Survey Time

ktwlpn, LPN · Nov 2, 2003

Originally posted by michelle126
We just had our annual state survey and although I wasn't part of it I heard "We did well! They said the best for a long time" When I heard this, I almost spit my coffee out and almost said outloud to the DON who are we paying off, because they weren't looking at the same place I work.

Ever have this happen? Not that its not a good thing to have a good survey, but I really wander who and what they were looking at. Just doing initial walk thru they could have found quiet a few infection control issues! I guess I just thought that maybe if the state would come in and find the same problems that I've been dealing with they would have to correct them.

Sorry I just had to rant...

It seems as though they focus on a different area every time they come visit us-and have blinders on to any other issues..The whole process needs to be a bit more subjective.Each inspector seems to have their own set of values.What are your infection control issues? Are you having a high number of infections in your residents? Your equipment and p and p? We have had our problems,too-we had our first case of Norwegian scabies diagnosed 2 years ago( still living and still being treated every 10 days) and what a mess we had.Several staff members called the board of health anonymously which certainly was their right but they still want to blame the recurrent problem on that unit on anyone they can..Someone MUST be doing something wrong..the nurses..the dermatologist,the i.d. consulting physician..the nursing staff-the DON...we all must be idiots...It's a locked dementia unit-the state came in and saw aides walking the hall in protective gear and gloves-going from room to room in the same iso gown and had a sh*t fit...We were able to show how we had tried to educate these people over and over so we did not get cited in this instance.The resident is now bed-ridden so it is less of a problem but she was ambulatory when first diagnosed and what a balls up it was. The state limited our ability to isolate her...As a consequence scabies blew through the unit a few times.It was a freaking nightmare.It always seemed as though the positve scrapings came back late on Friday afternoons-after central supply had left...It was such fun to gather together the equipment we needed....

deadend · Nov 30, 2003

ktwlpn

I know exactly how you feel in my scenerio; The DON got fired and guess who was left holding the bag as acting DON? Me.

Our patient stayed on isolation for 2 months finally he is cured staff came down with the scabies including me. The house MDs came to the floor one day and said, "All the pts are saying, I itch"

The state came in but had no findings. We too were blamed by the staff saying that we were not doing enough to contian the scabies. We did education up the whazoo but for some reason the laundry staff kept complaining and probably reported us. It was the scariest time of my life, thank God we survived. By the way the previous DON was let go because she was trying to give the staff over the counter NIX when they developed the rash/itch.

I am curious as to what was the states problem with isolating this pt? Our surveyor told us "because you protected the other residents and **** has been isolated we have no findings"How else are you going to contain this mess. We are due for our annual survey and I am wondering if they will revisit this issue all the charts have tx orders for Elmite. They will not be able to miss this. What should we be doing to prevent reoccurences/prepare for them to revisit this issue?

Your experience/reply will be greatly appreciated

ktwlpn, LPN · Nov 30, 2003

Originally posted by deadend
. By the way the previous DON was let go because she was trying to give the staff over the counter NIX when they developed the rash/itch.
I am curious as to what was the states problem with isolating this pt? Our surveyor told us "because you protected the other residents and **** has been isolated we have no findings"How else are you going to contain this mess. We are due for our annual survey and I am wondering if they will revisit this issue all the charts have tx orders for Elmite. They will not be able to miss this. What should we be doing to prevent reoccurences/prepare for them to revisit this issue?
Your experience/reply will be greatly appreciated

One of our biggest roadblocks was the DON and ADON-every time rashes would re-occur they would start with the denial....."It's the soap" "It's the heat"" It's some family member"blah blah blah-as we documented rashes spreading from room to room...And with the high rate of false negative scrapings we had a wildfire on our hands every time...And since it is a dementia unit we had problems with residents crawling in and out of each other's beds and rummaging through each other's clothing.And treating them thoroughly with any topical was a joke-a rodeo...The first time it was done the 3 to 11 staff did it and did not pay any attention to hands and nails...Major treatment failure that time-THANKS to the DON and ADON-they are out of there by 4pm no matter what so no-one was on the unit to manage the process...When our Norwegian gal was still ambulatory we were not permitted to isolate her in her room physically.I suggested a plexi-glass door...no go....We had a series of failed attemopts with things like duct tape and velcro and never could keep other residents out of that room....The shame of it was she was adfmitted with scabies-and had been treated several tim es.The family did not disclose this info.Our admissions dept are social workers and they know nothing about assessing a prospective patient...This could have been avoided if a nurse had looked at this lady.....Alot of folks suffered because of this....I am not on that unit any longer-thank goodness.I know that if a rash pops up they jump on it fast and a positive scraping gets reported to the board of health by phone right away....

jornac · Dec 3, 2003

I have had this very experience. It was 4 or 5 years ago by now. I will always remember it as my "Worst Infection Control Nightmare!!"

We developed a strange rash with itch. As Infection Control Nurse (at that time), I contacted our County Health Officer to discuss what he thought I should do. His recommendation was to have various physicians look at the rash that their residents had to see what they felt it was. Out of 6 physicians I had 1 that initially thought that it was the Scabies.

A couple of them did punctures for evaluation. In the mean time, while waiting for the results, I contacted my Infection Control Physician, administration, and the Consulting Physician for the facility (One of the docs that didn't think it was scabies). We decided to contact the state epidemologist.

The State Epidemologist set up an appointment with me for Sunday evening when he was going through town on his way to a Monday meeting. This physician was wonderful!!!

He took at look at three residents in various stages of the disease process and informed me that we had scabies (by this time we had 55 of our 75 residents symptomatic). His recommendation was to treat ALL 75 of our residents, all direct care staff, and all of the facility day care staff and children AT THE SAME TIME.

What we learned was that Scabies are spread by direct contact. The Isolation gowns we were using were of NO HELP. It seems that the litter bugger actually burrows under the skin in a matter of 2 to 3 seconds after contact. Our employees were being infected every time they helped a person treanfer, reposition, etc. and then carrying the scabies to the other residents in the facility.

Our consulting physician wrote the order to cover every one that needed treated, we ordered the medication, and set up our schedule for treatment.

The day before the treatment was to begin, the evening and night staff were sent home with treatment. The day shift staff were to come to work untreated. We treated every resident in our facility during the morning. Stripped every bed, sent all clothing to the laundry, housekeepers did terminal-type cleaning of every room including removing the divider curtains and window dressings which were sent to be laundered and shampooed all of the hallway carpeting.

When the evening shift reported to work - already treated and they had the distinct honor of showering every resident in the facility (all 75) to remove the lotion that had been applied.

From that time on, al staff had to have been treated (symptomatic or not) prior to reporting to work. We treated Nursing, activities, social services, housekeeping, , laundry and day care personel as well as all of the children in the day care and some of their families, at the expense of the facility. Cost of treatment exceeded $3,000.

We had about 15 residents that needed a second treatment and 2 that needed a third.

We have not seen scabies in the facility since that time!!! Thank God!

I no longer serve as the IC Nurse which I requested to give up due to my MDS and management work load. But, even this long after the epidemic, I still get questions about rashes that develop as to whether or not they are scabies. Our long term resident and employee population still has not forgotten. I have finally quit having dreams about epidemic outbreaks.

I am sharing this information with you so that you know that this mite can be erradecated and life can return to normal (whatever that is) in the facility.

Please try to see what you can do to eliminate this problem from your facility. It can be done!!!I can be done!!!

My good wishes and prayers are with you.