Under Viral Attack

oramar · Aug 15, 2009

I am working my 3 twelve hour weekend shifts so I have not much time to spend between working, and getting the sleep that I need to get thru it.
My Psych unit is under attack. The enemy is as yet identified. It snuck in with a patient transferred from a medical floor in our hospital. The patient came to us with uncontrolled diarrhea and vomiting a few days ago. He is feeling better now, but two staff are down, and another patient was transferred to ICU, a medically fragil anorexic weighing about 82 pounds with the same diarrhea and vomiting. Another patient developed the same s/s last night with staff gowned, masked and gloved, having to clean up stool, vomitus etc last night.
Add to this, staff members with sick kids with flu s/s at home (toddlers with high temps, congestion, cough etc). We are under major stress, and it is only August! We have no way to isolate anyone in our environment. This only works with stable, cooperative patients, but luckily most of our current residents are like this. We are wiping door knobs, and anything touchable like hallway phones, the community coffee pot with Cavicide. Anyone that gets served a food tray gets hands scrubbed with alcohol gel.
I don't believe that this is swine flu even though it has a GI component, but I don't know for sure. Patients have no UR s/s. I have to worry that it doesn't help the immune status of everyone here to be hit with this while flu is making its way thru our hospital, and the region. Maybe these other viral invaders help to weaken immune systems, helping the flu to overcome us.
I cannot believe that this is a noro/norwalk virus in August. What the heck is going on?
Trying to keep our heads above water...

Oh my, I am praying you don't get it. Perhaps something like a Norwalk Virus is going around. If that ravishes someone's immune system and then H1N1 hits is will not be good.(or like you said some with the flu & then gets the GI bug, we don't even want to talk about if they already have a serious illness)

dishes, BSN, RN · Aug 16, 2009

Have they done swabs on the infected people to determine what it is? I think since there is a big push to immunize this fall you need to know whether or not you are currently being exposed to H1N1. Hope you all stay healthy and wish all those affected a quick recovery.

regards

dishes

KristiePDX · Aug 17, 2009

With the different (than regular flu) presentation I find myself a bit wary of anyone coming through the doors.

We have active H1N1 in my community. My facility (one of many in our area) sees 2-4 cases a week. Often due to the presentation they are not properly identified by the time the are admitted to our floor. By the time they are all settled (by that time 2-3 staff have helped with the admission) does the true picture emerge.

Just the other night we had an admission "GIB with tachycardia" This person gets admitted, nurse goes on break and asks me to watch her Pts, no problem..... By this time the Pts blood transfusion is ready (needs it NOW). An un-masked phlebotomist leaves the room. I go in there to get fresh vitals. Temp is 38.3 (medicated in the er for fever already) the Pt says the have had vometing (no blood) for the last day and a half..... Pt had recently spent time around infected people. Meanwhile I am there without proper PPE, IV nurse is there without PPE, phlebotomy was there and this perons nurse was already there. Crap!

An hour or so later, admit is coming sometime in the next hour, nurse B has been running her tail off and needs a break badly or she will not have time to get one at all. Her Pt is being re-admitted (recent surg) for syncope. Transport comes before expected, I go in to help transport and get the Pt tucked and fluffed for nurse B who is scarfing her lunch (poor thing). Pt vomits opon arrival, has a temp, and by that time Nurse B is back. a few hours later an isolation cart arrives outside the door. It is right between the two new admits doors. (we have a shortage of isolation carts) so this time it worked out.

I have no clue if these people are infected with anything. The potential is always there. This flu has the ability of looking like anything. I can see this getting pretty bad. If we had a surge of H1N1 (flu season is coming) It will be prettty hard to control the spread.

My fellow nurses tell me not to worry about it. Maybe I shouldn't worry so much. I do think it is easier for them so say that though. They havent been reading this forum, they dont visit the CDC site. AND THEY ARE NOT IN THIER SECOND TRIMESTER AND WONT BE IN THEIR THIRD TRIMESTER AT THE PEAK OF FLU SEASON! Good greif. I dont know what to think.

oramar · Aug 17, 2009

With the different (than regular flu) presentation I find myself a bit wary of anyone coming through the doors.
We have active H1N1 in my community. My facility (one of many in our area) sees 2-4 cases a week. Often due to the presentation they are not properly identified by the time the are admitted to our floor. By the time they are all settled (by that time 2-3 staff have helped with the admission) does the true picture emerge.
Just the other night we had an admission "GIB with tachycardia" This person gets admitted, nurse goes on break and asks me to watch her Pts, no problem..... By this time the Pts blood transfusion is ready (needs it NOW). An un-masked phlebotomist leaves the room. I go in there to get fresh vitals. Temp is 38.3 (medicated in the er for fever already) the Pt says the have had vometing (no blood) for the last day and a half..... Pt had recently spent time around infected people. Meanwhile I am there without proper PPE, IV nurse is there without PPE, phlebotomy was there and this perons nurse was already there. Crap!
An hour or so later, admit is coming sometime in the next hour, nurse B has been running her tail off and needs a break badly or she will not have time to get one at all. Her Pt is being re-admitted (recent surg) for syncope. Transport comes before expected, I go in to help transport and get the Pt tucked and fluffed for nurse B who is scarfing her lunch (poor thing). Pt vomits opon arrival, has a temp, and by that time Nurse B is back. a few hours later an isolation cart arrives outside the door. It is right between the two new admits doors. (we have a shortage of isolation carts) so this time it worked out.
I have no clue if these people are infected with anything. The potential is always there. This flu has the ability of looking like anything. I can see this getting pretty bad. If we had a surge of H1N1 (flu season is coming) It will be prettty hard to control the spread.
My fellow nurses tell me not to worry about it. Maybe I shouldn't worry so much. I do think it is easier for them so say that though. They havent been reading this forum, they dont visit the CDC site. AND THEY ARE NOT IN THIER SECOND TRIMESTER AND WONT BE IN THEIR THIRD TRIMESTER AT THE PEAK OF FLU SEASON! Good greif. I dont know what to think.

I always enjoy hearing from people in the front lines. It is easy to talk about isolation and infection control but much harder to put into practice in real world. My guess there will a lax attitude by your institution until half their staff is out ill. Then all of a sudden they will get religion and clamp down. Meanwhile at that point it is to late. They need to come up with a policy that every one is assumed to have H1N1 till proven otherwise.

nerdtonurse?, BSN, RN · Aug 17, 2009

Sounds like our last norovirus outbreak *except for the vomiting

indigo girl · Aug 17, 2009

I have been in several LTC facilities with noro outbreaks in New England winters. This occurrence in the Florida summer, is remarkably familiar including the vomiting. This I know from past personal experiences... The docs are calling it a viral gastroenteritis, which I suppose covers it all.

What has happened on our unit is a useful analogy for the fall which is almost upon us. Patients come to us with no symptoms until already present on the unit. Staff come to work infected, but symptoms don't manifest until they are already working.

Hospitals rely on protecting everyone by trying to identify the obvious cases of ILI at the portals of entry into the facility. They tell staff not to come to work sick. They post signs telling visitors not to come in if sick. It's the best that they can do, but those with early infections before any symtoms will still slip thru.

As for my unit, I would hate for us to meet up with swine flu after just suffering a bout with noro or whatever this is. I suspect that this type of one, two punch is what does already happen frequently in the winter. I seem to recall that many staff became ill with ILI shortly after getting a GI bug. Perhaps they were already predisposed to further illness from the first infection.

Just a few thoughts from my exhausted brain. Sure glad that my three twelve hour shifts are over for the week...

indigo girl · Aug 18, 2009

I had managed to convince myself that my unit is undergoing a gastoenteritis viral outbreak. And, then I read this article today.

Let me just post these links first, and then I'll tell you how it relates to my unit.

http://www.timesonline.co.uk/tol/life_and_style/health/article6722264.ece

On day three, I woke at 6am with only one thing in mind: antibiotics. My tonsils were so swollen that I couldn't open my mouth more than half an inch. Yesterday it was announced that a six-year-old girl who died after becoming infected with swine flu suffered septic shock as a result of tonsillitis-and Dr Mark Porter, The Times doctor, said that there was evidence that influenza A infection such as swine flu could increase a person's susceptibility to other infections. Having suffered from tonsillitis since I was a child, it's likely that my flu increased my susceptibility. I knew there was one cure: penicillin.
Again, my husband rang the surgery and the doctor called back. "Mm've gnot tnonsllitis," I said, sounding like I was trying to swallow a large dumpling. "Plnease gnan I hnave . . ." "Don't say another word," she said, "I can't bear it. Send your au pair, I'll give her a 'script." She paused. "And the Tamiflu?" "Tnen tnimes wnorse," I mumbled. "Ah," she said, "So sorry. Everyone thinks that it's this big Holy Grail and it's not. Sadly, though, it's all we've got."

http://www.timesonline.co.uk/tol/life_and_style/health/article6722616.ece

According to the post-mortem, Chloe, from Middlesex, died from "septic shock as a result of tonsillitis infection" after the bacteria entered her bloodstream. Pathologists did not rule out swine flu as a contributory factor in her death. Doctors said that, like any flu, the influenza type A (H1N1) strain could increase the risks of secondary bacterial infections.

Now, I may not be the brightest bulb on the tree after working my 3 twelve hour night shifts in a row, but I think I can recognize a strange coincidence when I see one.

Here's what I here is what I am noticing. The first link above makes reference to the earlier case of death of a patient with tonsilitis and H1N1. Now, keep in mind that my unit is undergoing cases in patients and staff of GI s/s.

Yet, in a strange twist of fate, yesterday, one of our mental health techs had all the nurses looking at his very swollen tonsils. This is after he has returned from being out ill. He tells us that his currently swollen tonsils are an improvement from a few days ago when he could barely breathe from how they were so very swollen. I am not big on looking down anybody's throat, but our tech is a fine specimen of humanity, and as I am not dead yet and this young man could well pose for any major magazine, so I did take a gander, and those tonsils were very impressive indeed. It hurt to look at them.

So, I am wondering again, what is going on here? We have patients and staff with GI s/s, and we have some with other manifestations of infection. Not jumping to any conclusions here. Just noticing the constellation of disease manifestations, remembering my own conjunctivitis/malaise a few weeks ago, and what we know about the connection between influenza and conjunctivitis. Here is our thread about that:

https://allnurses.com/pandemic-flu-forum/swine-flu-conjunctivitis-410981.html

Did I neglect to mention my nursing colleague from last weekend coming in with flu s/s last Saturday, minor at first but gradually increasing in severity as our twelve hour shift progressed? She called the flu hot line in the AM, and was told not to come in on Sunday until tested on Monday. Not surprisingly, she tested negative on the rapid flu test. We know by now about the 50% false negatives with that test...She had all of the classic s/s of flu, chills, myalgia, sore throat, H/A, cough and in addition she had diarrhea as well. She had no fever, but then she never has a fever because she is immune suppressed with a hx of CA, chemo and thalessemia. Should we also mention that 30% of confirmed Swine flu cases in Mexico and 50% in Chile are afebrile? Several in her family were ill, and her niece who is a nurse at another facility was started on Tamiflu by her personal physician who was convinced it was H1N1. My colleague had visited her 3 days prior.

And, tonight I am hearing from my other night working colleagues on duty while I am off that some have had respiratory symptoms as well as the diarrhea and vomiting. So, I am throwing the noro virus theory out now.

The plot thickens, and it's only August.

oramar · Aug 22, 2009

I had managed to convince myself that my unit is undergoing a gastoenteritis viral outbreak. And, then I read this article today.
Let me just post these links first, and then I'll tell you how it relates to my unit.
http://www.timesonline.co.uk/tol/life_and_style/health/article6722264.ece
http://www.timesonline.co.uk/tol/life_and_style/health/article6722616.ece
Now, I may not be the brightest bulb on the tree after working my 3 twelve hour night shifts in a row, but I think I can recognize a strange coincidence when I see one.
Here's what I here is what I am noticing. The first link above makes reference to the earlier case of death of a patient with tonsilitis and H1N1. Now, keep in mind that my unit is undergoing cases in patients and staff of GI s/s.
Yet, in a strange twist of fate, yesterday, one of our mental health techs had all the nurses looking at his very swollen tonsils. This is after he has returned from being out ill. He tells us that his currently swollen tonsils are an improvement from a few days ago when he could barely breathe from how they were so very swollen. I am not big on looking down anybody's throat, but our tech is a fine specimen of humanity, and as I am not dead yet and this young man could well pose for any major magazine, so I did take a gander, and those tonsils were very impressive indeed. It hurt to look at them.
So, I am wondering again, what is going on here? We have patients and staff with GI s/s, and we have some with other manifestations of infection. Not jumping to any conclusions here. Just noticing the constellation of disease manifestations, remembering my own conjunctivitis/malaise a few weeks ago, and what we know about the connection between influenza and conjunctivitis. Here is our thread about that:
https://allnurses.com/pandemic-flu-forum/swine-flu-conjunctivitis-410981.html
Did I neglect to mention my nursing colleague from last weekend coming in with flu s/s last Saturday, minor at first but gradually increasing in severity as our twelve hour shift progressed? She called the flu hot line in the AM, and was told not to come in on Sunday until tested on Monday. Not surprisingly, she tested negative on the rapid flu test. We know by now about the 50% false negatives with that test...She had all of the classic s/s of flu, chills, myalgia, sore throat, H/A, cough and in addition she had diarrhea as well. She had no fever, but then she never has a fever because she is immune suppressed with a hx of CA, chemo and thalessemia. Should we also mention that 30% of confirmed Swine flu cases in Mexico and 50% in Chile are afebrile? Several in her family were ill, and her niece who is a nurse at another facility was started on Tamiflu by her personal physician who was convinced it was H1N1. My colleague had visited her 3 days prior.
And, tonight I am hearing from my other night working colleagues on duty while I am off that some have had respiratory symptoms as well as the diarrhea and vomiting. So, I am throwing the noro virus theory out now.
The plot thickens, and it's only August.

I just popped into see how that outbreak of GI illness at your facility is going. See that you already reported in.

indigo girl · Aug 22, 2009

All is well for now. Everyone has recovered including patient zero, who is still with us.

We will know more when the virus sneaks in again on another patient transferred to us before they begin showing s/s. I have no doubt that this will happen, and probably more than once in the coming months. Perhaps by then, our entire staff will have been immunized either naturally by the flu or by vax.

What I found most interesting was that this virus can exacerbate a problem that is already there under the radar, and make it so much worse. Take our staff member with the tonsilitis. His tonsils were very impressive, and this is after he recovered. I have found three other cases in the media, two in the UK, and one in South Africa of people with severe tonsilitis occurring with swine flu. Two out of three died. I suspect that there are many more that did OK, just got very sick. This is something to watch out for if you have a family member that is prone to having this problem.

phytosleuth · Aug 23, 2009

Indigogirl, thanks for providing this thread. I really appreciate news from the front lines. I'm not a licensed anything so I won't say much on this forum but I read the flu blogs and pass on info to friends and traditional medicine practitioners.

Could this be an adenovirus?

"Adenovirus infections often show up as conjunctivitis, tonsilitis (which may look exactly like strep throat and cannot be distinguished from strep except by throat culture), an ear infection, or croup. Adenoviruses can also cause gastroenteritis (stomach flu)." Wiki http://en.wikipedia.org/wiki/Adenovirus#Infections

indigo girl · Aug 23, 2009

Indigogirl, thanks for providing this thread. I really appreciate news from the front lines. I'm not a licensed anything so I won't say much on this forum but I read the flu blogs and pass on info to friends and traditional medicine practitioners.
Could this be an adenovirus?
"Adenovirus infections often show up as conjunctivitis, tonsilitis (which may look exactly like strep throat and cannot be distinguished from strep except by throat culture), an ear infection, or croup. Adenoviruses can also cause gastroenteritis (stomach flu)." Wiki http://en.wikipedia.org/wiki/Adenovirus#Infections

I don't have a clue, but sure it could be adenovirus. It's common enough. But, what is going around in our community right now is swine flu, and many of the hospital staff have tested positive. We will never know for sure what our unit had because no testing will ever be done. I would love it though if we could just test our staff for antibodies.

I have read of 3 cases of tonsilitis, 2 in the UK and one in South Africa in swine flu positive cases. Two of the three were fatal cases. At least one had a co-infection with strep.

It's all interesting, but not fun to deal with. In fact it was a real mess for a while there, but all is well now. At least until another patient infected with whatever is going around comes to our floor.

I hope I am immune now. My conjunctivitis and malaise was bad enough, but, I never got the GI bug like the rest of the staff.