Tag: hospitals

Droplet vs Airborne: Different and Important

Sometimes professionals use words in very specific ways that aren’t obvious. Just the other day I realized that is what happened with those two words. My Facebook friends have seen me very carefully point out articles like these, which suggest than COVID-19 is airborne, rather than droplet. I did this carefully because before yesterday, the WHO and CDC staunchly denied any such thing and today the WHO merely confirms that there is “emerging evidence.” Today I want to explain why it’s different, and a really big deal, in fairly simple terms.

I work in a hospital, as an Infection Preventionist. Just as the name suggests, I help keep people from getting sicker in the hospital. We used to be called “Infection Control Nurses,” and it’s a tradition that literally goes all the way back to Florence Nightingale. Hospitals use different kinds of precautions — safety measures — to prevent the spread of disease. These measures are based on how the disease itself can move from person to person.

Standard precautions are what we do to protect everybody at all times. This includes keeping your hands clean, using disposable gloves, and changing those gloves between patients. Hand washing is still the most important thing you can do to keep from getting or transmitting any disease. It’s so important the CDC has an entire section on it.

When we know a person has certain infections that could spread, we use Contact precautions. This is for fairly heavy organisms that can survive for a while on surfaces, and that we can inadvertently transport to a new victim on our hands or clothing. One such organism you may have heard of is MRSA, Methicillin Resistant Staphlycoccus Aureus. We also use Contact for more mundane bugs like head lice. For Contact, we make sure to use gloves, treatment gowns to cover our clothing, and we are extra sure to wash our hands after taking our gear off.

Now for the meat of this discussion. Droplet precautions are for organisms that can move in droplets we create when we talk, cough, or sneeze. These droplets can go maybe 6 feet or so (that’s where the 6 feet apart for social distancing comes from) before they go SPLUT! onto a surface. Droplet precautions always includes Contact precautions. That surface can be somebody else’s face, which is why the protective gear for Droplet precautions includes a facemask and ideally eye protection, in addition to gloves and gown. The most common organism for which we use Droplet is the Flu. Remember, up until yesterday, the WHO insisted this was all we needed to protect ourselves from COVID-19. And as of this moment — subject to change without notice — the CDC still does.

By contrast, Airborne precautions are for organisms that can float in the air a long ways and a long time. Much farther than 6 feet. And to do this, they are very small and very lightweight. Examples include Measles, Tuberculosis, and Ebola. These bugs are small enough to get through and around normal surgical masks. These patients should be cared for in a special “negative pressure” hospital room — the HVAC system is designed to create lower air pressure than in surrounding areas while still having fresh air move in and out, so germs aren’t likely to go into the rest of the hospital. To care for these patients, you need special masks, such as N95 or a powered respirator, and they need to fit correctly to prevent germs getting around the edges. That’s over any above gloves, gown, shoe covers, hair covers, and eye/face protection.

As you can see, there’s actually a huge difference between droplet and airborne transmission. And although many experts have privately held that COVID-19 is airborne, its a huge step for the WHO to admit that. I hope the CDC joins them shortly.

Things I Learned This Semester: Summer Nursing School

Another semester has ended, and that means it’s time for another set of interesting things I learned.

On Google Maps: When you notice Google suggesting a “short” route to an off-campus event that cuts through an historically bad neighborhood, it’s a good idea to assume that some of your classmates aren’t aware of that.

On Psych: I learned something important about myself: I am not cut out to work on a psych ward. However, mental health nursing does teach important skills that are needed in any nursing practice. There will always be patients and/or family members experiencing anxiety, grief, depression, or using ineffective coping mechanisms such as denial.

On Suicide Watch: Someone will tell the nurse almost anything if they think it will get them out of the legal hold. Oh, and these guys do important work.

On Assigned Groups: This semester I had the opportunity to work with people I would not have chosen. It was a good experience. You don’t get to pick your co-workers either.

On Florence Nightingale: Your brain is the most important tool you can bring onto your shift. Don’t forget to not only do your job, but leave the next nurse with the information she needs to do hers (please forgive my pronouns; most Med-Surg* nurses are still women).

On Alert: It is mentally exhausting to be paying close attention for long periods of time, even if you are mostly observing.

On Social Media: we say so much we shouldn’t online, that the Department of Health and Human Services can use Twitter to track potential emerging outbreaks.

On Nursing Specialties: Most people know there are jobs for nurses on hospital floors (Med-Surg = Medical-Surgical) and doctors offices. There are also nurses who provide home health, nurses who try to figure out how to reduce infections and other complications, nurses who work with the IT guys to make more effective hospital computing systems, and of course nurses who work in specialized areas of the hospital such as the emergency department, the operating room, or the catheterization lab.

More another day!

 

Hospitals Should Not be Allowed to Advertise

Recently, I received two ads for two different hospitals, and of course their emergency departments.

The first hospital’s ad arrived in the mail. It included a map, labeled “You’re only 6 miles from EXPERT ER CARE,” and the actual route I would need marked with a nice bold, blue line. Oh thank goodness, otherwise I might have had no idea how to get to that big hospital building clearly visible just off the freeway.

The second hospital left a card hanging on the door hyping how close they were. It included a refrigerator magnet with “IN CASE OF EMERGENCY,”  the address (including which freeway exit to take), a phone number, and even a web address. Because when you are having a medical emergency, you really want to check their website before going to the hospital. Right?

Now here’s the problem: to get to either hospital, I have to drive by a third hospital that is probably within walking distance of my home. Well, maybe not walking distance if I am having a medical emergency. Heck, the kids who hung the magnet on my door probably drove past the third hospital as well. Why on earth would I go to a hospital that is further away if I actually need the services of an emergency department? In a medical emergency, I need help now, not 6 miles from now.

The point is that both hospitals completely wasted money printing and delivering advertising to me. That money didn’t help a single patient. That money didn’t pay for a single doctor, nurse, medical assistant, or even janitor. That money didn’t buy any medical equipment or medications. That money didn’t keep the lights on in an operating room. That money didn’t even line the pockets of a hospital executive… unless his wife owns a printing company.

Cutting worthless ads won’t solve the issue of health care costs, but it’s a painless first step.

In Closing: Coming together online; frugality; and here’s some bonus health and health insurance links.

I’m sure it seemed like a good idea at the time

USA Today tells us that thanks to patient surveys, hospitals are kissing our butts:

Special air-blowing vests keep patients warm pre-surgery. Private rooms are the norm. Staffers regularly check in with patients to anticipate their toilet and showering needs to cut down on call-light usage. Patients are given clear discharge instructions. Cleaning is no longer done at night. Patients are taught the difference between “pain-free” and “pain-controlled.”

[snip!]

Amenities such as free lattes and valet parking are not new to hospitals. They began offering them years ago in a high-stakes fight to lure patients. However, what hospitals are doing now is, for the most part, tailored to the survey questions they know patients will be asked.

[snip!]

“The problem is America is a free-market economy,” [Rajesh Balkrishnan of the University of Michigan] said. “We need to give patients a way to speak on what they think about health care, what works for them, how health care professionals work for them, because those factors go into determining whether treatments are successful.”

I don’t think any of us have a problem with the idea that they are trying to make a hospital stay a more pleasant experience. It’s hard to recover from whatever when there is too much noise to rest, for example. It’s great that staff is making a better effort at explaining what’s going to happen. Anticipating needs? Well that is mighty fine customer service. However, I think now we are starting to go too far.

For one thing, who the heck is paying for these valets, lattes, and pre-surgery warming vests? In the end, you and I are through higher premiums and taxes. Could we perhaps make do with a clean blankie and a coffee maker?

Second, all this nonsense loses sight of Reality. In Reality, people choose a hospital based on two factors and only two factors: What hospital will my insurance company pay for? or What hospital is closest to the site of the accident? The overwhelming majority of people don’t have the luxury of saying “General Hospital has a better record of surgical outcomes” or “St. Elsewhere has free espresso drinks!” Let’s stop pretending that any of this is considered by Joe and Jane Average when Joe’s having chest pain.

Speaking of Reality, I understand that Obamacare means more insured patients means more demand for physician services. But where exactly does Stacy think she’s going to find doctors for that medical office space she’s trying to rent out?

In Closing: it would be nice if reporters would actually read scientific studies before telling us what they say; light up crosswalks; they had to get water from somewhere; college readiness may be more than academic skills; some taxes are going up regardless of what gets decided about the fiscal cliff (at this point I’m mighty tempted to say let’s just go there and watch the backpedaling); OBEY; and the ultimate helicopter parents.

Over the Milky Way Tonight

Once upon a time, there was a divine, weaving princess. She spent much time weaving, and was sad that it left her no time for love. So her father arranged for her to meet the cow-herder of the stars. They immediately fell in love and spent all their time together. However, this meant the divine clothes for the stars went unwoven, and the cows roamed all over the heavens as each of the lovers neglected their jobs. Her father had no choice but to separate them with the Milky Way. They are only allowed to meet one day a year — the seventh day of the seventh month — and then only if she’s done with her work.

Happy Tanabata.

In closing: can we just admit that the TSA’s job is to make us do what we’re told?; let’s ignore the fact that most of us choose a hospital based on what our insurance will cover or what’s closest to the accident; recycling; Bond, James Bond; ha; careful when you write a resume; fat; “could” is the important word; just what I don’t need; maybe if people would read; good luck explaining that to your insurance agent; and Cowboys and Indians.