Archive for the ‘Infection control’ Category

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Addressing Nurses’ Urgent Concerns About Ebola and Protective Equipment

October 15, 2014

By Betsy Todd, MPH, RN, CIC, AJN clinical editor. (See also her earlier post, “Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective.”)

This is not a time to panic. It is a time to get things right.—John Nichols, blogging for the Nation, 10/12/2014

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

For years, nurses have tolerated increasingly cheap, poorly made protective gear—one result of health care’s “race to the bottom” cost-cutting. Now the safety of personal protective equipment (PPE) is being hotly debated as the Ebola epidemic spills over into the U.S.

If all nurses had access to impermeable gowns that extended well below the knee (and could be securely closed in back, had real cuffs, and didn’t tear easily); faceguards that completely shielded; N95 respirator masks that could be properly molded to the face; and disposable leg and shoe covers, we might not be having the same conversation. Yet how much protection can we count on from the garb we now have available, especially considering the minimal donning and doffing training given to most nurses?

While there is more to be learned about possible “outlier” modes of Ebola transmission, it’s pretty clear from past experience (including recent Ebola hospitalizations at Emory University Hospital and the University of Nebraska Medical Center, where no transmission has occurred) that standard, contact, and droplet precautions will virtually always prevent Ebola virus transmission. Because of the theoretical possibility that the virus could be aerosolized during procedures like intubation or suctioning, airborne precautions are usually added. (And from what we’ve seen, they’re being followed routinely, and not used only during aerosolizing procedures.)

Many organizations, including National Nurses United, are calling for hazmat-type gear and PAPR hoods (powered air-purifying respirators, which are HEPA-filtered) for staff who care for Ebola patients. Because most nurses have not used these, this more complex gear presents new challenges, especially because of the potential for self-contamination when worn and removed by untrained staff.

Specific techniques for donning and doffing PPE are not new, but many nurses have never been taught to pay attention to these details. One has only to look at staff in a contact precautions room, only half covered by their untied gowns, to understand why resistant organisms continue to spread within hospitals. Many clinicians may not have believed that their cavalier attitude towards PPE had anything to do with the next patient’s nosocomial MRSA pneumonia. During this Ebola epidemic, though, we are quickly learning that the proper use of PPE is a matter of life and death—ours. Read the rest of this entry ?

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Ebola: Infection Control Resources Make All the Difference

September 16, 2014

This post is follow-up to our widely shared post (“Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective”) by AJN clinical editor Betsy Todd. The author, Amanda Anderson, is a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. Her last post for this blog is here.

Ebola virus viron

By CDC microbiologist Cynthia Goldsmith, this colorized transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. CDC image library.

I don’t know a single nurse who likes caring for multiple isolation patients. The process of donning a new gown, pair of gloves, and mask each time you enter an isolated patient’s room is arduous and time-consuming. Personal protective equipment (PPE) clogs the garbage cans and can be hot and confining.

PPE has been in the news quite a bit lately because of Ebola. An interview with Liberian nurses by Hunter College’s Diana Mason on her WBAI radio show Healthstyles revealed that the Liberian Ministry of Health estimates 75% of virus victims are women—mostly nurses and caregivers. Nurses in West Africa might really love some of those pesky yellow isolation gowns.

Ebola can be a messy virus. Infected people have copious diarrhea and vomiting, often containing blood. The basics of care for Ebola patients should not be new to us; HIV and hepatitis can be spread in many of the same ways. We’ve got little to fear if we follow CDC guidelines for PPE and infection control. But in parts of Africa, where supplies we take for granted are scant, nurses and caregivers can’t even hold the hand of a dying patient or family member, much less clean them, without fearing for their lives.

As Mason’s interview reveals, many nurses are assigned 25 or more patients each shift in hospitals that lack electricity, running water, and gloves. (In an article for Buzzfeed, Jina Moore describes a nurse working in an Ebola ward who wears the isolation kit sent to her by the Liberian Ministry of Health. The kit includes a shower cap, gloves, and rubber bands for her wrists. Her ankles and neck are exposed, peeking out from her own short scrubs.) Read the rest of this entry ?

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Enterovirus D68: Precautions, Surveillance, Yes; Alarm, No

September 15, 2014

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

EV68-infographicAs news coverage focuses on the latest clusters of suspected—and, in some instances, confirmed—cases of human enterovirus D68 (EV-D68) as they occur in successive regions of the U.S., here’s a quick primer on what is known about EV-D68.

Is this a new, dangerous virus?
EV-D68, a non-polio enterovirus, is not a “novel” virus—the term used to describe emerging infections such as SARS and MERS. It’s more accurate to describe it as the CDC does: it is an “increasingly recognized” cause of respiratory infections, especially in children.

EV-D68 was first isolated in 1962. While reports of EV-D68 since then have been sporadic, the CDC in 2011 reported on clusters of this viral infection in Georgia, Pennsylvania, and Arizona as well as in Asia and Europe. It’s likely that there are hundreds or even thousands of EV-D68 infections every year in the U.S. But as with many other viral infections, they will range in severity, and an infection that looks like “a cold” isn’t usually brought to the attention of a health care provider.

According to the CDC, most enterovirus infections are actually asymptomatic; this may be the case with EV-D68 as well.

Diagnostic testing for EV-D68 involves RT-PCR and gene sequencing. Most hospital labs therefore are unable to test for it. Some readily available diagnostic tests do identify “enterovirus” but don’t type the virus further; some tests misidentify EV-D68 as a rhinovirus. (Specimens from suspect cases in the U.S. therefore almost always are handled by CDC labs.)

Because treatment is symptomatic, the lack of a widely available test for EV-D68 is not an issue for the patient. But as more sensitive and specific tests become more widely available, more cases will be correctly identified, and we can learn more about the course of the disease.

Genetically similar to cause of common cold.
EV-D68 belongs to a genus of viruses that includes polioviruses, rhinoviruses, coxsackieviruses, and echoviruses. It is not “polio-like.” Biologically and epidemiologically, it is most similar to human rhinoviruses, which cause the common cold.

Severe respiratory infections in children? Visitor restrictions?
While we are seeing reports of severe respiratory illness in patients with suspected or confirmed EV-D68, it should be noted, as the CDC points out, that many/most of those hospitalized with this and other respiratory infections are people with chronic conditions such as asthma or other health issues. Visitor restriction is a routine response in any hospital when there is a cluster of respiratory infections in the community. Read the rest of this entry ?

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Labor Day Déjà Vu – Nurses’ Views of Work, Then and Now

September 2, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

Photo from otisarchives4, via Flickr.

Photo from otisarchives4, via Flickr.

If you like nursing history, there’s a new blog called Echoes and Evidence by the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania. (The first post draws on a 2005 AJN article on how nurses over 100 years ago responded to a series of typhoid epidemics in Philadelphia.)

Because AJN is over 100 years old (115 next year), it has a rich archive that I’ve been digging into recently (see my post from last week about an article Virginia Henderson wrote for AJN 50 years ago, and from late June, about nurses and D-Day).

So it seems especially fitting, just after Labor Day, to point to a January 1953 article by Sister Mary Barbara Ann, a former president of the Iowa Nurses Association (INA), which detailed findings from a survey of 223 general duty nurses in Iowa to learn their opinions of the hospitals in which they worked. I won’t present her exact findings here—we’ve made the article free until the end of September: just click through to the PDF. (Subscribers can always access the archives.) But here’s how she summarized what she learned:

“They [general duty nurses] are asking only for reasonable working conditions in which they can feel happy and secure. They are pleading for recognition and appreciation for what they are as persons and as nurses. They are asking for personnel policies which they have a voice in formulating, which are written and available to all, and which will be strictly adhered to by both nurses and administrators.”

Sound familiar?

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Much Ado About a Fist Bump Study

August 4, 2014

hands touching illustrates post about fist bump study and germsBy Karen Roush, clinical managing editor

In this world of evidence-based care, is there anything to be said for common sense? Last week a study was published in the American Journal of Infection Control that found that a fist bump transmitted fewer organisms than a handshake.

Really? We know that hands carry untold numbers of organisms. We know that skin-to-skin contact transmits organisms. We know that duration of contact plays a role in how many organisms are transmitted. Did we need a study to tell us that hand-to-hand contact with less surface area for a shorter duration of time would transmit fewer organisms?

With the attention being paid to this study, you might think it was a major discovery. Why? Because it’s fun to talk about fist bumps versus handshakes? (David Letterman seems to think so; he recently opened his monologue with a joke about the study results.) Because we kind of like the visual of everyone, from the staid to the cool, walking around giving fist bumps?

Or perhaps, on a serious note, because we’re still struggling unsuccessfully to get people to simply wash their hands and are ready to jump on anything that mitigates the risk of transmission when they don’t? (Adherence to hand hygiene guidelines among health care workers remains low. Read our March 2013 CE–Original Research feature, in which authors Kate Stenske KuKanich and colleagues describe their evaluation of a hand hygiene campaign in an outpatient oncology clinic and an outpatient gastrointestinal clinic.) Read the rest of this entry ?

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Tragic Plane Crash, Truvada Concerns, Changing Infection Rates: AIDS/HIV Issues in the News

July 21, 2014
Truvada

Truvada / via Wikimedia Commons

By Jacob Molyneux, AJN senior editor

There have been a number of recent high-profile news stories as well as some notable new research related to HIV/AIDS and its treatment and prevention.

First, AJN would like to add its voice to those expressing heartfelt regret at the deaths of a number of prominent and widely respected HIV advocates and researchers in the Malaysia Airlines jet that appears to have been shot down over Ukraine last week.

The Truvada controversy. Those who who died on the plane had been heading to an international conference in Melbourne, Australia, where one of the hot topics under discussion would be the pros and cons of the continuing expansion of the use of the antiretroviral drug Truvada beyond the treatment of existing HIV infection to long-term prophylactic use by the uninfected.

The topic is particularly timely here in New York where Governor Cuomo last week announced that New York State would make Truvada a centerpiece of its HIV-prevention strategy. The drug, taken every day, is more than 90% effective in preventing infection, but, as an NPR story recently described, a number of experts have raised concerns about widespread long-term use of Truvada for HIV prevention, noting

  • serious potential side effects of Truvada.
  • the $1,300/a month cost of the drug.
  • the reduction in the use of condoms by some of those taking Truvada, which could lead to higher rates of other sexually transmitted diseases.

Read the rest of this entry ?

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AJN’s July Issue: Diabetes and Puberty, Getting Patient Input, Quality Measures, Professional Boundaries, More

June 27, 2014

AJN0714.Cover.OnlineAJN’s July issue is now available on our Web site. Here’s a selection of what not to miss.

Diabetes and puberty. On our cover this month, 17-year-old Trenton Jantzi tests his blood sugar before football practice. Trenton has type 1 diabetes and is one of a growing number of children and adolescents in the United States who have  been diagnosed with either type 1 or type 2 diabetes. The physical and psychological changes of puberty can add to the challenges of diabetes management. Nurses are well positioned to help patients and their families understand and meet these challenges.

To learn more more about the physical and behavioral changes experienced by adolescents with diabetes, see this month’s CE feature, “Diabetes and Puberty: A Glycemic Challenge,” and earn 2.6 CE credits by taking the test that follows the article. And don’t miss a podcast interview with the author, one of her adolescent patients, and the patient’s mother (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article). Read the rest of this entry ?

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