Tag: Infection prevention

Thirty Six, Four, and One

Image courtesy of Pexels

This morning we came back from a long holiday weekend. The weekend’s lab results were waiting for me. These included:

  • Thirty Six cases of influenza, mostly Flu A
  • Four cases of RSV
  • One case of COVID.

Several facts struck me about this haul. One is of course that these all have vaccines available to prevent them — your insurance might even cover them at no charge to you. I must of course make the caveat that these vaccines are not available to everyone. There are restrictions based largely on age. Some of them work better than others, but all of them are “better than nothing.”

Another interesting fact is that although COVID is still with us, RSV and Flu were far bigger problems. Before you start saying “oh come on, it’s just the flu!” I’d like to point out that every year thousands of people die of influenza. RSV is also a potential killer, mostly in children on one end and older adults on the other.

Not so fun fact, we’re just barely getting to the middle of “flu season,” so you can expect even more of this lovely stuff wherever in the Northern Hemisphere you may be.

But the thing I found saddest is the number of children who passed through our Emergency Department and Freestanding ED (FED in hospital-talk). The saddest part is that most of them got sick after Christmas. It’s very likely some selfish relative who just had to see the kids/cousins/niblings/grandkids left an unintended extra gift this year: getting sick enough go to an Emergency Department for a respiratory illness panel. And that makes me unhappy.

My job is literally preventing infections. Please, do your part. Stay home if you’re sick rather than “power through it.” In particular, show love for the kids by not going to visit them when you’re sick. Wear a mask when appropriate. Keep your hands clean — literally the number one thing you can do to prevent all illness. And it’s still not too late to get vaccinated against preventable illnesses.

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.