communicable diseases

R

recklessdetrimenalist

Forum Ride Along
Messages
3
Reaction score
0
Points
0
Hi everyone,

Glad I found emtlife.com, seems like a great community and place to share/find info on the ever surprising occupation of being an EMT.

I completed my class at Boston University and just got a job through a great company south of the city.

I had some worries about communicable diseases like VRE, Cdiff and MRSA. I realize that VRE is transferred by blood but cdiff and MRSA can live on surfaces and especially things like your stethoscope and bpcuff. The EMTs preceptors I'm going through my training shifts with explained that any traces of things like MRSA or forms of hepatitis on inanimate objects found throughout the truck are so small they're not a worry. Though sometimes things like bed rails, stretchers etc. seem to be primary methods of transmission?

One of our patients the other day had MRSA, and of course, the gloves go on. However my fore arm at one point brushed against the patients upon reaching over to buckle them in, I'll learn to be more careful in my methods, but should I be worried? Neither the patient nor I had open wounds/sores but a lot of research states even shaking hands can transfer such things.

I wanted to hear some of your opinions on how you go about your day, personally I'm a little nervous to eat my lunch, even using my chapstick on the truck knowing I might be coming in contact with some serious stuff.
 
Most of the day in, day out communicable diseases found in hospitalized or nursing home patients don't present a risk to relatively healthy providers. Staphylococcus aureus itself is a normal part of your skin's flora, and if you're in health care for any significant amount of time, you'll likely become colonized with MRSA.

Clostridium difficile is a rather nasty infection, however it requires the resident bacteria in your gut (E. coli, etc) to be weakened or killed (e.g. being on certain systemic antibiotics) before it can really cause problems.

The reality is that we live in a world with germs. Some germs cause disease, some germs help us out, some do a little bit of both. As a heatlh care provider, you're going to be exposed more often to the bad germs, but that's why we have an immune system. The best things you can do is wear PPE appropriately (including, but not limited to gloves, for patients with patients with infectious diseases, signs of infectious disease, or exposure to bodily fluids. Not every patient necessarily needs to have gloves worn, it's a judgement call) and wash your hands after every patient. Chances are the door handle at the hospital is dirtier than your last patient's hands.
 
thanks for the reply.

Most of my education isn't towards healthcare and being an EMT was a decision I made because I wanted to do something I felt better about than my previous doings. Upon weighing pros and cons, my downfall is general information on some of the details..

how do you deal with coming home with this knowledge? Do you change your routine assuming that these germs are transferred to your personal belongings in your home? MRSA colonizing your skin affecting your loved ones?
 
I don't wear my boots in the house and take a shower as soon as a get home, other than that not really.

People are walking around everywhere with the same nasty bugs as people in the hospital have. Do you wear gloves to shake hands?

It may seem scary but in reality you've been exposed to it your whole life.
 
I had MRSA on my knee once. It hurt like a mother but w/ a round of sulfa drugs and lots of hot compresses it didn't take long to get rid of it.

Like everyone else said. Stay healthy-- eat right, exercise and SLEEP! and you don't have much to worry about. Your body's immune system is an amazing thing.
 
As a bit of a "germophobe" myself I know exactly where you're coming from, but I also know that with universal precautions and sound hygienic practices you have very little to worry about. Have you ever ridden on an ambulance? Visited a skilled nursing facility? Ridden the T? If so, then I'm reasonably certain that you've already encountered MRSA. Yeah, it's unpleasant to think about, and its effects on some of your patients can be gruesome, but as someone with a healthy immune system you should, in all likelihood, be set. Always wear your gloves, wash your hands frequently, and clean your equipment.

Now with that said, I'm still not a fan of eating on the ambulance. I know plenty of people that do it with no problem, but still. As already suggested, I chose to change out of my uniform at the base after every shift, shower immediately after, and wash my uniform by itself with hot water.
 
So do you wear gloves to go about all your daily activities where you might touch another human?
 
MRSA is more common than you might think and less a danger.

At least, to healthy people. Superficial minor staph lesions were not uncommon at my work, and many, including on caregivers, were probably resistant to something. Scrub it out, dress it properly, cover it up, and keep an eye upon it. Do not depend upon antibiotic oints much anymore.
Many people are carriers and the site of colonization is the nose. Hm.
 
mycrofft said:

Many people are carriers and the site of colonization is the nose. Hm.
Click to expand...

So if I pick my nose can I get the MRSA out? Is the benefit nullified if I eat said nose nugget? :ph34r: Just kidding haha

Wash your hands after every pt contact, nurses use the saying "wash in, wash out". Don't be touching your face any more than necessary, just be clean like most everyone said. I'm the same way as usals, all my dirty uniforms hang out in a hamper in the garage until I wash them separate from my regular clothes.
 
#1 defense against the many bugs you'll encounter: washing your hands... often... before and after every patient contact.

Anyhow, I had a MRSA infection once. The worst part was the antibiotic regimen of bactrim and rifampin - so many side effects. Though, the best side effect was having urine the color of orange gatorade. That was actually pretty cool.
 
usalsfyre said:
So do you wear gloves to go about all your daily activities where you might touch another human?
Click to expand...

No...but I do when making patient contact, since I know for a fact that many of them carry communicable disease or are immunocompromised and thus more susceptible to becoming infected themselves. Seems pretty standard amongst most healthcare providers I know.
 
medicsb said:
rifampin - so many side effects. Though, the best side effect was having urine the color of orange gatorade. That was actually pretty cool.
Click to expand...

I really want to try Rifampin just for that.
 
Hand washing and appropraite PPE are both important, but also consider not coming into work if you are feeling ill. No need to place yourself in an immune system compromising position when you are already compromised.

I worked for two weeks with Lyme Disease this summer before starting to feel feel bad enough to go to the doctor. She guessed that I might have picked up a bug or something from a patient during this time, and while I was normally strong enough to resist it, it got me good that time. Obviously I don't know if it came for work or somewhere else, but it seems logical. Incidentally working with Lyme Disease was terrible, I was so weak I could barely stairchair a 120 pound woman. After the antibiotics and some rest I felt like superman and my partners stopped dogging me for being so weak despite being bigger than all of them.
 
JPINFV said:
The reality is that we live in a world with germs. Some germs cause disease, some germs help us out, some do a little bit of both. As a heatlh care provider, you're going to be exposed more often to the bad germs, but that's why we have an immune system. The best things you can do is wear PPE appropriately (including, but not limited to gloves, for patients with patients with infectious diseases, signs of infectious disease, or exposure to bodily fluids. Not every patient necessarily needs to have gloves worn, it's a judgement call) and wash your hands after every patient. Chances are the door handle at the hospital is dirtier than your last patient's hands.
Click to expand...

I can control my own use of PPE and use it appropriately, but where I have trouble is with the patient. If the patient immunocompromised, sending facilities often send them with a mask for the patient to wear. The same is also done for airborne illnesses, though I have not had to deal with one of these patients yet.

My question, what do you do when the patient refuses to wear the mask? If the patient is suffering from a communicable disease I'll explain to them that they aren't helping themselves and leave at that, but what if the patient refuses the mask mid transport and is suffering from an illness with a risk of airborne communication? Obviously I can put a mask on, but that doesn't eliminate the risk for everyone.
 
Timely thread. We are constantly picking up patients on isolation for MRSA nares.

Sometimes it's gloves, gown and mask, sometimes mask only. Not sure what really protects against it but I'm only just starting to get paranoid about it.
 
Tigger said:
I can control my own use of PPE and use it appropriately, but where I have trouble is with the patient. If the patient immunocompromised, sending facilities often send them with a mask for the patient to wear. The same is also done for airborne illnesses, though I have not had to deal with one of these patients yet.

My question, what do you do when the patient refuses to wear the mask? If the patient is suffering from a communicable disease I'll explain to them that they aren't helping themselves and leave at that, but what if the patient refuses the mask mid transport and is suffering from an illness with a risk of airborne communication? Obviously I can put a mask on, but that doesn't eliminate the risk for everyone.
Click to expand...

I've only had one patient with a seriously communicable airborne disease, and he was very cooperative so we had no issues. If it were me, I'd try to reason with the patient as best I could, and if that didn't work I'd notify the receiving facility and see how they wanted to proceed...don't think you really can do more than that.
 
Steam Engine said:
I've only had one patient with a seriously communicable airborne disease, and he was very cooperative so we had no issues. If it were me, I'd try to reason with the patient as best I could, and if that didn't work I'd notify the receiving facility and see how they wanted to proceed...don't think you really can do more than that.
Click to expand...

I've come to see my uniform and entire truck as contaminated at any given time, despite any apparent decontamination or cleaning-- it's easier for me to be skeptical of coworkers and washing machines, and thus work clothes don't make it far inside my house.

When doing IFTs, gowns, gloves and masks are always available at the door of the patient's room (or at least it's supposed to be according to the Joint/JACHO). You're welcome to take advantage of those gowns and gloves if you feel your forearms are uncovered, although I don't think it's practical to wear a gown throughout patient care.

EMS Providers also need to get over ourselves, and start thinking proactively about the bugs that we transmit between patients. We don't see ourselves the same way as the SNF CNA who doesn't change gloves between patients, partially because we only see one patient at a time, but the opportunity for cross-contamination on our clothes is real (if for no other reason because we provide care in close quarters).

I'd love to see a study of colonizations of bugs on EMS workers uniforms... anyone up for it?
 
emt.dan said:
I've come to see my uniform and entire truck as contaminated at any given time, despite any apparent decontamination or cleaning-- it's easier for me to be skeptical of coworkers and washing machines, and thus work clothes don't make it far inside my house.

When doing IFTs, gowns, gloves and masks are always available at the door of the patient's room (or at least it's supposed to be according to the Joint/JACHO). You're welcome to take advantage of those gowns and gloves if you feel your forearms are uncovered, although I don't think it's practical to wear a gown throughout patient care.

EMS Providers also need to get over ourselves, and start thinking proactively about the bugs that we transmit between patients. We don't see ourselves the same way as the SNF CNA who doesn't change gloves between patients, partially because we only see one patient at a time, but the opportunity for cross-contamination on our clothes is real (if for no other reason because we provide care in close quarters).

I'd love to see a study of colonizations of bugs on EMS workers uniforms... anyone up for it?
Click to expand...

Totally agree with you...cross contamination to immunocompromised patients is one of the two main reasons I glove up / wear other appropriate PPE as necessary. The first is to prevent direct exposure to myself, even though as you stated our ambulances, gear, and bases are likely already plenty filthy. I'm curious though, how would you handle Tigger's hypothetical case of a severely contagious pt. refusing to keep the mask on upon arrival at the hospital (I'm thinking active TB, nasty MRSA-induced pneumonia, or something else along those lines.) Since I *legally* can't force a patient to wear a mask, the best I can come up with is hope and plead, and if that doesn't work get hospital staff involved. Any thoughts?
 
You must log in or register to reply here.
Back
Top