for "in line" type of catheter, so pt pays for them out of his own pocket. The catheters are expensive, so he refuses to allow the caregivers to change them any more often than once every 2 weeks. He will stretch the use to 3 weeks if possible. Through use, the plastic sleeve often becomes separated. He insists that caregiver "repair" the sleeve with surgical tape. At least one of his family caregivers frequently touches the catheter without handwashing. Pt has been hosp for pneumonia.

You can add to or take away from this scenario.

TazziRN, RN · Feb 23, 2007

Thank you so much, everyone!