"Well it doesn't matter, they're already on abx anyway"

[sapphire18]

I was reading another thread where a nurse was less-than-worried about preventing infection in a wound because the patient was already on antibiotics. The OP rightly corrected this line of thinking in her post by saying that not every bacteria responds to every different antibiotic.

...Right?!?

In reading this, I was reminded of a similar situation that I observed at my job a couple of months ago. A patient was not putting out any urine, when he had previously been putting out an adequate amount. It was a sudden change. The RN for the patient tried flushing the foley/irrigating, advancing the catheter, changing the patient's position, changing the level of the foley bag, nothing was working. She proceeds to deflate the balloon and pull the catheter a couple of centimenters out, then advance it again. No go. This continues on until the catheter is COMPLETELY OUT of the patient, and she proceeds to reinsert the same catheter, with the same clean (not sterile) gloves that she had been wearing during this entire process. I mentioned something hoping that we didn't give the patient a UTI, and her response was "Oh, he already has one, he's on antibiotics, he'll be fine." Really?!?

I've encountered several other situations like this at my current job, such as nurses not scrubbing the hub before giving IV meds, opening up the closed *sterile* suctioning system we have for our vents, and the list goes on. Certain people seem to be ok with the fact that "well, they're already on antibiotics, they'll be fine." I just don't get this. Maybe someone can offer some insight that I'm missing??

[leslie :-D]

i do agree the abx pt is taking, may not cover the different set of bacteria being introduced.

esp in healthcare, where the facilities are swarming in all types of contaminated areas, we always should be practicing as clean as possible.

just continue doing your personal and professional best sapphire.

really, that's all you can do. (and you're doing good.) :)

leslie

[caliotter3]

I had this very same attitude put out there by a doctor with a statement like 'the antibiotic he is on will take care of it', when I reported signs of infection. Signs of infection occurring in spite of the antibiotic therapy. And mom was there at the appointment listening to all of this. She was quick to tell me, "He's the doctor" when denigrating my concerns after the visit. I knew that no amount of education was going to change her mindset of "He's the doctor, you're not".

[MN-Nurse, ASN, RN]

Just doesn't strike me as best practice.

[sauconyrunner]

What you are missing is nothing. This is inappropriate practice. If that were your aunt, would you allow it? We are all "busy" and think we don't have time to do the basics-like hub scrubbing, and hand washing. Because there are not immediate repercussions that are notable for forgetting to do these things- we do them and assume that all is well. ie: if patients saturation dropped to 72% each time we forgot to wash hands, we would have 100% compliance.

Just last week, an RN in the ICU about our last CLaBSI- I said, yes it was Mr. Y.. She said, "Oh thats not our fault, he was too weak to fight the germ" I had to remind her that there was NO reason for that germ to have been introduced to his blood stream...except for a problem with hub scrubbing or handwashing. (It was a rather rare germ, and beautifully shared by his next door neighbour, coincidence, I think not!!!)

If we could see germs, like we can see lice or maggots, our patients would do better. You might want to talk to the infection Preventionists at your hospital, if there is something you see all the time, they can do some point to point education.

[kakamegamama]

I agree with Leslie....hang in there, do no harm, and keep up the good work

[Creamsoda, ASN, RN]

I think they they just dont "get" it. Do they not realize that despite being on ABX, the way they are treating these patients they could be introducing DIFFERENT bacteria into their system? People are idiots and these practices really make me angry. These are the same nurses who probably have poor hand hygeine so are spreading all sorts of crap to their patients. We all know MDRO's are on the rise. i even heard of a new resistant ghonorhea straing

Untreatable gonorrhea spreading worldwide - Health - Health care - msnbc.com

I went to a recent inservice provided by our pharmacy and it was really interesting. From the invention of antibiotics you can see the timeline from when each one was discovered, and within a few short years you also see when the resistances start popping up. I think Vancomycin took the longest, but that will change. And in the last few years there have been fewer new antibiotics discovered then when they were first discovered. Theres no money in it so the government is trying to encourage it by providing grants ect so the pharmaceutical companies start researching into alternatives. Why focus on trying to find drugs to treat a short term problem when they can focus on the drugs that our patients ned to take every day?

So do your patients a service and provide good care to them and guide your coworkers to do the same. Antibiotics are not something to be taken lightly. They can do some serious harm to your organs.

[Bec7074]

Well thank goodness none of these people are infectious disease docs. You'd think they'd realize there's a reason we culture and do sensitivity tests. That line of thinking is what can lead to multi-drug resistent infections. Let's just keep adding antibiotics for all the new infections we are giving our patients...until one day we give our patients a bug they can't beat, or are resistent too.

I'm shocked and appauled at this practice. How hard is it to get a new foley and insert it using sterile technique? Sounds like your facility (and maybe many more) need an inservice on this!

[tokmom, BSN, RN]

Have them tell that to Infection Control. They will be missing something....their heads once IC hears what they are doing.

[iluvivt, BSN, RN]

Well this sloppy and lazy practice is just pure ignorance and you are right in questioning it. I generally will take nurses aside and make it a bit more personal if I think they are just taking and unacceptable shortcut " Would you like it if we did that to you or a loved one". if it is just lack of knowledge I am happy to refer them to a reference and the nursing policy. Remember that Medicare will no longer pay for a central line associated blood stream infection if it was NOT present on admission. Now that is tied to reimbursement there has been great strides in reducing these types of infections. Rememeber that generally if you have a confirmed CLABSI early in the life of the catheter (usually less than 7 days) it is usually insertion related..after that it's generally all nursing care. So if cap and hub scrubbing is not done and dressing changed on time and when loose wet,or soiled ..yes your infection rate will go up and they are not cheap to treat.

[Pets to People]

But didn't you know this is "real world nursing", not all that fancy stuff that teach you at school (jokingly sarcastic) :rotfl: Soooo tired of hearing that real work nursing bologne.

[interleukin]

Check it, flush it, then get a bladder scan...if there ain't no urine, you ain't gonna get none.

Stop messin' with it.