Infection Control Today - 08/2002: Hands That Heal, Hands That Hurt

August 1, 2002

Hands That Heal, Hands That Hurt

By Lynette Hancock Smith, RN, BSN, CIC

Afterbecoming an infection control coordinator, I have learned a great deal moreabout what nursing really means and the significance of the taskshealthcare workers (HCWs) perform. I started my nursing career with a strongdesire to help and heal others. Now that I am involved in infection control, Iwonder just how much help and healing I really provided.

Prior to my current infection control position, Pseudomonas aeruginosa,Stenotrophomonas maltophilia and even vancomycin-resistant enterococciwere not in my professional or personal vocabulary. And although I washed myhands and wore gloves as a staff nurse for 19 years in the progressive carestep-down unit and in the gastroenterology (GI) lab, I had no idea I wasperforming this ritual to remove transient organisms and prevent thetransmission of disease to other patients.

I did not realize the significance of my hands spreading disease andillnesses to the innocent patients I was caring for. My role in infectioncontrol 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 someonesusceptible to their devastation.

I have learned that infection control measures are so simple that oftentimesthey are overlooked. What is so difficult about wearing a mask while suctioninga ventilated patient? I wear one so that I do not become colonized with apatient's droplet-dispersed resistant organisms through my nasal cavity. I alsodon't want to shed these pathogens onto to another one of my immunocompromisedpatients.

Or what about disinfecting equipment I used on one patient before I use it onsomeone else? Or making sure the head of my patient's bed is elevated greaterthan 45 degrees to prevent aspiration while receiving continuous enteral tubefeeds? Simple infection control measures that take mere seconds to perform arenot being done consistently, and nosocomial infections prevail. I am aware thatstaff nurses and other HCWs face many challenges, such as recognizing when apatient has converted from sinus rhythm to second-degree heart block; observingthe slight penetration of aspirate by speech pathologists during a modifiedbarium test; recognizing when to call a code if a patient shows subtle changesof deterioration; and the observant eye of the case manager who recognizes anunsafe 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 bottleused in that endoscopic suite and that using sterile water and disinfecting thatbottle is vital.

I know that Clostridium difficile spores could have been on thatrectal thermometer and that is why I needed to disinfect it before takinganother rectal temperature.

I see why the environmental services worker needs to be aware of theseriousness of terminally cleaning patient rooms.

I understand why it's important for the rehabilitative/life-skills staff todisinfect their tools of restoration between patients.

I recognize the significance of pharmacy personnel using sterile technique inmixing intravenous medications and solutions.

I've learned the importance of personal protective equipment for laboratorypersonnel to protect themselves and their patients while drawing blood andprocessing specimens.

And I now comprehend the importance of the GI lab staff, operating room andcentral sterile processing technicians disinfecting and sterilizing equipment toprevent the transmission of mycobacterium, vCJD and hepatitis.

I've learned that infection control and prevention is a trans-disciplinaryprocess from administrative support, to all healthcare employees, to CEO, tohousekeeper to hospital visitors -- everyone can help prevent exposures andinfections. Lastly I've learned that my hands can either heal or be a weapon ofharm to every susceptible patient that I so passionately want to protect andheal.

Lynette Hancock Smith, RN, BSN, CIC, is infection control coordinator forLifeCare Hospitals in Pittsburgh.

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