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?
Today, our mental health counselor called out with fever, respiratory symptoms, and with what I am sure could only be a strange coincidence, a case of conjunctivitis. She also has underlying health conditions, and is somewhat fragile. She went to a class this weekend where many were sick with a virus.
Our nurse manager refuses to believe that this could all be manifestations of the same disease.
Today, our mental health counselor called out with fever, respiratory symptoms, and with what I am sure could only be a strange coincidence, a case of conjunctivitis. She also has underlying health conditions, and is somewhat fragile. She went to a class this weekend where many were sick with a virus.
Our nurse manager refuses to believe that this could all be manifestations of the same disease.
No doubt, she's right...
I am quite worried about my grand children. The both had fevers and respiratory infections. It only lasted 3 days for the 6 year old but the 6 month old is still sick. I know there is a thousand things that cause these symptoms in kids and my daughter is blaming it on teething but I worry. I bet in the next 24 hours the infant will be at the doctors. IF she were mine she would already be there but my kids are not in the medical field and tend to be more relaxed about these things.
this sounds exactly like what happened on my unit with patients and staff recently. gi s/s, strep in one staff member plus he developed tonsilitis, very little fever, some sore throats, two had upper respiratory s/s along with the gi s/s.
everybody knows by now that 30% of lab confirmed cases in mexico, and 50% in chile had no fever even when some were severely ill, right?
a high number of students at sylacauga city schools are reporting being sick, but it appears to be a stomach virus doing most of the damage right now instead of the h1n1 strain of influenza that has worried health officials around the world.
lisa mcgrady, the school system's registered nurse, said students are fighting off strep throat, the flu and a stomach virus which are all making the rounds right now.
mcgrady said her main complaint has been the stomach virus with students complaining of headaches and being nauseated but without any signs of fever.
the above comments describe a rapidly spreading pandemic h1n1 outbreak in alabama (see map), but similar statements have been made by others regarding other swine flu outbreaks. 10-20% of the schools population is ill, and only a portion of the illnesses is attributed to swine flu. however, swine flu causes sore throats, has a gastrointestinal component, and over 50% of infections have no fever. consequently, the above comments suggest there is little swine flu, even though strep throat and upset stomachs generally do not affect 10-20% of the student population in august.
in addition to the above outbreak, there are similar outbreaks throughout alabama, as well as other states in the south (see map) where the school season started several weeks ago. these other outbreaks include students that are influenza a positive and have flu-like symptoms. however, even in those outbreaks officials are stating that swine flu hasn't been confirmed, even though there is little seasonal flu in august, and over 99% of influenza a positive infections are swine h1n1.
thus, although it is clear that swine flu is spreading rapidly, the general public is confused by false statements by officials, testing limited to influenza a determinations, or the lack of any testing.
Would that decrease the risk of fatality? As in, there are no tonsils to become infected to the point of sepsis.
d, most folks are not getting tonsilitis. And, most are not dying either. You seem worried.
These are rare complications. Even the robust, handsome tech on our unit that did get tonsilitis, did not get hospitalized. He does have quite a set of tonsils on him though, I must say! They were hugh but not as big as they were when he was sick, he says.
The fatal swine flu cases are usually from pneumonia and progressive multi-organ failure.
This sounds exactly like what happened on my unit with patients and staff recently. GI s/s, strep in one staff member plus he developed tonsilitis, very little fever, some sore throats, two had upper respiratory s/s along with the GI s/s.
Everybody knows by now that 30% of lab confirmed cases in Mexico, and 50% in Chile had no fever even when some were severely ill, right?
College students returned to their dorms around the 15th of August in the Western end of Pa. By the 25th of August reports of outbreaks at CMU and PSU were in the news(only took 10 days!). I am sure the rest of the colleges and Universities will be reporting in soon. It only took 10 days, the younger kids went back to school this week. If the pattern holds we will have outbreaks in schools by Labor Day.
College students returned to their dorms around the 15th of August in the Western end of Pa. By the 25th of August reports of outbreaks at CMU and PSU were in the news(only took 10 days!). I am sure the rest of the colleges and Universities will be reporting in soon. It only took 10 days, the younger kids went back to school this week. If the pattern holds we will have outbreaks in schools by Labor Day.
Yes, Catholic schools have been in class 2 weeks now in my area, and reports are coming of numbers of kids out sick already.
This morning on our unit, the young man who had tonsilitis came back to work. When I saw him last, he had just recovered from tonsilitis. He relapsed a few days later and has been out since. He was still sick when he returned to work today having lost some 10 pounds. He still has chest congestion, fever, chills, and sore throat. We persuaded him to go back to employee health. I just found out that he is a brittle diabetic! Talk about risk factors...
He shared with us that he just lost a 23 year old friend in a nearby city. This friend died of pneumonia, and multi organ failure. He was very obese. Who dies of pneumonia in August? Not 23 year olds!
This morning on our unit, the young man who had tonsilitis came back to work. When I saw him last, he had just recovered from tonsilitis. He relapsed a few days later and has been out since. He was still sick when he returned to work today having lost some 10 pounds. He still has chest congestion, fever, chills, and sore throat. We persuaded him to go back to employee health. I just found out that he is a brittle diabetic! Talk about risk factors...
He shared with us that he just lost a 23 year old friend in a nearby city. This friend died of pneumonia, and multi organ failure. He was very obese. Who dies of pneumonia in August? Not 23 year olds!
Wwe really need employers to be understanding of how long a person can be out with this thing. It is the only decent thing to do. However, so many employers are not decent. I have worked places where if you missed 5 days you got a warning, 6 you got suspension, 7 you were let go. What are they going to do dismiss 30% of their staff?
Just as I suspected from what happened a few weeks ago, our unit has again been hit. This time, we nailed down the suspect as novel swine flu. Again, we admitted a patient to the psych unit with no s/s of influenza or any viral illness until she had been with us for a few days.
Our case was a thirtyish woman, morbidly obese with reactive airway disease, and MS, also a smoker. She was admitted with sucidal ideations, and on the day of her discharge, she began to spike temps. Because she always has chronic muscle aches, nausea, and h/a it would have been difficult to realize any change except for the temps and sore throat. She gradually developed a dry cough. The rapid test was of course, negative, but 24 hours later, we finally got a positive PCR at 4pm. It took us until 3am to get her transferred off the unit to an isolation room with a real hospital bed instead of our unadjustable, bolted to the floor beds.
If she had only told us, or if we had only asked about the health of her family, we would have known that her child was home from school all week on Tamiflu.
It was very difficult to care for this patient on a psych unit that is so not set up to care for patients that need to be in isolation. All masks, gowns and gloves had to be kept in the nurses station. Forget about her privacy because we could not keep the other patients from noticing our PPE as we walked down the hallway to her room. One staff member foolishly tried to tell the other patients that this was only seasonal flu.
I constantly worried that she would go sour on us due to her risk factors. I suspect that this will happen again, and again over the next 2 years. Maybe we need a better plan, and better assessment of risk factors.
Just as I suspected from what happened a few weeks ago, our unit has again been hit. This time, we nailed down the suspect as novel swine flu. Again, we admitted a patient to the psych unit with no s/s of influenza or any viral illness until she had been with us for a few days.
Our case was a thirtyish woman, morbidly obese with reactive airway disease, and MS, also a smoker. She was admitted with sucidal ideations, and on the day of her discharge, she began to spike temps. Because she always has chronic muscle aches, nausea, and h/a it would have been difficult to realize any change except for the temps and sore throat. She gradually developed a dry cough. The rapid test was of course, negative, but 24 hours later, we finally got a positive PCR at 4pm. It took us until 3am to get her transferred off the unit to an isolation room with a real hospital bed instead of our unadjustable, bolted to the floor beds.
If she had only told us, or if we had only asked about the health of her family, we would have known that her child was home from school all week on Tamiflu.
It was very difficult to care for this patient on a psych unit that is so not set up to care for patients that need to be in isolation. All masks, gowns and gloves had to be kept in the nurses station. Forget about her privacy because we could not keep the other patients from noticing our PPE as we walked down the hallway to her room. One staff member foolishly tried to tell the other patients that this was only seasonal flu.
I constantly worried that she would go sour on us due to her risk factors. I suspect that this will happen again, and again over the next 2 years. Maybe we need a better plan, and better assessment of risk factors.
I so do not want to go through this again...
Oh geeze, I remember you last post when this happened. I know what you fear. One case will become two, two will become four, then once again the entire floor will be down.
Well, if what happened duriing the last outbreak on our unit was really swine flu, then most of the staff should be immune by now, but not this group of patients.
During the few days this woman spent on the unit, she was not coughing or sneezing while out amongst the others on the unit. It is important to note that we are still learning how influenza is transmitted, and if anyone tells you that they know how for sure, it is simply not true. The IOM meeting and recommendations to the CDC a few weeks ago should have made that abundantly clear.
Influenza is most likely transmitted via the airborne route, and as well as via droptlets with fomites being the least method of spread to worry about. All of this talk about disinfecting and wiping down surfaces in the schools is similar to telling the expectant father to go boil water during his wife's delivery. It serves to look like it is helping, and gives you something to do, but is not that helpful. Wearing a mask is what really works.
This is yet another point that was emphasized at the recent CIDRAP Conference in Minneapolis on keeping the world working during the pandemic. The science does not support handwashing as a prevention of swine flu. This is not to say that handwashing is not
worth doing. It is, but mostly for other reasons, but, do not expect it to prevent influenza or that it will slow down the transmission rate in the schools.
indigo girl
5,173 Posts
Today, our mental health counselor called out with fever, respiratory symptoms, and with what I am sure could only be a strange coincidence, a case of conjunctivitis. She also has underlying health conditions, and is somewhat fragile. She went to a class this weekend where many were sick with a virus.
Our nurse manager refuses to believe that this could all be manifestations of the same disease.
No doubt, she's right...