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  1. I'm a senior nursing student and this debate arose with a couple of my classmates and me. I work as an ER tech and they work as patient care techs on the floor. As of right now, CDC guidelines state for PPE: So basically CDC is saying wear an N95 if you have it, but if you don't, wear a surgical mask until you can get an N95. So if you have a suspected or confirmed COVID-19 patient, and all you have is a surgical mask and no N95, can you refuse to take care of that patient? Do you face any legal repercussions or potential fallout from your employer if you do refuse? Asking not only about tech positions, but RN positions as well.
  2. One individual's personal experience as a journalist on a coronavirus reporting team ... Read the article in its entirety: I Lived Through SARS and Reported on Ebola. These Are the Questions We Should Be Asking About Coronavirus
  3. On Tuesday, February 25th, the Center for Disease Control (CDC) held a telebriefing to update the media on the agency’s response to COVID-19.  Federal health officials are implementing preparedness and response plans, as more cases are expected in the U.S. Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases emphasized U.S. community spread is expected. Locations of Virus Detection The coronavirus was first detected in Wuhan City, Hubei Province, China.  Now named “coronavirus disease 2019 (COVID-19)”, the virus has been detected in 37 locations internationally, including cases in the U.S.  A U.S. soldier has been diagnosed while stationed in South Korea, where more than 1,140 cases have been detected. Update On U.S. Cases As of February 25th, there have been 14 COVID-19 confirmed cases in the following states: Arizona (1) California (8) Illinois (2 cases) Massachusetts (1) Washington (1) Winsconsin (1) Of the 14 cases, twelve were related to travel to China and two through close contact with a diagnosed individual.  Repatriated Cases There has been an additional 3 cases reported among U.S. citizens, residents and their families returning from Hubei province, China and 36 from the Diamond Princess Cruise ship docked in Yokohama, Japan. To date, there have been no reported deaths from COVID-19 in the U.S. CDC Public Health Response A total of 1,336 CDC staff members have been working with state, local, tribal and territorial health departments to assist with case identification, evaluation and medical management.  In addition, the CDC is collaborating with academic partners to understand the virus characteristics, such as risk for transmission. CDC multidisciplinary teams include: Physicians Nurses Pharmacists Epidemiologists Veterinarians Laboratorians Communicators Data scientist and modelers Coordination staff Containment and Mitigation According to Dr. Messonnier, the CDC will work to prevent the spread of the virus, while also implementing strategies to soften community impact. Currently, there’s no vaccination available to prevent COVID-19 and no targeted medications to treat.  Therefore, nonpharmacological interventions (NPIs) will be used within communities. NPI categories addressed will include: Personal - daily personal protective measures Community - social distancing to keep those sick/diagnosed away from others Environmental - surface cleaning measures Dr. Messonnier reports CDC has been successful in slowing the spread of COVID-19 in the U.S., as well as, allowing more time for the country to prepare. She also warned as more countries experience community spread, it will be harder to successfully contain U.S. borders. Risk Assessment According to the CDC, COVID-19 poses a high potential public health threat in both the U.S. and globally. But, individual risk of contracting the virus depends on exposure. This immediate health risk from COVID-19 for the general U.S. public, who are unlikely to be exposed to the virus at this time, is considered low. Individuals who care for patients with COVID-19, such as healthcare workers, will have an increased risk of infection. If the virus reaches pandemic levels, the risk assessment would likely change. Listen To The Full Briefing Listen to the full February 25th CDC telebriefing here. Follow updates at CDC’s COVID-19 U.S. Situational Summary Let Us Hear From You What is your employer and/or community doing to prepare for COVID-19? References CDC’s COVID-19 informational website
  4. The sprays, wipes and liquids nurses frequently use to prevent infection could be harmful to lung health. A new study, published in JAMA Network Open found workplace exposure to cleaning chemicals significantly increases the risk in COPD among nurses. In the study, researchers used data from an on-going study of more than 116,000 registered female nurses, in 14 states, dating back to 1989. The study focused on women who were still nurses and without lung disease in 2009. The nurses completed questionnaires every other year to track work history and lung health from 2009 to 2015. Occupational Exposures and COPD COPD is not only the third leading cause of death worldwide, but a chronic condition that often can lead to long term disability. Cigarette smoking remains the major risk factor for COPD in the U.S. However, data suggests that 15% to 20% of cases are caused by occupational exposures. Workplace exposures can also contribute to the disease burden of someone with COPD. In the past, studies on occupational exposure and COPD have investigated broad categories of causal agents, such as vapors, dust, gases or fumes and only on a limited number of occupational settings. Significant Increase in Risk According to the study findings, nurses were between 25% and 36% more likely to develop COPD based on exposure to certain cleaning products. The percentages reported in the study were determined after accounting for whether the nurses were smokers or suffered from asthma. Researchers found weekly use of disinfectants to clean hospital surfaces increased COPD risk by 38%, while weekly use of chemical to clean medical instruments increased the risk by 31%. Women at Risk Although gender roles have changed over the past few decades, exposure to cleaning products at home and at work are more common in women. The majority of nurses are female, with males being only 13% of the nursing workforce. A 2014 survey by the US Bureau of Labor and Statistics found that women perform 55-70% of household cleaning, which is about 30% more than men. In the healthcare industry, exposure levels to cleaning products and disinfectants are particularly high. Irritation Causing Chemicals Orianne Dumas, lead study author and researcher with Inserm, states, “We found that exposure to several chemicals were associated with increased risk of developing COPD among nurses.” Glutaraldehyde and hydrogen peroxide, used to disinfect medical instruments were among the chemicals identified by Dumas. Glutaraldehyde exposure can cause throat, nasal and lung irritation, asthma and difficulty breathing, skin irritation, wheezing, burning eyes and conjunctivitis. Nurses were also regularly exposed to fumes from bleach, alcohol and quaternary ammonium compounds, which are used to clean surfaces and floors. All these chemicals are known to cause lung irritation and could lead to the development of COPD. However, Dumas states researchers only found an association in the study, not a cause-and-effect relationship. More Research Needed The study authors found further study is needed to determine how these cleaning products might cause COPD, and if they increase the risk of lung disease for workers in other professions. Findings also suggest the need for further research to determine exposure-reduction strategies that provide adequate infection control for healthcare settings. What Are the Alternatives? Hospitals could continue to protect nurses’ and patients’ health by using safer alternatives, such as ultraviolet light or steam for disinfecting equipment and surfaces. Another option is for hospitals to switch to “green” cleaning products that don’t emit harmful fumes. The key is finding a balance between safeguarding the health of nurses while maintaining the needed level of infection control. Additional Resources CDC Fact Sheet- Glutaraldehyde Cleaning Chemicals: Know the Risks
  5. Okay, so maybe it’s not time to toss out your N-95. However, a recent update from the Centers for Disease Control and Prevention and the National Tuberculosis Controllers Association shows an overall decline of TB cases. The organizations also report that TB cases following occupational exposure have dropped, too. This new information has created a few updated recommendations All healthcare personnel should get a baseline TB risk assessment, screening for symptoms, and TB skin or blood test upon hire Annual testing is not recommended for healthcare personnel unless there is a known exposure or ongoing transmission in your facility Personnel with an untreated latent TB infection should be screened each year for symptoms and treatment is highly-encouraged All staff should receive yearly TB education, which includes information about risk factors, TB infection control policies and procedures, and a list of signs and symptoms Personnel with a positive TB skin or blood test should be evaluated for symptoms and have a chest x-ray performed to rule out the disease Understanding Your Risk Tuberculosis is an infectious disease that mainly affects your lungs. TB is spread through tiny droplets that are released into the air following sneezing and coughing. Once it’s in the air, the droplets can be breathed in by others, and they can become infected. The disease was once thought to be rare in developed countries. However with the increase of HIV, it gained momentum in the mid-1980s. The disease is difficult to treat because many drugs have become resistant. Treatment can take several months, and the patient will need to be separated from others until they are no longer actively contagious. Symptoms Active TB creates severed illness. It can make you sick shortly after you contract the condition, or it can make you sick years later. The main signs and symptoms include: Coughing up blood Persistent cough (lasting three or more weeks) Chest pain Fatigue Unintentional weight loss Fever Night sweats Loss of appetite Chills TB can also remain in your body in an inactive or latent state. This means that you have the bacteria in your body. However, the disease doesn't make you ill. Latent TB can become active, so it’s important for people who have latent TB to receive treatment to decrease the spread of the illness. What Are The High-Risk Populations? You may be at an increased risk of contracting TB if you work with high-risk populations. Here are a few populations you need to consider: Patients with Weakened Immune Systems Your immune system helps to keep you safe from TB and other infections. If you have a weakened immune system, you may be at an increased risk of contracting the condition. Pediatric or geriatric populations A few diseases that can put you and your patients at a higher risk include: HIV/AIDS Malnutrition Diabetes Severe kidney disease Drugs used to treat RA, Psoriasis, or Crohn’s Chemotherapy drugs Certain cancers Drugs used to prevent rejection of transplanted organs Traveling to Foreign Areas TB runs rampant in some under-developed areas. If you or your patient has been to one of these areas, you may need to consider the possibility of TB: Latin America Russia Africa Asia Caribbean Islands Other Populations There are a few situations that can also place patients at an increased risk of contracting TB. Those individuals with poor overall health and medical care, those with substance abuse issues or those who use tobacco are more vulnerable to TB.
  6. Flu vaccine education, consents and declinations..... Oh My! The 2018-2019 flu season is upon us and flu vaccination campaigns have been launched across the United States. The Center for Disease Control (CDC) recommends receiving the flu vaccine prior to the end of October. However, flu activity commonly peaks in December and January and later vaccination is still beneficial. As the most trusted health professionals, nurses play a critical role in preventing and treating influenza within their communities. Research indicates adults are more likely to consent to vaccination if it is recommended by healthcare providers. This article will explore what you need to know to make a strong recommendation and a strategy for implementing in your practice. Knowing the facts about the impact of influenza is a crucial part of preparing for the new flu season. According to the Center for Disease Control (CDC), the 2017-2018 flu season resulted in 80,000 U.S. deaths, a record high for the last decade. During the 2017-2018 flu season, deaths related to pneumonia and influenza were numbered above epidemic levels for 16 consecutive weeks. In addition, 183 pediatric flu deaths were reported and 80% of those deaths did not receive the flu vaccine. There are steps healthcare providers can take to lay the groundwork for making a strong recommendation for vaccination. The goal of a strong recommendation is providing clear and accurate information so individuals can make an informed decision Be Aware of Your Own Attitudes Are you own attitudes toward flu vaccination preventing you from providing your patients with a strong recommendation? Being aware of common reasons the flu vaccination is declined will prepare you to make recommendations based on facts and not personal biases. Common excuses include: "I'm not sick and don't need the shot" Fact- The flu is a contagious illness that can lead to serious complications and the vaccine helps to protect you from flu. "I can get the flu by the vaccine." Fact- The vaccine will not give you the flu, but you can still catch non-flu viruses. Since the vaccine takes 2 weeks to take effect, you can still get the flu during this time. "I'll wait until the flu breaks out in my area" Fact- it is risky to try to time your vaccine with a flu outbreak in your area. Remember- you need at least 2 weeks after vaccination to be protected. "I had the flu shot last year" Fact- the vaccine is updated for each flu season so you will be protected against the circulating strains. To be prepared to respond to these excuses, refer to the CDC's handout, No More Excuses: You Need a Flu Shot.Use S.H.A.R.E. to Make a Strong RecommendationThe CDC recommends using the S.H.A.R.E. method to help you educate patients and make a strong vaccination recommendation. S-Share patient specific reasons why the flu vaccination is recommended based on age, health status and risk factors. Vaccination is recommended for anyone 6 months of age and older with rare exception (i.e. life-threatening allergy, history of Guillain-Barre' Syndrome). Be familiar with populations that are at higher risk for potentially serious flu complications. If you need a refresher visit the CDC resource People at High Risk for Developing Flu-Related Complications. H-Highlight the benefits of vaccination. Try sharing positive experiences with the vaccine to boost confidence. Try sharing your own personal experience or a positive patient outcome as a result of vaccination. A-Address patient questions or concerns about the flu vaccine. Common questions often include side effects, safety and effectiveness. Information should be appropriate for the patient's health literacy level and easy to understand. R-Remind patients of the role the vaccination plays in protecting them and those close to them from flu and flu-related complications. If the patient initially declined vaccination, it is important to remind them of the health benefits. E-Explain the potential consequences of getting the flu, such as serious complications, missed work or school and financial burden. Sinus infections are an example of moderate flu complications and more serious complications include pneumonia, inflammation of the heart, brain or muscle and multi-organ failure. It is important for healthcare providers to continue making a strong recommendation for flu vaccination beyond the initial campaign push. The CDC recommends vaccination as long as influenza viruses are still circulating- often continuing into January. Many individuals know the importance of vaccination, but need a reminder beyond the month of October. What can you do to continuing making a strong recommendation for vaccination beyond the campaign blitz? For additional information, explore the CDC's Influenza (Flu) Site. You will find resources for facts, resources for healthcare workers and educational materials.
  7. MassED

    2013 Superbug

    While I should be studying for my upcoming CEN test date, with coffee in hand, I decide to wander the "science" headlines, as I am apt to do on a warm and sunny Sunday morning. I pay attention to these headlines, as being on the front line in an emergency room; these concerns can become a reality and we need to be prepared for when they make an appearance on our doorstep. This type of headline, "Superbug," has me perusing in that vein into other outbreaks of the same nature. We have all read of Norovirus outbreaks on cruise ships, nursing homes, daycare facilities, and restaurants. I suppose we can all avoid salad bars and oysters, but is that realistic? How long would we have to modify our diets and lives? I come across an eye catching headline of "superbug" on ABC news. It appears more as "SUPERBUG" to my paranoid eye. The Centers for Disease Control is concerned about a new strain of Norovirus, originally found in Australia in 2011, that will strike the United States. Noroviruses are the leading cause of epidemic gastroenteritis, including foodborne outbreaks, in the United States. Most infections were reported by long term care facilities and restaurants. 20% of these infections are foodborne where 28% are unknown transmission routes. Exactly what are these "unknown" transmissions leads my brain down a rabbit hole that I do not have the energy (or stomach) to investigate (Barclay). This new superbug is a type of Norovirus. Norovirus is a genus of genetically diverse single-stranded RNA, non-enveloped viruses in the Caliciviridae family. Normally with 21 million people affected annually from Norovirus, 800 people die. That is not a troublesome fatality rate compared to trauma or car accidents. What catches my eye about this strain of this virus is the virulence. Due to the lack of immunity to this strain, it is expected that 50% more Americans are going to be affected by this strain. The Norovirus is far more contagious than Influenza. Influenza is airborne via cough and sneezing and has 1000 different particles that can attach to a person. This Norovirus only has 18 particles that can make a person sick. That is scary and amazing (Besser). That should strike some degree of fear in all the hearts of all medical personnel. We all use "gel in, gel out" hand sanitizers at work, but reading about this new virus, it will not be eliminated by this gel; this brings about a whole new approach to cleanliness and hand washing not just in the workplace, but in our community. The flu virus lives on surfaces for a few hours outside of the body, but this new Norovirus can survive and remain infectious for weeks! My stomach just dropped. Not only do we have to be concerned for the patient influx with this new virus, we have to worry about each other and protecting ourselves from becoming statistics. Bleaching of surfaces, as well as soap and water hand washing remains to be the treatment of choice for this type of virus, but I have to wonder about the potential for pandemic. How will your local Wal-Mart and supermarket sanitize their carts? There is a vaccine in the finishing stages by Japanese company Takeda Pharmaceuticals, to combat the Norovirus that would provide lifelong protection for 95% of recipients (Bloomberg). That sounds pretty fantastic. Until that time comes, what are your thoughts? How will your facility handle an outbreak? Where I work we have only 4 isolation rooms. One of the methods to control the outbreak is to isolate ill persons. That would be a near impossibility in my facility. How else could this be controlled? work-cited.txt
  8. Julie Reyes

    Tuberculosis (TB) - The Unseen Villain

    TB - what is it? Mycobacterium tuberculosis (M. tuberculosis - or TB) is an airborne disease carried in airborne particles (droplet nuclei 1-5 microns in diameter). Inhalation of the TB droplet can develop into the lungs - in most cases - but can affect any part of the body. Infection in the lungs is called pulmonary infection, and outside of the lungs is called extrapulmonary infections. Extrapulmonary tuberculosis can be found any other organ systems such as the kidneys, heart, or brain - as well as in joints or in bones. Types of TB Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection and TB disease. Latent TB (LTB) means a person does have TB in their body but does not have TB disease and cannot spread the disease to other people. If a person is healthy or not immunocompromised, their immune system may be able to stop the TB from multiplying and prevent progression of the disease. If left untreated, LTB can turn into TB disease. TB Disease (TBD) happens when the body is unable to halt the disease progression. The person may progress from LTB to TBD immediately after exposure to many years after exposure. TB - what are the signs and symptoms? a bad cough that lasts 3 weeks or longer pain in the chest coughing up blood or sputum weakness or fatigue weight loss no appetite chills fever sweating at night You may also see a signs/symptoms of synovitis, pericarditis, meningitis, cervical lymphadenitis, pleuritis, or infections of the bones, joints and/or skin (such as an abscess). TB - how is it spread? Droplets can "float" in the air almost indefinitely due to its small size and virtual weightlessness, and can be carried on normal air currents (Biological Controls, 2015). Droplets not only can come from an infected person's cough, but can also come from an infected abscess when opened and the particles become airborne, for example. This may seem like a no-brainer, but the closer the proximity a person is to an infected TB patient, the more droplet nuclei in the air, the more exposure a person has, and the longer duration of exposure will increase the risk for transmission. TB Incubation Period A person who is suspected of coming into contact with TB should be tested. The recommended testing period is 8-10 weeks after exposure - after the incubation period. It can take 2-8 weeks for a person to test positive for TB with a skin test or IGRA. TB programs - What is your facility doing to protect you? TB mask fitting OSHA requires healthcare facilities to provide mask fit testing annually for healthcare workers who may come into contact with TB. This includes (but is not limited to) nurses, therapists, environmental services, clergy, lab employees, maintenance workers, and doctors. Your facility will fit test you to a NIOSH mask that will provide you protection from inhaling in the tiny TB droplets than can pass through regular face masks. There are several types of masks that are available and approved by OSHA. The mask must make a tight seal over the nose and mouth and under the jaw to provide protection. People with facial hair will not be able to get a tight seal and a NIOSH mask will not be effective for them. Additionally, OSHA requires a yearly questionnaire to be completed and kept on record every year as well. Unfortunately, this questionnaire must record the weight of the employee. WHY? The employee should be fit tested again if there is a 5% change in body weight as this can change the facial features and the mask that once fit may no longer be adequate. Other reasons to have a fit testing redone include reconstructive facial surgery or dental work affecting facial features. TB testing There are a few different tests that are available to test for TB. Many healthcare facilities continue to use a TB skin test (TST). While the CDC approves of this method, there are other tests available which are more accurate and can eliminate false negatives or false positives. Interferon-gamma release assay's (IGRA) are an example of this type of test (you may have heard of QFT or Tspot). This is a simple blood test that does not require fasting. A chest x-ray may be ordered to look for cavitations in the lungs. TB exposure at work - what to do? An exposure at work would be followed closely by the Occupational Health and Infectious Disease departments. Occupational Health will have the responsibility of tracking down and informing all employees who have been or may have been involved in an exposure and guide them on the exposure process. This will include a TST or IGRA in 8-10 weeks after the exposure, providing signs/symptom information, and referring any positive results to the health department or to the employee's primary care provider. Resources CDC Tuberculosis (TB) Data and Statistics CDC | TB | Fact Sheets - Tuberculosis: General Information Biological Controls Inc. Transmission and Pathogenesis of Tuberculosis (PDF) CDC | TB | TB Education and Training Resources
  9. Brenda F. Johnson

    There Is A New Fungus Among Us: Candida Auris

    What Is Candida Auris? The Auris part of the name for Candida Auris refers to the ear because this fungus is found in the ear. Although it is found in the ear, it is also detected in many other parts of the body such as the bloodstream and wound infections causing invasive and deadly infections according to the CDC. Any type of candida can kill but it is not yet determined whether Candida auris is more deadly than other strains. The CDC does know that 60% of patients with C. auris pass away, however, they all have had serious other medical problems that contributed to their death. C. auris has been found in the bloodstream, ear infections, and wound infections. Even though it has been found in the bladder or lungs, the CDC is not sure if it caused the infections. Because C. auris can easily be confused with other yeasts such as Candida haemulonii, or Saccharomyces cerevisiae, molecular methods are needed to test body fluids to detect it specifically. Hospitals in several countries have reported hospitalized patients that have illnesses related to C. auris. There are many strains of C. auris including one that is resistant to all three major classes of antifungal drugs the CDC tells us. They also warn healthcare facilities that it is not easy to identify. As with other unusual and communicable disease, it needs to be reported to the CDC at candidaauris@cdc.gov. Who Is At Risk For C. Auris? Information collected on patients who have contracted C. auris reveals that they are hospitalized, and often have cancer or other serious illness. All of them have reduced immune systems and are less able to fight infections. Because of this, it is not clear that the fungus killed them, just that they had C. auris in their bodies. One patient in Illinois, was a paraplegic who had an infected catheter. Even after treatment, he still remained infected. In other states such as New York, Maryland, and New Jersey have reported to the CDC four patient deaths. Again, it is ambiguous C. auris' role in the patients deaths due to the fact that the patients were already very sick: one had a brain tumor, one had respiratory failure, two had blood cancers. We can see that those with not a lot of reserve are attacked by C. auris. Across the globe, healthcare facilities have disclosed that several patients have contracted C. auris through the bloodstream. These infections are challenging to treat because they don't respond to the usual antifungal medications. Those that are in the most danger, according to the CDC, are ICU long term patients, or those with a central line. Also, those patients who have been previously treated with antibiotics and antifungal medications. Again we see that C. auris is no respecter of the ill, but attacks those most at risk. Not only are the extremely sick susceptible to C. auris, all ages from elderly to preterm babies are all in the fungus' eyesight. The CDC is quick to say that more studies are needed to determine specific risk factors. Stats for C. Auris In America and Elsewhere The first case of C. auris was diagnosed in Japan in 2009, but an early strain was collected in the year 1996 in South Korea. Countries who have cases of C. auris: South Korea, India, Pakistan, Canada, United States, Kuwait, South Africa, Japan, Venezuela, Colombia, Kenya, United Kingdom, and Israel. It has been found that with genome sequencing, the strains in regions contain the same DNA fingerprint, differing from those in other regions. "These differences suggest that C. auris has emerged independently in multiple regions at roughly the same time," reports the CDC. Dr. Tom Chiller who is head of the fungal disease area of the CDC is quoted as saying, "It appears that C. auris arrived in the United States only in the past few years." Number of cases as of December 13, 2016 Illinois - 2 May 2016, July 2016 Maryland - 1 April 2016 New Jersey - 1 July 2015 New York - 15 May 2013, April 2016, Aug. 2016(3), Sept. 2016(2), Oct 2016(3), Nov 2016(5) Treatment/Tests Available To Treat and Identify C. Auris C. auris is not easy to identify, and not all facilities have the equipment to do the tests. The two tests used to diagnose C. auris are; Matrix - assisted laser desorption/ionization time - of - flight analysis D1 - D2 region of the fungus' 28s ribosomal DNA It is resistant to many drugs, but usually responds to at least one antifungal medication. There are three main concerns of the CDC regarding C. auris Difficulty in identification, misidentification leads to wrong treatment. Has caused outbreaks in healthcare settings, rapid identification is vital. Often multidrug-resistant "Isolates from the two Illinois patients were nearly identical and were most closely related to isolates from South America," CDC. One patient's room was swabbed and C. auris was found on the mattress, bed rail, chair, window sill, and bedside table. Bleach did kill it, but the fact that it was all over the room is concerning. Recommendations of the CDC The need for action is now in order to stop the spread of C. auris and protect vulnerable patients. In the meantime, they recommend thorough cleaning of hospital rooms where the fungus is found. Also, giving the heads up to facilities that are receiving an infected patient. More study is need to track routes of contamination whether person to person or contaminated surfaces. While working with health agencies, labs, and hospitals, they ask for preventative action by following the guidelines found at Interim Recommendations to report cases because five of the seven cases were found in the U.S. Conclusion While we as nurses have little power over what our healthcare facilities put into action, being aware and educated on new issues is very important. The next time a patient has a fungal infection resistant to the medications being given, question the source. Ask the doctor to consider C. auris. Awareness brings education and better treatment. Have any of you had patients diagnosed with C. auris? Please share with us! References CDC. "Candida auris." 13 Dec. 2016. Center for Disease Control and Prevention. 17 Dec. 2016. Web. CDC. "Candida auris Questions and Answers." 4 Nov. 2016. Center for Disease Control and Prevention. 17 Nov. 2016. Web. Fox, Maggie. "New Killer Fungus Found in U.S. Patients." 4 Nov. 2016. NBCNews. 17 Nov. 2016. Web. Harris, Richard. "First Cases of New, Infectious Fungus Reported in U.S." 4 Nov. 2016. NPR. 17 Nov. 2016. Web.
  10. The infant was fretful and screaming after she gave him his injection. Since she did not bring the portable sharps container to the isolette, she quickly recapped the used syringe, and in her haste, she poked her finger with the needle. She grabbed some gauze and wrapped her finger before she bundled him up tightly to soothe his agitation. Born to an addicted mother, the baby was constantly irritable and had tremors - swaddling him seemed to comfort him some. The nurse, however, will not find comfort so easily. As a transport RN, he was doing his morning check off in the ambulance. He saw the sharps container needed to be changed out and when he went to grab the container, he was poked with a dirty sharps. Whoever put in the last syringe did not dispose of it properly and the needle was sticking out of the top. She was deaccessing a mediport without assistance from another coworker to help hold the child still. The child hit her hand and she stabbed herself with the needle. He was disposing of the biohazard waste. During a code, someone had thrown sharps into the biohazard bin. As the bin was emptied, a needle poked through the box and stabbed his hand. The surgeon dropped the sharps during handoff, slicing the first assistant's finger. An anesthesiologist left an ART line induction needle on the bed and an OR tech was stabbed by the needle while transferring the patient to the stretcher. The horror stories are miles long. The lives of those who are on the receiving end of a sharps injury are now at risk for life-threatening health problems. Hepatitis C, Hepatitis B, and HIV are a very real result of a sharps injury that could absolutely have been prevented. The CDC estimates an average between 600,000 to 800,000 needle sticks (NS) occur annually (roughly 1/2 of all NS injuries go unreported). The statistics for contracting an infection are also staggering: The CDC reports: 1 in 300 injuries from NS will result in HIV infection 5.4 in 300 will result in Hep C infection 69 - 186 out of 300 will result in Hep B infection Unfortunately, the numbers in these statistics will place nurses at a higher risk than other health care employees. Nurses are by far the highest risk group! Here are the collected stats for the highest risk groups from the CDC: Nurses (44%) Residents (10%) Physicians (9%) Housekeeping (5%) Students (2%) Sharps, NS injuries, and bloodborne exposures are all mandated reportable injuries to OSHA each year. Hospitals and clinics can be fined hundreds of thousands of dollars for violations for failing to protect staff for injuries related to sharps or needlesticks. In fact, did you know that OSHA has a Needlestick Safety and Prevention Act? This act (in summary) requires certain employers to: Have an exposure control plan that is reviewed and updated as needed to reflect changes in technology, etc., as well as document consideration and implementation of appropriate commercially available and effective safer medical devices; Maintain a sharps injury log that includes incident information (i.e., the type and brand of device used, where the injury occurred, and an explanation of the incident); and Encourage injured health care workers input on engineering and work practice controls Requires such modifications of the standard to: be in force until superseded by regulations promulgated by the Secretary of Labor under OSHA; and take effect without regard to specified procedural requirements. So, how can you make a difference at your job to decrease the incidence of bloodborne exposures, sharps and needlestick injuries? Let's start with the basics: Protect yourself, your coworkers, and your patients! Whenever possible, use sharps with safety features Wash your hands at least 15 seconds before and after you care for your patient Always wear gloves if blood or body fluids are present Use gowns and face and eye protection Always properly dispose of sharps in the proper container Additional resources and information: The CDC has created a Stop Sticks Campaign you might want to implement at your place of employment. The goal is to reduce sharps injuries and help organizations create a culture of safety. To find more information on this campaign that you can customize to the needs of your place of employment, visit CDC - Stop Sticks - NIOSH. Now, ask yourself ... As a nurse or student nurse, what are your thoughts on sharps safety? Were you aware of the statistics listed above? Were you aware of the infection risks from a sharps/NS injury? What have you seen at your place of employment that would be an example of a safety of culture or a lack of safety? What do you think would improve practice at your place of employment? Do you have any stories (good or bad) to share? Remember, this life you save may be your own! References Bloodborne pathogens. - 1910.1030 | Occupational Safety and Health Administration Summary of H.R. 5178 (16th): Needlestick Safety and Prevention Act - GovTrack.us CDC - Stop Sticks - NIOSH
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