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Posts Tagged ‘mrsa’

So, a question for the nurses (and physicians) out there:

As I’ve been going about my business, inevitably, maybe 30%-40% of the time, a patient will be on some sort of precautions:  MDRO, VRO, Airborne, Droplet, Enteric, etc.  Whenever I go into these rooms, I always gown up, put on gloves, and maybe mask (if indicated).  More often than not, the RN or MD assigned to that patient will do the same … but every now and then an RN or MD will enter the room with, say, only gloves, and comment to me, “Oh, you externs and students, always so proper with the gowning up!”

Now, I realize that, sometimes, the patient might be on unnecessary precautions, or the RN or MD might know something I don’t know (labs, etc.), but the question remains:

Why do some RNs and MDs do this?  Is the risk for spreading any pathogens lower than I’m assuming?

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Today was spent in the hospital, and I was assigned an interesting patient:  49-year-old female with history of recurrent wound infection.  Complicating this was the fact that the patient spoke very little English.  And the patient was on contact precautions.  And the patient wasn’t very happy.  Anyway, here’s a few thoughts about what transpired this lovely, rain-soaked, chilly, dreary, filled-with-awful-miserable-weather kinda day:

  • MRSA:  contact precautions means that the patient was suspected of carrying an antibiotic-resistant organism.  With these patients there is a very large sign on the outside of the door that states “MDRO” (meaning Multiple Drug-Resistant Organism”).  This tells anyone going into the room that he or she has to take very specific precautions before entering, ie, I had to first put a gown on, then put on gloves.  After this I could enter.  And this has to be done every time you enter the room.  Then, on the way out, you have to do the reverse and throw everything away:  take off gloves, take off gown, throw away.  Anything that was in the room that you take out of the room has to be wiped down thoroughly with Clorox Wipes (this means any of my pens, penlight, stethoscope [although there is a disposable stethoscope in the room that stays in the room], and any machinery such as the Dynamap [the machine that takes blood pressure, pulse ox readings, etc]).  Anything that you want to throw away has to be thrown away inside the room — today I threw away a used water carafe.  First thing I did when I got home was take a hot shower — felt like I needed to get anything off of me, even though this was probably not the case.
  • Wound care:  my patient had some very serious wounds going on, and right before I left for the night, I got to observe my nurse performing wound care — it was really awesome.  I expected it to smell worse, but it didn’t smell so bad.  We removed the old dressings on 2 of the wounds, took off the Xeroform (which is a dressing with petroleum in it), and then cleaned around the wound with regular gauze.  Then we put new Xeroform on, put new gauze on, and taped it down.  Not much to it, really.  The other wound was left open to the air to heal, so we cleaned that with alcohol wipes only (per doctor’s orders).  My nurse said she had never had orders to use only alcohol before.
  • General craziness:  during the middle of the shift, there were about 4 admissions.  All the nurses were going crazy, because apparently an admission takes quite a bit of work and time.  They have to drop everything and go take care of the new patient to get him or her settled.  Understandable.  The nurses were pretty upset about this — seemed to be a general anxious feeling coupled with a small amount of animosity towards the SICU and PACU for sending so many patients our way all at once.  One nurse’s patient was in the middle of bleeding profusely, and he was asked to take his new patient and get him admitted.  Hmm …
  • Accu-Chek:  I learned how to check someone’s blood sugar with the Accu-Chek tonight.  Pretty easy, actually.
  • General helplessness:  a lot of us were talking at various times of the day about how we really wish we could be more helpful and self-sufficient.  We all realize we’re only 3 weeks into our first rotation, so none of us really knows anything about how to be a nurse.  However, that doesn’t make us feel any more useful on the floor.  For example, my nurse asked me today, “You know how to do Accu-Chek?”  I had to tell her no, but then she did it and I observed, so now I know how to do it.  Next time I can answer with a resounding “Yes!”  Of course all of us are feeling like we want to know everything immediately … in time, in time.
  • Handwashing:  it’s true what they say — handwashing is everything.  Especially since I had a MRSA patient tonight, I was washing my hands every 5 minutes (hyperbole, yes, but not that far off).  My hands have started to become very cracked and dry and brittle and chapped and generally super-yikky feeling.  I’m starting to use real lotion at home, because I can’t use it in the hospital, so hopefully they’ll stay in okay shape.

And that’s about it for the Thursday night report.  Tomorrow’s post might be about an ethical dilemma I faced recently.  Good night!

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