A nurse’s 5 tips to “never” get sick....

I hesitate to say I never get sick because whenever you say never, it’s the equivalent to shouting out, “Here I am infectious world! Come and get me!”

It’s the horror movie equivalent to saying, “I’m going to go check this out alone. I’ll be right back.”

It’s the … well, you get the idea. Never say never.

I would say, however, that I rarely get sick. I think part of this is because I spent most of my first year of nursing sick all the time. After a year of coughs, colds, vomiting, and the like, my immune system just got better at the whole immunity thing. But I also think that the following tips may have helped:

1. I am crazy about washing my hands. I carry antimicrobial hand sanitizer everywhere. In every purse, in every gym bag, in every nook and cranny of my house. I even carry it in my car and I sanitize when I get in the car from anything…the grocery store, the gas station, ALL THE TIME!

2. I don’t wear my work shoes in the car or in the house. They stay in the garage, on the front porch, or in the trunk of my car.

3. I try to be SUPER aware of touching my face. Before I do touch my face, eat, put on lipstick or anything I…yes, you guessed it, sanitize.

4. I take a multi-vitamin every day and try to drink at least one liter of water. I know what you don’t use you pee out, but it just makes me feel better.

5. I exercise at least three times per week. It is good for the mind and body. And, I think, for the immune system!!

Fellow nurses, what are your tips to “never” get sick?

BY REBEKAH CHILD

Lesser Known C-Diff turns out is more of a Hospital Treat than MRSA.....

There's good and bad news on the "superbug" front. In community hospitals in the Southeast, an easily spread bacterium appears to have overtaken the widely feared MRSA as the most common hospital-acquired infection. But a pilot project in Ohio found that pushing hard on simple things such as hand washing and thorough cleaning can lower rates of that bug significantly.Known as Clostridium difficile, or "C. diff," the bacterium resides in the gut, is spread by contact and can cause painful intestinal infections and in some cases death. It's primarily seen in those over 65, and relapses occur in a fourth of patients, despite treatment.More than 90% of cases happen after antibiotic use, when thC-Diffe healthy flora of the gut are destroyed and C. diff can take up residence.C. difficile was 25% more common than MRSA in a study of 28 hospitals in the Southeast, says Becky Miller, an infectious-disease researcher at Duke UniversityMedical Center in Durham, N.C. The proportions nationwide aren't known.MRSA "was the big bad pathogen in hospitals," but C. diff has overtaken it, Miller says.

She worked the study by looking at C. difficile ra tes at community hospitals in the Duke Infection Control Outreach Network. The data were presented over the weekend at the Fifth Decennial International Conference on Healthcare-Associated Infections conference in Atlanta.Rates of MRSA, or methicillin-resistant Staphylococcus aureus, have been falling nationwide as hospitals increased infection control work, says Jose Cadena, a professor of infectious disease at the University of Texas Health Science Center at San Antonio. MRSA causes serious skin and soft tissue infections. C. diff rates doubled between 1996 and 2003, research has shown.Each year in the USA, more than 28,000 people die of C. diff, according to the Centers for Disease Control and Prevention. The breakdown is:• Hospital-acquired, hospital-onset cases: 165,000 patients, $1.3 billion in excess costs, and 9,000 deaths• Hospital-acquired, post-discharge (up to 4 weeks), 50,000 patients, $0.3 billion in excess costs, and 3,000 deaths.• Nursing home-onset cases, 263,000 patients, $2.2 billion in excess costs, and 16,500 deaths.That is why work in Ohio is so promising. A carefully monitored study of a quarter of the state's hospitals showed that following strict guidelines on hand washing, contact isolation and cleaning caused the number of cases to fall from 7.7 per 10,000 patient days in the hospital to 6.7 between the first and last half of 2009, says Julie Mangino, a professor of internal medicine at Ohio State University Medical Center in Columbus, Ohio."One of the units which was very vigilant had no new cases," she says.

The procedures aren't rocket science: "hand washing before and after room entry, compliance with gown and glove rules and meticulous cleaning," she says. But the researchers actually set up observers, to make sure they were happening. That made the difference.While prevention may seem a no-brainer, it's anything but.C. diff is hugely expensive to treat. Each case of hospital-acquired C. diff is estimated to cost between $4,000 and $9,000 to treat, she says.Many other states also are targeting C. diff prevention, using federal stimulus funds. Ohio and New York were first, but there are about a dozen coming, says the CDC's Nicole Coffin.C. difficile is especially difficult to stop because in addition to being a bacterium, it can exist in a dormant spore form, which can survive for weeks or months on hard surfaces, then begin multiplying when ingested. The alcohol-based hand foams that have become ubiquitous in hospitals don't kill it. It doesn't even appear that soap and water kill the bacteria when it's in spore form.

"But some people think just the physical process of washing gets it off your hands," says Neil Fishman, president of the Society for Healthcare Epidemiology in America.Hospitalization is a double whammy, both because the bacteria can become resident in a given facility and contaminate others and because people in hospitals are already sick and have lower resistance.Judicious antibiotic use is another key factor in lowering rates, says Coffin. "Good" bacteria in the gut can keep C. diff in check. But antibiotics can wipe out those good bacteria, allowing C. diff to flourish.In general, it's hard to convince individuals that they should not take antibiotics unnecessarily, because the threat is a general one — it might in the future render that antibiotic less effective against disease. But in the case of C. diff, it's very immediate. "If you're being treated with antibiotics for something else, you're at higher risk for C diff. It's a big reminder to clinicians that they need to make sure that you're using antibiotics appropriately and judiciously.

Clostridium difficile: Trouble for adults and children....

http://www.sciencephoto.com/

CLOSTRIDIUM DIFFICILE ...infections (CDIs) aren't new. Historically, CDIs were diagnosed in older adults who were taking antibiotics, had gastrointestinal surgery or manipulation, were hospitalized for long periods, had a serious underlying illness, or were immunocompromised.¹

What is new, however, is a recent study that shows the rate of hospital-acquired CDI in children almost doubled (from 7.24% to 12.80%) from 1997 through 2006.² But in contrast to trends in adults, the researchers found no increasing trend in the severity of CDI in children.³

Other studies have identified a decrease in nosocomial CDIs and an increase in community-acquired CDIs in adults. More adult patients with CDIs hadn't previously received prescribed antibiotics, suggesting that C. difficile can now be found outside of the hospital setting.^2–5

Take a closer look

C. difficile is a Gram-positive anaerobic spore-forming, toxin-producing bacillus that commonly causes antibiotic-associated diarrhea. The major reservoirs are infected patients, both symptomatic and asymptomatic, and items or surfaces contaminated with feces. C. difficile is often transferred to patients via the hands of healthcare personnel who have direct contact with infected patients or who have touched a contaminated surface or item.¹ Signs and symptoms of CDI include watery diarrhea, fever, anorexia, nausea, and abdominal pain. Untreated, CDIs may lead to pseudomembranous colitis, toxic megacolon, colonic perforation, sepsis, and, rarely, death.¹

A CDI is diagnosed through history and physical assessment, stool cultures, and polymerase chain reaction (PCR) assays. Unfortunately, stool culture results may not be available for 48 to 96 hours. PCR assays can be run with a high degree of sensitivity within 1 to 2 hours. If stool specimens won't be processed or picked up by the lab within 2 hours, they must be refrigerated because the toxins rapidly deteriorate at room temperature.¹

According to the CDC, 20% of CDIs resolve after discontinuation of the antibiotic that inadvertently created the bacterial imbalance. For the remaining 80%, antibiotic therapy is necessary. Children with moderate-to-severe illness or persistent diarrhea after the inducing antibiotics have been stopped should receive antimicrobial treatment.⁷ Oral vancomycin and metronidazole are most commonly used.⁸

Unique risk for children

The increasing trend of CDIs in young children may be the result of a new hypervirulent strain of C. difficile that is resistant to quinolones. Hospitalized children with medical conditions such as inflammatory bowel disease and immunosuppression or conditions that require antibiotics are at a higher risk for CDI.^3,6

Young children are also at an increased risk of contracting and spreading CDIs due to oral exploration of their environment, hand-to-mouth behaviors, limited experience with hand washing, and poor elimination hygiene. Diaper-changing stations may be another source of infection, especially if protective coverings aren't available and surfaces aren't sanitized after each use. Childcare centers are another reservoir for community-acquired CDIs. Toys, toileting, and changing facilities as well as caregivers' hands may all contribute to inadvertent CDI transmission.

Reduce the risk

Some steps you can take to lower the risk of spreading CDIs in your facility include the following.

* Move patients who need contact precautions into a single-patient room if possible. If not, consult with infection control personnel to assess the risks associated with having another patient in the room. Separating beds by 3 feet or more can help reduce sharing of items.⁹

* Wear a gown and gloves for all interactions that may involve contact with the patient or possible contaminated areas in the room. Put them on when entering the patient's room and discard them before leaving.⁷

* Follow hand hygiene protocol before and after patient care and after removing gloves. Alcohol rubs aren't effective with C. difficile because they're not sporicidal. Use soap and water and vigorously scrub to clean hands.⁷

* Clean and disinfect nondisposable equipment with sodium hypochlorite diluted 1:10 with water.⁷ Use equipment dedicated to the patient whenever possible.

* Make sure toys provided for pediatric patients aren't plush or porous.

* Visit www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf for specific health facility cleaning guidelines.

Patient education

Educate patients and caregivers on the importance of frequent and proper hand hygiene. Teach patients and caregivers that soap, water, and vigorous scrubbing for at least 15 seconds is the best method for getting rid of bacteria on hands.¹

Emphasize the importance of perineal care after toileting, incontinence, or diaper changing. Tell parents to wash toys and air dry them daily with sodium hypochlorite (household bleach) diluted 1:10 with water.⁷

Advise patients and parents of children who've been diagnosed with a CDI to take antibiotics as prescribed and to avoid antidiarrheal medications because they may prolong a CDI. Supportive care includes maintenance of hydration and nutritional status.⁷ Remind them to contact their healthcare provider if the diarrhea persists or returns.

The recent increase in CDIs in children emphasizes the need for additional education in proper hygiene for these younger patients. Taking extra steps to prevent CDIs in your facility can help avoid complications.

REFERENCES

Sole Property of....

© 2011 Lippincott Williams & Wilkins, Inc.

Isolation Guidelines....click here

Isolation Skill and Tips....see 17th Edition study guide for Excelsior recommendations....