Friday, March 25, 2011

Hospital Stay Infection History

The History of an Infection

I introduced myself to the nurse as a friend of the patient. I then humbly ask, would you mind washing your hands before you treat her. “I’m not treating her” she snaps at me. “I’m just getting her vitals”. The patient lies helplessly in her bed, bloodied through her bandages under the warm blankets and sheets from a large surgical site - that I am supposed to hope doesn’t get infected through prayers?

The nurse mumbles something about all she does all day is wash her hands and use gel but that’s not enough. I carefully wash, with disinfectant wipes, the door knobs that must be touched to open and close the doors. I wash the whole doors opening in case that was touched and then everything the nurse touches.

An hour later, the cleaning woman comes in and wearing green gloves, empties the garbage by the door and in the bathroom. I hear the spray bottle in the bathroom then the wet, dirty mop glides across the floor. She uses the same gloved hand to open the doorknob of the bathroom and turn on the water in the sink. The same gloved hand that emptied the garbage, handled the dirty mop and picked garbage off the floor. As she leaves, I follow with my own gloved hand now and grab a long string of sanitary wipes off her cart. I asked her permission and she gladly agrees.
Bloody Container
was like this for days

This is my 2nd day (30th hour) at this hospital that I witnessed this “cleaning” of my patient’s room and the second trip to this hospital in 2 years where the same behavior took place. I had to ask the cleaning woman to wipe the blood off the sharp’s container, not because I was afraid for the germs associated with it to infect anyone but because the site of it was unsettling. She did on the second day.

On a trip to the cafeteria, in this small community hospital, I counted 4 hand sanitizers which were empty. One was broken.

On my third day, a little tired from sleeping on a chair, in sweat pants, a flannel shirt, no make up and hair messy, I visited the administrative office of infection control.  I knocked and a man opened a door of a room no bigger than a large closet. I asked him if I can see his hospital infection rates. I had my friend and colleague in Florida do a search on-line of this hospitals infection rates and it came up fairly low.  The infection rates were worse than the average in this state and throughout the country. I thought I would ask the administration if they would explain it or give me different numbers. “I can’t do that” he explained that it would have to go through his superiors. I told him that I looked at the public information and his hospital didn’t look very good. He agreed and was familiar with the websites I offered and shared another website with me to use. He cleaned off a chair of stacks of papers and asked me to sit down. I asked if I can share what I have seen.

He allowed me to share in detail some of what I saw and told me he is the whole infection control department. There is a large staff turnover so people who are trained to clean leave and train the next one who leaves and trains the next one. He has no middle management to oversee it. This hospital also filed for bankruptcy last year.   I asked him if he was aware of the push back from nurses being asked to wash.  "You give out literature in the admission packets that says we are supposed to ask" I explained to him.  I asked if he knew that the country is encouraging patient participation.  "I know" he said.  I asked if he was aware of NPSF, IHI and The Joint Commission.  "Yes, I know" he said with a shrug.

I found myself sympathizing with him as a human being, being honest and stuck in a dilemma. I can’t imagine that he wanted his department to be the cause of problems. But I can see, he was at a loss of what to do.

Reporting him to senior management would probably cause him to either lose his job or cause him more grief. I can’t imagine a hospital in this condition could suddenly come up with money to pay more staff, fix the broken hand sanitizers or train the people appropriately. My guess is that his superiors know the problems but are not addressing them or, are too disconnected from the front line staff to have any clue. Either way, I can’t imagine that they want to make changes – or they would.

What this hospital needs is a camera crew to come in and show the public what they are getting into when they enter this hospital. I would not want to see this hospital, or any hospital close. I want to see them improve care. That’s all anyone wants.

After my own 3 day stay in the hospital, I can see firsthand where hospitals are still failing us. We are vulnerable when sick but the senior staff in hospitals will not make themselves as vulnerable as I was when hospitalized. Or, any patient is. They will go in to their hospital with the words Director of Quality, CEO or Nursing Director taped to their forehead. They will be treated differently than someone like myself who went in as a “regular” patient, unprepared as to what I found during my own hospitalization or the patient / friend who entrusted me to keep her safe during her one week stay.

There is a disconnect between the administration who makes the decisions and the people who work at the bedside. The problems need to be addressed. I don’t have all the answers but I do have some.

I left the infection control office and headed back to my friends room frustrated that nothing there will change. As I passed the room next door to her it was closed off to visitors. That patient was infected.
One of 4 empty sanitizers
I found just from a room
to the cafeteria

A broken hand sanitizer



11 comments:

Pat said...

Ilene,

I think what you're doing is great - documenting, taking photos, plus understanding the down side sometimes of "blowing the whistle", and how getting that man fired would not solve anything.

You touched on the need for a "camera crew" to expose the situation. Understand you already have one. What would happen if everyone started recording images of empty hand sanitizer dispensers, bloody equipment in patient rooms, inadequate cleaning procedures and inappropriate responses of caregivers? I'm thinking the big news shows would love it, because we would be doing the work for them. Video doesn't lie or exaggerate. It was cell phone images and videos that ultimately won concessions and lawsuits for airline passengers.
Such a campaign would need a point person.

Just my 2 cents.

Bart Windrum said...

Ilene, all I can offer is more fishing. Perhaps you've seen my IHI PA or blog post about moving away from "wash hands" to "disinfect hands"? Maybe a similar shift ought to occur. "Treat" is more appropriate than care, but your experience clearly shows that sometimes even "treat" may not be the best term. Maybe "before you do what you're here to do"?

Next, and this might be a risky move for you as a PULSE person, have you considered going further with the pictures? First, by making picture sets of closeups and wide angle shots that put the closeup in recognizable perspective (that is, as being takin in XYZ facility). Next, finding a place beyond the blog to publish them—like the newspaper...?

What do you think?

Lori Nerbonne said...

Ilene,

I just provided a link to your blog-post in my comment under this recent article in the LA Times. Great post you have...keep these 'reality stories' coming. (Maybe a new reality show that follows patients around in the hospital is what we need)

http://latimesblogs.latimes.com/lanow/2011/03/superbug-spreading-to-southern-california-hospitals.html

Margo Corbett said...

Ilene,

Keep up the great work. We can't do enough to raise awareness and spur action.

I had surgery in January - relatively small incision - in and out the same day. I just finished my 3rd round of antibiotics for the infection I acquired in the operating room.

Since I had less than a minute to look around before they knocked me out I haven't a clue what happened that caused it.

How can we find out what goes on in ERs?

Lisa said...

My grandmother always said, there was no job worth doing unless you were doing it right. That definitely applies here.

Cari Oliver said...

Ilene - Kudos to you for writing this important blog.

My view is that you just lean forward with a bottle of gel disinfectant in your hand and say, "We're asking everyone who comes into the room to use this." Then you push the lever.

People automatically open their hands when they see that bottle close to their hands. Try it.

No upfront talking about "have you" or "would you." Just action. If you miss the hands the first time, then say, "Oh, so sorry, here . ." And push again.

Anonymous said...

I wish that you could get the publicity this needs. Really, any CNN, or network program (20/20, etc) need just spend 24 hrs in an ER or on a corridor to see. Though cameras - unless hidden - would place all on their best behavior. But how "best" could it be, with the same dirty mops, gloves, broken purls, etc

My own story is of a friend mistakenly diagnosed from admission. She came in severely dehydrated and confused. The only thing that had changed in her routine was a mega dose injection of mega steroids for bronchitis, mind you, to be followed by more mega dose pills

Severe diarrhea followed, her confusion kicked in quickly (combo steroid daffiness, offness we've all seen or heard of, officially known as steroid "psychosis"). Now she was also off of taking her two daily regular MEDS she had been on for years

Her family takes her to the ER. She is ambulatory but woozy. They tell the drs about the steroids, but the drs are more interested when her brother says he is afraid she has taken too many painkillers for recent back surgery she had

bingo! They label her a substance abuser. She does not get hydrated for over 25 hrs and only because her sister keeps insisting. They treat her on the lowest rung

No catheter, no bedpan, no bathroom access, they let her lie in her feces, urine and menstrual flow. Her sister returns hours later to find her lying in the excrement

It gets worse. Now that they have her labelled (mislabelled, grossly) she cannot get painkillers needed for her back. She cannot get her daily MEDS and now IS in a state of withdrawal from them. It gets worse but enough said

Damn hospitals and doctor, nurses, what to do!?

pharmacy said...

when it comes to sanity in a hospital I think that that has to be strictly regulated and control because a infection can be spread and affect the whole hospital in a matter of hours

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