The Real Nurse Jackie

Breaches of basic infection control practices — why?

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Basic infection prevention and control isn't rocket science. It is essentially following some general guidelines. Some of them pretty simplistic.

Wash your hands before and after every patient contact; don't touch something nasty and then touch other stuff; don't wash-up C-diff diarrhea up off the floor and then use that same mop and water on someone else's floor; don't use a single-dose/single-use vial (SDV) on more than one person.

Not too hard right? You would think, but …

On July 12, the Centers for Disease Control and Prevention released a report about life-threatening outbreaks that occurred when healthcare providers used medication from SDVs for multiple patients. At least 10 patients contracted life-threatening staph or MRSA infections and had to be hospitalized. Scary stuff.

The clinicians in both of the outbreaks (one on Arizona and one in Delaware) reported difficulty obtaining the medication type or vial size that best fit their needs. And why? If you ask me, it's more greed than system issues.

Let's review, shall we? Single-dose/single-use vials were used for multiple patients. Why? These weren't nursing homes where we're losing 11% per bed in reimbursement and we're trying to scrape together pennies. These were outpatient pain clinics where they were getting reimbursed per-procedure — big time.

The outbreak in Arizona originated in a pain clinic. They couldn't obtain small vials of contrast material so they used a 10ml vial of contrast material, mixed it in two large vials of saline and THEN used those vials multiple times for multiple patients. Yuck!

Dude, throw the extra stuff away. (Size in this case does NOT matter). Geesh!  So why do it?

Now the case in Delaware is a bit more complicated. That happened in an orthopedic clinic. This time, access was an issue. Not just size, but not being able to get enough of the “stuff” in the right size. When a drug shortage limited the supply of 10ml SDVs, staff members used 30ml SDVs of bupivacaine for multiple patients. (Joint injection procedures typically required 1–8ml of the anesthetic.) Again, penny-wise and pound-foolish. 30 ml SDVs of bupivacaine were not in short supply, so they didn't need to use them multiple times.

Now, I know that we on long-term care have had outbreaks of hepatitis B when using single designated blood glucose monitors for multiple patients. A huge breech of basic infection control practice. And glucometers are covered durable medical equipment so we don't have to borrow. Greed isn't the case here. It's probably just laziness or lack of education.

But is it clear that the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration say, “One to a customer please!”

What about outbreaks of (one of my least favorites) C-difficile diarrhea? How hard is it to follow contact precautions? I guess hand washing, changing gloves and taking off those nasty gloves before going out of the resident's room and into the hallway and touching everything is just way too hard.

But what is harder is cleaning up non-stop pooh from every resident in your facility, washing bottoms, changing sheets, extra environmental service cleanings — I won't get started on not changing bucket water and then going to another unit — all the while having resident's with excoriated bottoms becoming dehydrated, getting delirium and having to go to the hospital because someone didn't follow basic infection control practices.

So whether it is acute care or long-term care, greed, laziness, lack of education, whatever … we need to get a grip and do basic infection control right. There is no cutting corners here, pandemically speaking!

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. 

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who also is the director of clinical affairs for AMDA - The Society for Post-Acute and Long-Term Care Medicine. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.


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