MRSA

It has been pathetically slow in ICU the past two weeks. We have had an average patient census of 3 for 10 days now. I took two days off in the last pay period, I'll be lucky to get a paycheck at all at this rate!

Today I went in to start my 3 day stretch and our census was two. I did "projects" all day and finally went home at 3:30. I attended a lecture at lunchtime by some of the infectious disease doctors about MRSA and what we are doing about it here. The room was packed full of doctors and some RNs and a few other hospital staff. MRSA has been in the news,overhyped by the mainstream media.

Remember all the scare stories about Ebola virus? Omigod people are going to start bleeding from their eyeballs!!!! Again, what we have here is a big scare story that sells newspapers and television advertising. There are lots of antibiotic-resistant bugs out there. But we always need a good scare story to distract us from the important things going on in the world. Like Iraq, Iran, our lack of health care access in this country, among other things...

Anyway I sat with two of my co-workers through this hour-long presentation which was actually quite informative. They talked about the incidence of community acquired MRSA which is much higher than hospital-acquired MRSA. And debunked a lot of the paranoia that the media has been spreading. They also discussed some of the antibiotics that are more or less effective at fighting MRSA.

We don't have nearly as high of an incidence of MRSA in the community here as other places do but the doctors want to get a handle on it and have a protocol in place before we get more MRSA in the community.

What I took away from it was that it will be cost-effective at our hospital to do what they propose, that is, testing all patients admitted to ICU for MRSA in order to catch it if the patient is colonized, since ICU patients are the most likely to develop infection as they are also most likely to be immunocompromised. We will put MRSA positive patients in isolation and treat any infection they have, if they are infected. We will do nasal swabs since most MRSA colonization is found in the nose. But the doctors cautioned, MRSA infections can be found in skin, wounds, urinary catheters, groin, and lots of other places. Nasal swabs will miss these.

And of course handwashing and alcohol gel hand hygiene is most effectve at preventing the spread of MRSA, which we already knew. Using standard precautions is really the key as with any potentially infectious organisms.

The moral of the story: Wash your hands before AND after you pick your nose, and if you pick 'em, don't flick 'em. I can see it now, the new CDC guidelines: If you pick 'em, don't flick 'em, as the new MRSA prevention motto for 2008. I think the Bush administration could understand that. I see my next career on the horizon: healthcare public relations.

I had a terrible bout of homesickness for the desert a few weeks ago. Don't know what hit me. I decided to make tamales this year. I haven't done that since before nursing school but I remember the Mexican workers at the hospital said, "A gringa made THESE?" when they tasted my tamales. I took it as a hgue compliment.

I got ambitious yesterday and made a small batch of green corn tamales after my 20 mile run. I have one more long run to do before I taper for the new years run in Arizona and then I have time to do things like clean the house nand sort through piles of papers and receipts for taxes, etc.

I was so happy to be done with classes. But I am taking a 12 lead EKG class in January. It starts the day I get back from vacation. I have figured out the secret of getting the schedule I want. If I sign up for classes, I get to take some 8 hour shifts so I don't go into overtime. I have decided I will sign up for as many classes as I can stand to take with minimal homework, and that way I get only two 12 hour shifts on those weeks.

Lately I've been feeling better about things. I think part of it is that I feel better physically. After 3 months of messing with medications and patiently waiting in between testing, I finally have my thyroid medication right. I am down to just two PBJs a day and not eating nearly as much. I am sleeping better most of the time too. I feel less emotionally labile.

Ever since taking the TNCC class I feel like somehow things fit together more. Something about the TNCC class helped me put things together. I don't know why but I felt so much more confident and better able to think about what I needed to do. TNCC was a lot more fun than PALS was, too. There were a bunch of us from ICU in there and we got to strap each other down to a backboard for spinal immobilization, a way to take out pent up aggression on each other which was worth every minute we sat through the whole 16 hours of class.

Things have been somewhat volatile at work, there's a lot of political crap going on in the department, some people are not happy with the approach that management is taking toward making changes in ICU. I am okay with it because I think all of it is truly going to make it better. People are resistant to change but I think the people with good attitudes outnumber the whiners. I think our manager needs to not worry so much about pleasing the lowest common denominator. She seems really worried about rumors and I think she needs to stop trying to please the chronic whiners. There aren't enough of them to make it worth her effort.

Peace, love, & hand hygiene,

Towanda, ICU RN