Hands That Heal, Hands That Hurt
By Lynette Hancock Smith, RN, BSN, CIC
After becoming an infection control coordinator, I have learned a great deal more about what nursing really means and the significance of the tasks healthcare workers (HCWs) perform. I started my nursing career with a strong desire to help and heal others. Now that I am involved in infection control, I wonder just how much help and healing I really provided.
Prior to my current infection control position, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and even vancomycin-resistant enterococci were not in my professional or personal vocabulary. And although I washed my hands and wore gloves as a staff nurse for 19 years in the progressive care step-down unit and in the gastroenterology (GI) lab, I had no idea I was performing this ritual to remove transient organisms and prevent the transmission of disease to other patients.
I did not realize the significance of my hands spreading disease and illnesses to the innocent patients I was caring for. My role in infection control has taught me that just because I can't see transient organisms, they are present on my hands and are waiting to be passed on to someone susceptible to their devastation.
I have learned that infection control measures are so simple that oftentimes they are overlooked. What is so difficult about wearing a mask while suctioning a ventilated patient? I wear one so that I do not become colonized with a patient's droplet-dispersed resistant organisms through my nasal cavity. I also don't want to shed these pathogens onto to another one of my immunocompromised patients.
Or what about disinfecting equipment I used on one patient before I use it on someone else? Or making sure the head of my patient's bed is elevated greater than 45 degrees to prevent aspiration while receiving continuous enteral tube feeds? Simple infection control measures that take mere seconds to perform are not being done consistently, and nosocomial infections prevail. I am aware that staff nurses and other HCWs face many challenges, such as recognizing when a patient has converted from sinus rhythm to second-degree heart block; observing the slight penetration of aspirate by speech pathologists during a modified barium test; recognizing when to call a code if a patient shows subtle changes of deterioration; and the observant eye of the case manager who recognizes an unsafe condition and alerts appropriate personnel.
Here's what I've learned as an infection control professional:
I know now that pseudomonas could have grown in the endoscopic water bottle used in that endoscopic suite and that using sterile water and disinfecting that bottle is vital.
I know that Clostridium difficile spores could have been on that rectal thermometer and that is why I needed to disinfect it before taking another rectal temperature.
I see why the environmental services worker needs to be aware of the seriousness of terminally cleaning patient rooms.
I understand why it's important for the rehabilitative/life-skills staff to disinfect their tools of restoration between patients.
I recognize the significance of pharmacy personnel using sterile technique in mixing intravenous medications and solutions.
I've learned the importance of personal protective equipment for laboratory personnel to protect themselves and their patients while drawing blood and processing specimens.
And I now comprehend the importance of the GI lab staff, operating room and central sterile processing technicians disinfecting and sterilizing equipment to prevent the transmission of mycobacterium, vCJD and hepatitis.
I've learned that infection control and prevention is a trans-disciplinary process from administrative support, to all healthcare employees, to CEO, to housekeeper to hospital visitors -- everyone can help prevent exposures and infections. Lastly I've learned that my hands can either heal or be a weapon of harm to every susceptible patient that I so passionately want to protect and heal.
Lynette Hancock Smith, RN, BSN, CIC, is infection control coordinator for LifeCare Hospitals in Pittsburgh.