Infection Contol in the U.S.

[VentMedic]

After reading the thread about Muslim Women Medics in the U.K., I see at least one country has taken an aggressive effort to control infection with a few common sense measures. In the U.K., the white lab coats worn by doctors and other professionals have been ruled unfavorable in the healthcare setting. In the U.S., only in the higher level NICUs and surgical ICUs have the "no sleeves or jewelry below the elbow" been enforced adequately.

The U.S. has put a strict enforcement on handwashing but not equally across the board. EMS is still lagging there. Most believe gloves will protect them from everything and buy the super heavy duty gloves only to use them as a notepad with a pen and the possibility of poking holes in them. They also use one pair to load, drive, deliver and chart at a nurses station while continuing to wear them until they are back in their truck after walking through the entire hospital.

Hospital staff that have been diligently working to control infections at both the sending and receiving hospitals are now seeing other possibilities as to where these infections are coming from. The CCT ventilator that infected several patients a couple of years ago was an easy one to figure out. There are now hospitals that are conducting their own surveys on transport teams. Some "spotters" will tell the EMS teams to remove their gloves and wash their hands especially when they are as the coffee pot wanting to get a cup for the road. Even without being one of the "spotters", that is my pet peeve and I will slam the lounge door in an EMS crew's face until they remove the gloves they just transported with and wash their hands. I especially don't like to hear "but they don't look dirty".

Unfortunately, EMS education has put little emphasis on infection control due to time constraints and/or it was always considered "not their problem". "That is something for the hospitals to worry about". We were told that even clean (not sterile) technique didn't matter in prehospital because the patient would be covered by antibiotics. Guess where all that antibiotic coverage has gotten us?

So, my questions to the audience here:

How often do you wash your hands?

How often do you change gloves?

Do you walk outside the patient room still wearing gloves?

Do you go to the nurses' station still wearing the gloves you touched the patient with?

Do you make notes with a pen on your gloves?

Do you wipe your pen and stethoscope with a disinfectant before putting it back in your pocket or around your neck?

Do you reach in your jacket or pants pocket with gloved hands during patient care?

Do you consider your gloves dirty only if visibly soiled?

Do you clean the steering wheel frequently?

Do you wear long sleeved shirts?

Do you wear a jacket?

How often do you launder your jacket?

If you have long hair, do you keep it pulled back? Or, do you have to push it back while working on a patient with your gloved hand?

Do you treat all patients with the same infection potential either for their safety or others?

Do you wear a mask if you have a cold around an immunosuppressed or elderly patient?

These questions are asked of all heathcare professionals inside the hospital on a regular basis.

[Dustdevil]

Some "spotters" will tell the EMS teams to remove their gloves and wash their hands especially when they are as the coffee pot wanting to get a cup for the road. Even without being one of the "spotters", that is my pet peeve and I will slam the lounge door in an EMS crew's face until they remove the gloves they just transported with and wash their hands. I especially don't like to hear "but they don't look dirty".

Unfortunately, EMS education has put little emphasis on infection control due to time constraints and/or it was always considered "not their problem". "That is something for the hospitals to worry about". We were told that even clean (not sterile) technique didn't matter in prehospital because the patient would be covered by antibiotics.

That's why I would never hire a medic who had not ever taken microbiology. And that's why EMS is a joke in the eyes of the medical professions.

How often do you wash your hands?

By the book. Before and after each and every patient, as well as multiple other times throughout the day.

How often do you change gloves?

I rarely wear gloves. But when I do, I remove them as soon as I step away from that patient, replacing them before returning to patient care.

Do you walk outside the patient room still wearing gloves?

Nope. Not unless I am carrying a specimen or other contaminated objects with me.

Do you go to the nurses' station still wearing the gloves you touched the patient with?

No.

Do you make notes with a pen on your gloves?

Yes, occasionally. More often, I write on tape on my leg.

Do you wipe your pen and stethoscope with a disinfectant before putting it back in your pocket or around your neck?

Gotta admit, I don't do this one immediately, unless there is visible mung on the item. I do disinfect them in between patients, but not always before putting them back on my person. Good point.

Do you reach in your jacket or pants pocket with gloved hands during patient care?

For that very reason, I don't carry anything in my pockets that I need on a scene, unless you count shears strapped into the "EMS pocket".

Do you consider your gloves dirty only if visibly soiled?

No. There is a reason they call it MICRObiology.

Do you clean the steering wheel frequently?

Yes. I keep a bucket of disinfectant wipes in the cab for that very reason.

Do you wear long sleeved shirts?

Yes, but I usually have the sleeves rolled up mid-forearm, unless it is wicked cold. If there is a significant chance that sleeves (or any other part of the shirt) was contaminated, I always have a spare to change into.

Do you wear a jacket?

LOL, that can't be a serious question. I wear a parka anytime it drops under 70 degrees F.

How often do you launder your jacket?

At least weekly. More often if there was risk of contamination.

Do you treat all patients with the same infection potential either for their safety or others?

No. I don't think anybody does. Any hospital that says they do is lying. If you get extra info on a patient's infection or immune status, you are obviously going to take extra precautions. That's why only some patient rooms have gown and mask areas in front of them.

Do you wear a mask if you have a cold around an immunosuppressed or elderly patient?

I don't work those days, and neither should you. You're not doing anybody any favours by exposing your partner and everybody else to your germs.

[mobey]

So, my questions to the audience here:

How often do you wash your hands? After each call

How often do you change gloves? Every call, at traumas I layer and change before I touch the stretcher, doors to the rig etc.

Do you walk outside the patient room still wearing gloves? Yes

Do you go to the nurses' station still wearing the gloves you touched the patient with? No

Do you make notes with a pen on your gloves? No

Do you wipe your pen and stethoscope with a disinfectant before putting it back in your pocket or around your neck? No, after each shift

Do you reach in your jacket or pants pocket with gloved hands during patient care? Never

Do you consider your gloves dirty only if visibly soiled? Nope I consider them dirty as soon as I put them on

Do you clean the steering wheel frequently? Daily

Do you wear long sleeved shirts? In winter

Do you wear a jacket? In winter

How often do you launder your jacket? After each 4 day rotation

If you have long hair, do you keep it pulled back? Or, do you have to push it back while working on a patient with your gloved hand? I have short hair...Which reminds me I should be washing my touque more often.

Do you treat all patients with the same infection potential either for their safety or others? I have been working on this recently but as of now NO.

Do you wear a mask if you have a cold around an immunosuppressed or elderly patient? No

These questions are asked of all heathcare professionals inside the hospital on a regular basis.

I realize this was geared at US but I answered anyway.

I recently did a fall with a closed hip fracture, when I got to the Pt. I realized I Was not wearing gloves. I didn't stop anyway (such a sweet old lady).

Long story short, Pt. was MRSA positive and I had a cut between my fingers. Stupid Stupid Stupid.

I am now very aware of infection control and greatful I didn't have to contract Hepatitis to open my eyes up.

Great post.

[Dustdevil]

I have short hair...Which reminds me I should be washing my touque more often.

LOL!

I had all sorts of disturbing visions going through my mind before I realised you hadn't said TONGUE.

[AnthonyM83]

How often do you wash your hands?

With soap and water, after any call where where I saw anything dirty, patient looked less than clean, sick-type call, touched hospital equipment without gloves.

Either way, I'm constantly using the evaporating alcoholic disinfectant gel at the hospitals after everything I touch.

How often do you change gloves?

New pair for approaching patient, when I get into ambulance, and when I get out of ambulance at hospital (I take them off when pushing gurney to ambulance to keep gurney cleaner...try to remember sides are never clearn people people rest their feet on gurney sides while in ambulance).

Do you walk outside the patient room still wearing gloves?

Not really, unless I'm pushing a dirty gurney out or still cleaning up. Never to nurse's station unless I'm grabbing equipment that's deemed 'dirty' already.

Do you make notes with a pen on your gloves?

Yes, good point. But that's usually the driver who makes notes, while the attendant is interviewing patient.

Do you wipe your pen and stethoscope with a disinfectant before putting it back in your pocket or around your neck?

Never carry it on me. On-scene bag equipment doesn't get cleaned often. Ambulance equipment cleaned at beginning of day or after a 'dirty' patient.

Do you reach in your jacket or pants pocket with gloved hands during patient care?

Unfortunately, sometimes for my mini-light (I try to clip it on outside if it looks like I might use it on that call, though) or shears in my boot or extra sap pocket).

Do you consider your gloves dirty only if visibly soiled?

Eww, no, don't think anyone here does.

Do you clean the steering wheel frequently?

No, only at the beginning of the day, b/c I don't previous crew's habits.

Do you wear long sleeved shirts?

Not available for us.

Do you wear a jacket?

Only when it gets seriously cold. I consider it contaminated, though. I never wash it...but use it so infrequently still has originally crispness to it. I hate jackets, feel constricted and bulky.

Do you treat all patients with the same infection potential either for their safety or others?

No. For example, many patients you have to press up against you to carry them. Or if an otherwise healthy looking patient with what seems like a cold is coughing under their NRB Mask, I won't wear a mask myself. But if they have Hep/TB, etc, I'll put a mask on myself in addition to the NRB on the patient.

Do you wear a mask if you have a cold around an immunosuppressed or elderly patient?

No....though I'm wearing gloves and I don't touch my face with gloves. I cough into my shirt. I guess still the risk of spitting while you talk...

[JPINFV]

How often do you wash your hands?

I tried to wash my hands or use hand sanitizer between every call. That, unfortunately, didn't always happen.

How often do you change gloves?

Extremely often. I always [99% of the time on the ambulance] wore gloves when touching a patient and always [100%] removed them prior to doing paperwork/getting out of the ambulance/etc. I did get into the habit of changing gloves then doing paperwork so that if something happened I could work on the patient while keeping my paperwork as clean as can be.

Do you walk outside the patient room still wearing gloves?

If I did, which happened from time to time since half of have SNF nurses couldn't be concerned enough to go to the room, I was conscious of where my hands where and did my best not to touch anything.

Do you go to the nurses' station still wearing the gloves you touched the patient with?

Only if I need to ask a question or request assistance. If I'm getting/giving paperwork, getting a signature, or anything where I wasn't going to be returning immediately to the patient, then I didn't.

Do you make notes with a pen on your gloves?

No.

Do you wipe your pen and stethoscope with a disinfectant before putting it back in your pocket or around your neck?

Not as much/often as I should have. From time to time I did.

Do you reach in your jacket or pants pocket with gloved hands during patient care?

No. I didn't carry anything outside of extra gloves that I would need anyways in my pockets.

Do you consider your gloves dirty only if visibly soiled?

Gloves are soiled by default after they touch the patient. Visibly soiled gloves were handled with more concern though.

Do you clean the steering wheel frequently?

When I was driving, I tried [75%+] to wipe down all of the front [steering wheel, microphone, dash, seatbelt] at the start of the shift. I never wore gloves while driving though, clean gloves or dirty.

Do you wear long sleeved shirts?

No, see below.

Do you wear a jacket?

From time to time depending on the weather, less than 25% of the time.

How often do you launder your jacket?

Rarely.

Do you treat all patients with the same infection potential either for their safety or others?

Standard precautions were used at all times. Additional precautions dependent on the patient's history [MRSA/VRE/etc] as well as symptoms [vomiting+possible airway management concern=glove/gown/goggles]

Do you wear a mask if you have a cold around an immunosuppressed or elderly patient?

No. The ambulance didn't have enough masks on board to make this a realistic possibility to begin with.

[mrmeaner]

LOL!

I had all sorts of disturbing visions going through my mind before I realised you hadn't said TONGUE.

Imagine my surprise when I read definition #3 while I was trying to figure out what the hell at touque was!