What it means to be in an "outbreak"

Ray36 · Feb 15, 2012

When an outbreak of any kind is declared, what generally happens?
I'm so sick and tired of constantly having the threat of MDROs or C.diff dinned in our (nurses) ears when no one else seems to care. .... Still, if they're so concerned about MDROs, then they should just close the unit!
I want to complain to someone but I'm not sure even where to start...

Mandatory reporting and public comparisons between hospitals, and the new policy of CMS to not pay hospitals for care for infections acquired while in the hospital should increase the pressure somewhat on the administrators to care about this problem.

Well publicized examples of hospitals that have cut their infection rates dramatically put a lie to the legacy apathy that "it's just the way it is, nothing can be done about it." Patient advocacy groups may the ones to add local pressure there.

I don't think infection control departments are very powerful in the scheme of things, compared to other interest groups.

And people in general (patients, families, visitors) are astoundingly uninformed about infection control. More than once I've observed visitors with infants in strollers pick up a dropped pacifier off the main corridor floor and pop it back in their child's mouth.

I hesitate to estimate what fraction of visitors don't wash their hands after visiting the heavily used public restrooms, often more poorly designed for infection control than the local Interstate rest-stop. As a society we've grown sloppy and complacent.

From a public health point of view, in terms of MDRO's, hospitals in general are a nightmare. If all you cared about was infection control, hospitals and ICU's should all simply be shut down because they are the primary incubators and spreaders of MRDO's. But no one wants to admit that antibiotics are failing, or that untreatable TB is on the rise.

But we don't know how to grapple in public yet with situations in which, regardless what policy we select, some people will die as a result of the choices we make. The "medical establishment" doesn't want to cope with an issue that shows the "feet of clay" and the reality that doctors are not gods, and have limits. So don't expect this issue to be dealt with without very real outside pressure and even that is hard to generate.

In fact, society is great at putting this question out of mind. The 1918 "Spanish flu" epidemic killed more people than World War I, and was the single most important event of the day. Yet studies of recent history textbooks show that it merits at most a sentence, or no mention at all. At all levels, people just don't want to think about it.

Public health departments have been aware of and pushing on these issues for over a century, but the response of society and the AMA to the statistics has been largely to do everything possible to squelch that voice and slash the budgets for such departments, and misportray them as "advocates of free care for underserving poor people" who need to be put out of existence.

All that said, nurses ARE the primary line of defense of the patient, and increasing the power and influence of nursing organizations may do more than anything else to help.

It's hard to care when no one else seems to, but that's also when it matters the most.

Chiggysmom · Feb 15, 2012

OMG! At the hospital I work at, if you're caught without your gown and gloves on in an isolation room, you could be fired on the spot!!!

Esme12, ASN, BSN, RN · Feb 15, 2012

You could start with your local Department of Health

Wishinonastar, BSN · Feb 15, 2012

Agree about the public being uninformed, but they theoretically are not doing hands-on care either. At my hospital they have a hand sanitizer dispenser at the door that serves as a good reminder. They need posters and signs everywhere too, and I don't see much of that.

Unfortunately I have seen a lot of nurses and doctors who are still pretty lazy about gloves. That bothers me the most.

NsugaBuga · Feb 16, 2012

And ofcourse its the nurses fault, and always will be. Its frustrating because we're not the only staff who hops from room to room. I've seen family members call from home and say Theyve caught what the patient has, then bring the illness right back after the pt gets better.

Jaimie.RN · Feb 16, 2012

Yuck, I wear gown and gloves anytime it's necessary, not just for patients but for myself. Why spread nasty germs around? But I can completely relate to where the OP is coming from. Had a lady with mrsa and c diff on vanco, family would come in, crawling babies on the floor, hugging, kissing, using the bathroom, sitting in the bed and such, etc., no handwashing, then just leave the room. So disgusting. Don't people know that bacteria and germs are real? It's not just made up for kids, people.

linda535 · Feb 16, 2012

In our facility, we've been working hard toward not spreading anything that we can prevent spreading. We do a lot of hand sanitizer, hand washing, wiping down rooms between all patients, and have masks on us and all patients and family members with any URI complaints.

I still see some providers NOT following the rules - for instance, a provider not wearing a face shield when swabbing for pertussis (we have an epidemic now), and not wearing masks with all patients who cough. Yes, I know many doctors who think they have some kind of antibacterial bubble. Everyone needs to be accountable.

I've noticed since we have become tougher with this, we've all been less likely to catch whatever the patients bring in. Hello? It's nice not getting every other crud that comes through!

I tell parents daily, "Please don't let your baby or young child play/crawl/lie on the floor, because some people pee or vomit on the floor." Parents are insulted that I'm saying this. Although our carpets are "cleaned" nightly, REALLY? Does this get them clean??

Infection Control departments need more teeth. If all patient care facilities had the "fire for not using PPE (personal protective equipment)" policy, maybe employees AND MEDICAL STAFF would take this more seriously and we could cut the infection rates.

beachmom · Feb 17, 2012

There was a study done in a hospital on handwashing by employees after using the bathrooms. Doctors scored the lowest. Housekeepers scored the highest - yes, even higher than the nurses. Hmmm.

elprup, BSN, RN · Feb 17, 2012

I agree it is a problem. Places I have worked, I have seen the reuse of gowns, if any, with the premise being to save the all mighty dollar. I can also understand the thinking of why medical staff do not wash and wear protective gear...because there are too many things to do in the amount of time given and they do not want to be slowed down. Alas, we know the time issue is valid but the thinking they are saving anything is incorrect. Because when they get it and spread it, everything gets 10 times worse.

jmRNip · Feb 17, 2012

Infection control nurse here to weigh in. First, you don't necessarily need to close units with an outbreak. There are other interventions that can be instituted prior to doing that. You do not know what is going on behind the scenes and with administration, so please don't be so quick to judge.

Second, and I say this to all of the nurses that complain about families lacking in PPE use - YOU are responsible for their education and compliance. Your facility probably has one infection preventionist for every 100-150 beds. You have no idea what their responsibilities entail and I can assure you they are overloaded. You are on the unit with your patients. If you find families non compliant, please educate them so they are compliant. I'm certain that if you need assistance from your ICP/IP, they will be happy to help. They cannot be everywhere at once.

I find this daily on my rounds. It is the responsibility of every caregiver on the unit to enforce proper use of PPE. OP, if you have specific questions, feel free to PM me.

Aeterna, BSN, RN · Feb 23, 2012

Infection control nurse here to weigh in. First, you don't necessarily need to close units with an outbreak. There are other interventions that can be instituted prior to doing that. You do not know what is going on behind the scenes and with administration, so please don't be so quick to judge.
Second, and I say this to all of the nurses that complain about families lacking in PPE use - YOU are responsible for their education and compliance. Your facility probably has one infection preventionist for every 100-150 beds. You have no idea what their responsibilities entail and I can assure you they are overloaded. You are on the unit with your patients. If you find families non compliant, please educate them so they are compliant. I'm certain that if you need assistance from your ICP/IP, they will be happy to help. They cannot be everywhere at once.
I find this daily on my rounds. It is the responsibility of every caregiver on the unit to enforce proper use of PPE. OP, if you have specific questions, feel free to PM me.

In the recent past, we've had so many isolation cases on our floor that we've had to close down beds because we ran out of private rooms. Also, because of the nature of our unit, we have plenty of neutropenic patients around, too. And sometimes, administration just doesn't think. Just a couple of days ago, they admitted a patient to our floor and then informed us they were a "potential meningitis case". Their room was just across the hall from two neutropenic patients. Or the time when bed allocation wanted a terminal clean of a room done in 13 minutes because the ER was so overloaded (yeah, I understand the need for beds, but you can't rush a terminal clean!)

Also, I find most visitors do ok with PPE, but every now and then you get a certain few who refuse to wear any of it. I once had the wife of a patient refuse to wear PPE. If you explained it to her, showed her the gowns and gloves, it was like she wasn't listening or she couldn't understand English (Italian was her primary language), but for all other communication, she was perfectly fluent in English. And because she wasn't wearing a gown, the other visitors would see and ignore the gowns and gloves, too. Every single day, we were reminding them about the PPE, and then some would reluctantly go back out into the hall and put it all on. And again, this is right near some neutropenic patients.

I'm just frustrated because it always seems like everything is pinned on the nurses. Yeah, we're right in the patient rooms and in contact with the patients, but we're not the only factor. I've learned that one housekeeping staff has already been fired for not doing a proper job with cleaning rooms, which I think is a step in the right direction, at least. Still, just yesterday, one nurse said after a supposed terminal clean of her former isolation room, a table was still visibly dirty. I feel like I have so many other things to do already besides chasing down people who aren't following proper procedure!