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Should I be worried about the measles outbreak in BC?

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Should I be worried about the measles outbreak in BC?

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research in progress...

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I'm a hospital PICU nurse, what precautions should I wear when bringing my isolated patient to CT scan?

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I'm a hospital PICU nurse, what precautions should I wear when bringing my isolated patient to CT scan?

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hummmm.... answer on it's way

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answer loading...
gathering resources:

Public Health Agency of Canada (2010, November 12). Guidance: Infection Prevention and Control Measures for Healthcare Workers in All Healthcare Settings [guidance]. Retrieved February 28, 2019, from https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/guidance-infection-prevention-control-measures-healthcare-workers-healthcare-settings.html

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From Heidi (PICU RN): Is using the Bair Hugger on a patient with an open chest a risk for infection? 

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From Heidi (PICU RN): Is using the Bair Hugger on a patient with an open chest a risk for infection? 

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This one sounded so simple. In short: maybe? The patient who sparked this question was a baby who we used the Bair Hugger on for many days while she was open –chest and then went on to develop bacteremia. Good news: in her case, the Bair Hugger is unlikely to have caused the bacteremia based on the bacteria that was cultured.
Now the not so great news: in trying to answer this question, I came across data about lawsuits in the States against Bair Hugger for surgical wound infections and a warning by the inventor Scott Augustine about the possible infection risk of forced air warmers (Elkins, 2018). However, according to 3M's Bair Hugger instructions there is no counter-indications for use. There is an air filter (changed by biomedical) that should protect the patient from bacteria that may be inside the heater/fan. Most reviews did not find enough evidence to stop using the Bair Hugger in the operating room. In fact, keeping the patient's temperature is often cited as a way to decrease the risk of infection (Beltramini, 2011). Almost no data is available for the way we use the Bair Hugger in the PICU: longer-term in a less sterile environment. I’m waiting to hear back from our infectious disease docs here at the MCH to have their take on the issue. For the time being, we should try other methods first to maintain a patient’s temperature if they have open wounds, such as heating lamps or adding more blankets, and if this is unsuccessful then can use the Bair Hugger.
To other ICU/OR nurses out there? What are your units doing? Do you use Bair Huggers? Are there specific guidelines on their use on patients with open-chests?

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References:

Beltramini, A., Salata, R., & Ray, A. (2011). Thermoregulation and Risk of Surgical Site Infection. Infection Control & Hospital Epidemiology, 32(6), 603-610. doi:10.1086/660017

Elkins, C. (2018, April 30). Bair Hugger Warming Blanket Inventor Warns of Infection Risk. Retrieved from https://www.drugwatch.com/news/2015/10/19/bair-hugger-inventor-warns-of-infection-risk/

Forced-air Patient Warming | 3MTM Bair HuggerTM System | 3M US. (n.d.). Retrieved from https://www.bairhugger.com/3M/en_US/bair-hugger-us/

Legg, A. J., Cannon, T., & Hamer, A. J. (2012). Do forced air patient-warming devices disrupt unidirectional downward airflow? The Journal of Bone and Joint Surgery. British Volume, 94(2), 254–256. https://doi.org/10.1302/0301-620X.94B2.27562

McGovern, P. D., Albrecht, M., Belani, K. G., Nachtsheim, C., Partington, P. F., Carluke, I., & Reed, M. R. (2011). Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. The Journal of Bone and Joint Surgery. British Volume, 93(11), 1537–1544. https://doi.org/10.1302/0301-620X.93B11.27124

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From Samara: If a patient had C.Diff in the past should they be screened for it if they are coming in from home for a surgery?

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From Samara: If a patient had C.Diff in the past should they be screened for it if they are coming in from home for a surgery?

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No- as long as they are asymptomatic. This question came up recently about a patient admitted from the OR that ended up testing positive to C.diff in the days following the surgery. According to my institutions pediatric policies, patient should be tested for C.diff after 3 liquid stools above their normal. Once a patient has 3 liquid stools they should be put on Contact precautions- the Brown (Brown for um... you know what...) sign-which includes washing hands with soap and water once exiting the room. If the test comes back positive for C.diff the patient is to be kept on precautions for 72hrs after the resolution of symptoms. After this time, the room must be cleaned (mention C.diff when calling so that the room is cleaned with bleach), all items must be disposed of, and the patient must be bathed and changed. The brown sign can then be removed and the patient is no longer on precautions. Notice

that we do not re-test the patient. This is because C. diff is often found in patients’ months after having the illness. This is also why we do not ‘screen’ asymptomatic patients for C.diff. Another interesting fact is over 50% of infants under one year old are colonized with C.diff but do not mount an immune response to it- therefore displaying no symptoms. This is why we are discouraged from testing infants for C.diff. Also - another good reason to always wear gloves while changing even the cutest baby’s diaper!

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Image from: https://medcomic.com/medcomic/clostridium-difficile-infection/
Check them out for other great comics!
References:

Jansen, B. (2013, September 13). Avoid C. difficile testing in infants. Retrieved February 28, 2019, from https://www.mdedge.com/pediatrics/article/77455/pediatrics/avoid-c-difficile-testing-infants

Rousseau, C., Poilane, I., De Pontual, L., Maherault, A.-C., Le Monnier, A., & Collignon, A. (2012). Clostridium difficile Carriage in Healthy Infants in the Community: A Potential Reservoir for Pathogenic Strains. Clinical Infectious Diseases, 55(9), 1209–1215. https://doi.org/10.1093/cid/cis637

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I received this question from an anonymous staff member in the PICU.
Ok. It’s happened to all of us. Patient is vomiting and that perfectly designed kidney basin; total miss. So what exactly can barf transmit? Bad news here. Studies have found that the classic “gastro” (aka Norovirus) is transmitted fecal-oral. As in the fecal (=poop) must make contact with the oral (=yuck.). Historicaly, vomit was thought to not transmit the virus as long as the person who was vomited on did not transmit to their oral cavity using prompt hand washing. More recent studies have found that this is not entirely true. A study done on cruise ships found that proximity to a vomiting episode was a predictor of catching Norovirus. They found that a small amount of virus is aerosolized when a patient vomits (as a note: this was found out after researchers spent 3 years building a vomiting robot named Larry). Even a vomit of low force sent 14 000 virus fragments flying. The amount needed to catch norovirus is 20 to 1300. Less research exists about other viruses (for example our common respiratory viruses: RSV, adenovirus, rhinovirus). Based on their contagiousness and ability to contaminate surfaces, it could be presumed that you could catch a respiratory virus from a vomiting patient. So next time you have a patient that is vomiting grab yourself full precautions: gown, gloves, and mask (with face shield!). And wash your hands after taking it all off.
Thanks Larry for your hard work in this area.

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References:

Gastroenteritis (Stomach Flu). (n.d.). Retrieved February 18, 2019, from https://www.quebec.ca/en/health/health-issues/flu-cold-and-gastroenteritis/gastroenteritis/

Makison Booth C. (2014). Vomiting Larry: a simulated vomiting system for assessing environmental contamination from projectile vomiting related to norovirus infection. Journal of infection prevention, 15(5), 176-180.

Veillette, M., Turgeon, N., Charlebois, R., Bonifait, L., Duchaine, C., Vimont, A., … Longtin, Y. (2015). Detection and Quantification of Airborne Norovirus During Outbreaks in Healthcare Facilities. Clinical Infectious Diseases, 61(3), 299–304. https://doi.org/10.1093/cid/civ321

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This website was born of a personal and professional interest in Infection Prevention and Control in my work as a nurse clinician in the Pediatric Intensive Care Unit. Sometimes seen as a 'boring' topic for healthcare workers ("ok.ok. i get it. wash my hands. AGAIN") it is a topic that has paramount importance to our littlest patients.

Guiding this website is a desire to reframe Infection Control and Prevention from a 'boring' or 'annoying' topic to one that is not only interesting and thrilling, but also at the front lines of the future of healthcare.

Little Bugs was created to be interactive: please do not hesitate to send me topic suggestions (either as a parent of a patient or as a healthcare worker) I will do my best to find answers for you.