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Topics About 'Personal Protective Equipment'.

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  1. Dear, dear friends. We all hate being "under the man". I get it. But goodness. Let's face it. Protective gear is a rule because it is so very necessary. If you are ever fearing a back spray, please, wear the gear to protect your ever-absorbing skin and EYES. We touch some of the most unruly things in our profession. In the longest run on sentence I would love to share with you some of my icky-stickiest: maggots in the feet, wounds to the bone, explosive clostridium difficile, excessive lice that took over a week to treat (HEAD TO TOE), tunneling wounds in the peri-area that exceeded 8 inches in depth, infected boils bigger than golf balls, dehisced abdominal surgical sites (staples flew across the room), goopy tracheostomies that hadn't been cleaned in so long they were almost cemented in place, shingles galore, meningitis with fevers of 104, tuberculosis with projectile sputum that was yellow/green, anything sputum (makes me cringe), explosive bloody diarrhea, Mount Vesuvius-like blood spurts when inserting an airway while in a code, removing feeding devices thus spurting bile, etc, etc, etc. Did you turn a little green yet? If you're a nurse, I am sure the answer is no. For me, sputum always makes me a bit (more like a LOT) nauseated, and sometimes uncontrollably gaggy. Funny and so not funny all at the same time. It's kind of embarrassing. I'm always afraid it will make my patient feel bad (in any way shape or form). Moral of the story above is that PPE is not just a GREAT choice when dealing with our usual: MRSA, VRE, Cdiff, Meningitis, Tuberculosis, Shingles, etc. Any time you are coming into contact with flaking skin, excessive wound drainage, foot care, you name it, WEAR SOMETHING TO COVER YOURSELF. We all know that Cdiff has legs. The spores have legs people. It attaches to things and it clings on for dear life. Do you not realize that this advanced bug has the ability to live on surfaces for extended periods of time unless it's given a proper clean? Seriously. If you can't imagine anything else, imagine these microscopic critters sticking to you, your hands, your clothes and shoes. Now think of what you touch. Your face, phone, private parts (you gotta pee at some point), say you pick your nose for that stubborn boogey, or capture a stray eyelash, or even chew a nail.. Yum yum, nom nom, right? Wrong. Disgusting. Hospitals are cesspools. May I remind you that everyone is sick? (That or asking for Aunt Dilaula, but that's a different issue). It is OVERLY tedious to gown up, remove, gown up, remove, and go from room to room. I guarantee that your neutropenic patient who is crazy sick (or may even have cancer) greatly appreciates your attention to detail when washing your hands in between patients. It's easy to get cavalier when moving fast, rushing or just thinking that hand sanitizer will do the job. If I could give you a sad face/awkward frown, I totally would right now. The thing is that we all know this is necessary, an issue, and a PIA, but we have to do it. Personally, when I get home and hug my love, I don't want to pass someone else's poo to his lovely person. It's rude. And it's just down-right gross. What do we do then? Comply comply comply. Wash your hands. Comply some more. We are a profession that washes our hands before and after using the bathroom. It's just the way we need to conduct ourselves. I personally don't want to go to the bathroom and take care of MY business after putting a suppository up someone else's end. Just saying. Your poo-poo platter doesn't need to be on my platter. Okay okay. Enough puns. Things are becoming more and more resistant to antibiotics. When in doubt, don the yellow gown (or whatever color your hospital PPE is). When there are creepy crawling things that are jumping, break out the hazmat and have no shame. I've worn hazmat and I felt so so SOOOOOO blessed. I did NOT want to bring that ju-ju home with me. I love my job, but I don't have to love the bugs involved. What can be a controlled infection can turn to sepsis quickly. Be aware and seriously, just wash your stinking hands! I will never forget how horrified I was when palpating an abdomen that I didn't know had a tunneled wound down to the patient's infected stomach appliance from bariatric surgery. Let's just say that warm puss from someone's insides on your bare hands is enough to make you want to autoclave your body for the rest of the shift. Believe me when I say that I love wounds and wound care. I find it fascinating. But when I'm assisting on an Unna boot and physical therapy is blasting off dead skin with their crazy machine, I'm covered with PPE head to toe. Because as rewarding as it is to heal wounds and assist in curing the sick, I'd rather not have your skin flakes in my hair (thank you very much). There have been times when a culture has come back and I wasn't sure if the patient needed contact precautions or not. The navigator for that is literally a phone call away. If night shift can't get ahold of someone who knows for sure then a 'cheat sheet' needs to be made. For you and your safety, always err on the side of caution. Two last things to keep germs at bay... REMOVE your shoes before getting in the car. If I had a dollar for every time I stepped in poop, pee, vomit, spit, blood, or found those things clinging happily to my shoes, I would have paid for all of your school loans and probably paid off your mortgage (you're welcome). Leave those nasty buggers in the TRUNK of your car in a box. It is NOT necessary for those shoes to see the light of day besides fluorescent lights at your job, and then the brief walk to your car. You don't wear shoes in the house? Good for you. I don't either, but! Wearing work shoes home with first driving, then leaving them wherever you do and then driving the next day while (you're off) in your awesome civilian kicks, heading to a friends house and walking into their door... You're welcome. Whatever grime was on your work shoes, can make a lovely imprint on your car's pedals and excitedly await another shoe to make close friends with. It's truly that simple. Lastly, my dear dear germ-ED family, our scrubs. Our scrubs. They need their own planet. If there was a laundromat in space, we'd need it for frequent use. Since that is not (yet) a possibility (let's go NASA!) we have to wash our scary things at home. Rule number one. I don't care how much you paid for those super cute/stylish/comfy Grey's Anatomy scrubs (they are my favorite too), if you get excessive bodily fluids on it. Trash it. End of story. Buh-bye! I had Cdiff pooped down my leg once. I bought the scrubs the DAY BEFORE. Guess where they went? BIOHAZARD. OR scrubs the rest of my shift, for the win! Rule number two. Scrubs need to be cleaned on HIGH heat and washed separately from the rest of your gear. Think about it.. Wash your washcloths with your scrubs. Later on, wash your face, bum, etc with that washcloth... I don't think I need to elaborate more. I make my own detergent and use essential oils for their antimicrobial properties in my fabric softener. Then I do an empty cycle behind my scrub laundry to clean out the machine. Do what you need to do friends, the bugs we deal with daily are serious. Unfortunately, the germs we work with, deal with, fight with, all deserve respect beyond what we've been giving them. I'm sure we are all walking around carrying something or with some antibodies of some sort... But for me, I'd rather win than have to deal with MRSA boils, or Cdiff diarrhea.. Personally, I'd also like to refrain from nursing my own tuberculosis. We need to have compassion for our patients. Not the germs.
  2. The headlines have moved onto other dramatic local and world events, but Ebola is still out there, killing. After declaring the Ebola outbreak over on May 9, 2015, Liberia buried an Ebola positive person on June 28, 2015 according to the article, "2014 Ebola Outbreak in West Africa - Case Counts" by the Center for Disease Control and Prevention. Although it is not considered an outbreak anymore, one death from Ebola is too many. Early detection is the key, and although Liberia is now considered a country with "former widespread transmission" public officials continue to keep an active watch for Ebola cases. As of July 31, 2015, the above mentioned article stated that there are no cases of Ebola in the following countries: Nigeria, Spain, United States, Mali, Senegal, the United Kingdom, and Italy. Who developed the Ebola Vaccine?In The Washington Post article the, "Ebola vaccine appears to be highly effective, could be 'a game changer," the new vaccine is introduced as VSV-EBOV. The Public Health Agency of Canada developed the vaccine which is licensed through Merck. Donald Henderson, a professor at John Hopkins Bloomberg School of Public Health and known for his work on the smallpox vaccine, also played a part in the design of the Ebola vaccine trial. On July 31, 2015, the information was released out of Geneva that a review board of international experts, the Data and Safety Monitoring Board, stated that the trial for the new vaccine should continue, calling it "highly effective." Funding for the Ebola vaccine has come from the U.S. and Canadian governments. What kind of vaccine is VSV-EBOV?Although the vaccine is alive, it has no live Ebola virus in it (Phillip). The vaccine replicates and is modified by replacing one gene with a single Ebola gene. This allows the body to fight the Ebola virus. How did they conduct the study?Beginning in March of 2015, researchers used a "ring" method to vaccinate people in Guinea. The ring method was used in the 60s and 70s to abolish smallpox and has proven to effective again. The vaccine is given to the people around the patient in a "circle of protection" (Phillip). This controlled circle helps prevent further transmission of the Ebola virus. In Guinea's affected communities, single doses of the vaccine were administered. According to the article, "World on the verge of an effective Ebola vaccine," by the WHO, "over 4000 close contacts of almost 100 Ebola patients, including family members, neighbors, and co-workers, have voluntarily participated in the trial." Because the vaccine has been deemed safe, the continuing trials will include 13-17 year olds and possibly 6-12 year old children. What were the results of the study so far?Of the over 4,000 people who have received the vaccine, none of them contracted the Ebola virus, it is one hundred percent effective (Phillip). Caution is raised by the researchers, knowing that further studies are needed to prove the vaccine's effectiveness over a long period of time. They know it works short term, it's the long term results they hope will be just as good. The Guinean national regulatory authority and ethics review committee has approved the study of the Ebola vaccine to continue. Because of the fantastic results so far, researchers have started to vaccinate all at risk people. One of the doctors from Doctors without Borders, Bertrand Draguez is quoted as saying, " For the first time ever, we received evidence of efficacy of a vaccine that will help fighting Ebola. Too many people have been dying from this extremely deadly disease, and it has been very frustrating for healthcare workers to feel so powerless against it (Phillip). The fast and credible results that have come out of the vaccine trial proves that nations can work together for an end result. This collaborative effort has brought many organizations and has changed how the world counters a life threatening disease. PrecautionsFor nurses, not only is our concern for the patient, but how do we protect ourselves? There were quite a few healthcare workers who were infected with Ebola in the outbreak in the Fall of 2015. The CDC admits in their article, "Review of Human-to-Human Transmission of Ebola Virus," that healthcare workers did not have the correct personal protective equipment (PPE). Some of the cases where health care workers contracted the virus over the years has been a break in protocol. In 1995 in Kiwit, Democratic Republic of Congo 25% of the cases of Ebola was health care workers. It was determined that most did not use the appropriate precautions, specifically, one nurse admitted to rubbing her eyes with soiled gloves (Review). The most recent outbreak of Ebola has been a learning experience regarding PPE for healthcare workers. Because it has not been determined whether the virus is airborne, the CDC recommends standard, contact, and droplet precautions with no skin exposure. All healthcare workers involved with an Ebola patient are required to train in dressing and undressing proper PPE, and be observed by a manager at all times. ConclusionThe most important thing a nurse can do is protect him/herself by using the applicable PPE. Take the time to make yourself safe so you can then help the patient. Don't let doctors or the clock rush you into short changing yourself and opening the opportunity for a virus or other contractible disease to bite you. The Ebola vaccine is good news for everyone, let's hope for continued good results. If you have had any direct experience with the Ebola virus, please share with us! References "Review of Human-to-Human Transmission of Ebola Virus." Center for Disease Control and Prevention." 22 July, 2015. 1 August 1, 2015. Web. "2014 Ebola Outbreak in West Africa - Case Counts." Center for Disease Control and Prevention." 31 July, 2015. 1 August, 2015. Web. Phillip, Abby, Larimer, Sarah, & Achenbach, Joel. "Ebola vaccine appears to be highly effective, could be a 'game-changer." The Washington Post. 31 July, 2015. 1 August, 2015. Web. "World on the verge of an Effective Ebola vaccine." World Health Organization: news release. 1 August, 2015. Web.