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  1. caretakerofkids

    Tired of being "the bad guy"...

    I am tired of being the "bad guy" and I just want to keep our kids safe! Are the rest of you getting negative feedback from parents when you have to call to tell them their child needs to quarantine due to being a close contact of a positive student? A lot of the parents are great and understanding, but I have just as many lately that complain about how their child "is hardly ever around that kid" (the one that is positive) or that they have to work and this is hurting their job, and "this is just stupid! My child is fine! You all are over-reacting!" I have heard every excuse in the book as to why their child shouldn't have to quarantine, and I've been lied to and cursed at over this. I try to patiently explain that we are following Department of Health and CDC guidelines, and I am very sorry, but we have to follow those rules for everyone's safety. I would rather have a bunch of parents mad at me for "overreacting" than to not do enough and someone get critically sick with COVID! I am in a very small town and there is so much drama! My co-workers and I do our best in identifying close contacts. We interview teachers, students to the best of our ability (keeping the name of the positive COVID person out of it) and even watch the security camera videos to see what happened in certain situations in order to identify those close contacts. I've had parents try to talk us into letting their child return from quarantine early with a negative test, though we've been told by the health department that a negative test doesn't get a close contact out of quarantine! 10 days is our district's minimum quarantine for close contacts. I DO feel for the parents and I DO know it's taking a toll on everyone! I am sympathetic and I DO care, some days just take the wind out of my sails. I'm trying not to take it personally. I'm not the only one getting backlash - all of administration is! Here's hoping we can put this COVID mess behind us as soon as possible! Thank you for letting me vent!! I knew you all could probably understand my frustration!!
  2. 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
  3. 10/21/2020 CDC expands definition of who is a Covid-19 ‘close contact’ in contact tracing section to include multiple individual exposures within 24hr period totaling 15 min. Karen CDC: Close Contact definition
  4. As AN members wisely surmised due to virulence infection in many families. Wonder how many at SCOTUS nomination that came up positive also attended indoor reception?? Karen CNN 10/05/2020 New CDC guidance says COVID-19 can spread through air CDC Advice COVID-19 can sometimes be spread by airborne transmission
  5. JAMA 9/9/2020 JAMA: Clinical Outcomes in Young US Adults Hospitalized With COVID-19 Per CDC's latest figures. Covid-19 is increasing rapidly among young adults age 18-34 and highest among young adults ages 20 to 29. From June to August 2020 in the US, this age group accounted for more than 20 percent of all confirmed COVID cases. Findings published in this months JAMA Internal Medicine reveal how severely Covid-19 can affect young adults. The article found that among more than 3,200 adults ages 18 to 34 who were hospitalized with the disease, 21 percent required intensive care, 10 percent required mechanical ventilation and nearly 3 percent — 88 patients — died. Of those who survived, 3 percent — 99 patients — had to be discharged to another health care facility to continue their recoveries. Morbid obesity, hypertension, and diabetes were common and associated with greater risks of adverse event --same as in older adults. Younger adults likely contribute to community transmission of COVID-19. (no surprise) https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770542 CDC MMR 9/23/2020: Changing Age Distribution of the COVID-19 Pandemic — United States, May–August 2020 Gotta get periodic CDC MMR Reports broadcasted on Fox News to get President Trump to understand and accept COVID-19's serious effects on young adults; also stop the spread of COVID misinformation. Return to college life and sports not the answer to get the US Covid epidemic resolved.
  6. CDC reverses course on testing asymptomatic people for COVID-19, again Do you agree with the CDC's reversal?
  7. Joe V

    COVID-19: The War

    By now, every single solitary person on the face of the earth knows what is happening. Covid-19 is on the news hour after hour, day after day. We keep up with alerts constantly. We practice social-distancing. We work under adverse conditions, pleading and demanding adequate PPEs … and, we worry. One thing first and foremost on our minds is our family and friends. We strive to ensure that they are not infected. What about you as a Nurse? Other than the CDC recommendations, what additional precautions do you personally take to ensure your family members are safe?
  8. Well I sure hope my name is off of McKessons Flu vaccine delivery slip at prior employer.... got call last year at home I had delivery after I had changed positions and no longer responsible for vaccine distribution. Red Flags Flying.... The new letter says HHS and CDC “are rapidly making preparations to implement large-scale distribution of Covid-19 vaccines in the fall of 2020,” Karen SF Gate 9/3/20 CDC tells states: Be ready to distribute vaccines on Nov. 1 Forbes:
  9. 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
  10. 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.
  11. 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
  12. 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.
  13. 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 recommendationsAll healthcare personnel should get a baseline TB risk assessment, screening for symptoms, and TB skin or blood test upon hireAnnual testing is not recommended for healthcare personnel unless there is a known exposure or ongoing transmission in your facilityPersonnel with an untreated latent TB infection should be screened each year for symptoms and treatment is highly-encouragedAll 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 RiskTuberculosis 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. SymptomsActive 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 bloodPersistent cough (lasting three or more weeks)Chest painFatigueUnintentional weight lossFeverNight sweatsLoss of appetiteChillsTB 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 SystemsYour 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 populationsA few diseases that can put you and your patients at a higher risk include: HIV/AIDSMalnutritionDiabetesSevere kidney diseaseDrugs used to treat RA, Psoriasis, or Crohn’sChemotherapy drugsCertain cancersDrugs used to prevent rejection of transplanted organsTraveling to Foreign AreasTB 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 AmericaRussiaAfricaAsiaCaribbean IslandsOther PopulationsThere 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.
  14. 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
  15. Lane Therrell FNP, MSN, RN

    Avoiding Antibiotic Resistance: What to Tell Your Patients

    Antibiotic resistance is an ongoing problem in healthcare. Many of our institutional quality assurance and performance improvement measures are linked to infection control and different forms of reducing antibiotic resistance. And that's a great place to start. But I can't help thinking we can do more to prevent antibiotic resistance, especially when it comes to patient education. All too often, the things that seem obvious to us as nurses with all our specialized training, can seem like babble in a foreign language to a patient. We see this all the time if we're paying attention: The patient's eyes glaze over while we're talking to them. They nod knowingly, but the lesson gets lost in mid-air, and the desired outcome never materializes. A revealing 2018 study published in JAMA Internal Medicine analyzed thousands of telemedicine visits, to show that patients tend to consider their visits successful when they receive prescriptions for antibiotics, whether the medication is medically necessary or not. When you consider the power of patients' expectations paired with heavy institutional emphasis on patient satisfaction scores, prescribers have a strong disincentive for prescribing antibiotics appropriately. This study made me think about the difference between patient expectations and patient education. Do patients truly understand the problem of antibiotic resistance? My musings seem to be in line with the CDC's public education materials on antibiotic resistance prevention, which suggest that patients do not fully understand what antibiotic resistance is, or how they might be contributing to the problem by expecting, demanding, and taking antibiotics when they don't really need them. Note: The CDC's educational brochure, "Antibiotics Aren't Always the Answer" is free to download here. Targeted, specific, patient education helps patients and healthcare professionals partner together to reduce antibiotic resistance. Here are some thoughts for nurses at all levels on improving patient education about antibiotic resistance. Four Key Concepts Patients must understand at least four key concepts in order to understand antibiotic resistance. First, not all diseases are caused by bacteria. Second, not all bacteria are bad. Third, antibiotic resistance happens in bacterial cells, not in the human body's cells. And fourth, the overuse of antibiotics will render them ineffective over time. First, patients must understand there are many other types of disease-causing microbes besides bacteria- such as viruses, parasites, and protozoa just to name a few. This distinction matters in the world of antibiotic resistance because antibiotics are specifically designed to target bacteria-not other microbes. So if the patient's illness is being caused by something other than bacteria, an antibiotic won't work, and the patient shouldn't be taking one. Second, not all bacteria are bad. Help patients understand the human body requires good bacteria to survive and function properly. It's the "bad" or pathogenic bacteria that cause infections and illnesses. Resistant bacteria are like pathogenic or "bad" bacteria with superpowers. Third, clarify that the resistance part of antibiotic resistance is something that happens in the cells of the bacteria, not the cells of the human body. Patients who have familiarity with the concept of drug tolerance may mistakenly conflate this concept with the idea with antibiotic resistance. Helping the patient understand that antibiotic resistance is all about the bacteria's own drive to survive in the presence of the antibiotic that's trying to kill it can help the patient see the problem in a new light. When patients realize how taking antibiotics makes them a part of the "war on bugs" rather than the "war on drugs," they become more motivated to take the full course of antibiotics as prescribed. Fourth, the overuse of antibiotics, including using them when they're not necessary, means more bacteria have more time and opportunity to develop resistance. New antibiotics aren't being developed as quickly as bacteria develop resistance, which means the antibiotics we have now could eventually become useless. Using antibiotics judiciously and appropriately is necessary if we want to continue using them. Managing Patient Expectations If antibiotics are NOT prescribed, it's important to say the right things to reassure the patient that their needs are being met. A speaker at the American Association of Nurse Practitioners (AANP) conference in 2015, Kim McGinn-Perryman, DNP, shared the acronym, PEARLS, as a strategy for managing patient disappointment when expectations and appropriate antibiotic use practices don't match. While this acronym is especially useful for NPs who find themselves in the position of NOT prescribing antibiotics to someone who is expecting them, all nurses can use aspects of this approach to reinforce their patient education messages throughout the workflow in clinics or any environment where oral antibiotics are prescribed. Partnership. Acknowledge that you are working in partnership with the patient, toward a goal of resolving the problem. Example: "Part of my job is to help you manage this." Empathy. Express empathy for the patient's situation. Example: "I understand you're feeling terrible." Apology. Offer an apology. Example: "I'm very sorry you're not feeling well." If you know the patient is upset about not receiving antibiotics, you might consider taking the conversation a step farther so the patient can sort out their feelings with you instead of taking out their frustration in a rating system or on social media. "I'm sorry you're not getting a prescription for antibiotics today. Do you understand our explanation on why?" Respect. Show respect for the patient, including their beliefs, intentions, goals, and actions: "You did the right thing coming in to get this checked out today." Legitimize. Legitimize the patient's thought process: "I can definitely see how you might think an antibiotic would help your symptoms." Support. Offer actionable support. "I know you want to feel better as soon as possible. Let me give you some treatment suggestions you can use instead of antibiotics." The bottom line is that nurses at all levels must work with their patients to provide adequate patient education about appropriate antibiotic use. It's not enough to simply direct a patient to take their antibiotics as prescribed. They won't if they don't appreciate why it matters. We must use our patient education skills to ensure they have a clear understanding of antibiotic resistance. Sources Antibiotics Aren't Always the Answer Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine | Infectious Diseases | JAMA Internal Medicine | JAMA Network Patient Satisfaction Ratings May Be A Factor In Doctors' Prescribing Behavior : Shots - Health News : NPR Using PEARLS to reduce unnecessary antibiotics - The Clinical Advisor AU_trifold_8_5x11_508.pdf
  16. 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.