Shut Down

It’s official.  Our ward has been shut down. We got the call this morning, confirming that yet another patient contracted VRE, bringing the total to seven patients in three weeks.  We were aghast and embarrassed.  (We wash our hands!  Really!)  Before we could blink, Infection Control had swooped in with their menacing signs and stern looks of disapproval.  The doors to the ward were shut.  The patients who had tested positive were whisked away to the infectious disease ward.  The remaining patients must stay put - no campus privileges (Sorry, smokers!) and no transfers, save for a medical emergency.  No new admissions permitted, either.  We were lectured at length on the importance of hand hygiene.  Oh – and everyone working on the ward, doctors included, must wear little plastic aprons.  (Which we don’t change between patients, so how is that is going to prevent the spread of anything?)

The entire situation is mind-boggling.  I’ve never heard of an entire ward shutting down for infection control purposes.  (I haven’t been a nurse too long, though, so maybe this is more common than I realize?)  But, I’m also surprised of this nature hasn’t happened sooner.  The majority of our patients reside in ward-style rooms, each housing four beds.  Private or semi-private rooms are virtually non-existent.  The bathroom is shared.  The shower room is shared.  The vital signs machine is shared, so the BP cuff goes from one patient to the next.  And when one bed is discharged, another one is immediately wheeled in to fill the empty space.  We wipe down the bed and equipment, but the entire room isn’t disinfected.  The floor isn’t mopped.  The curtains aren’t changed.  How does anyone expect germs not to get spread?

But, as far as I’m concerned, the clincher for this entire debacle is the lack of full contact precautions (gown, gloves and mask), once we know a patient is positive. Instead, we are to don the afore-mentioned plastic apron and gloves when entering said patient’s room.  (We can’t even get our hands on the full disposable gowns, as they’re not stocked on our floor!)  How is a little piece of plastic going to do any good?  Maybe full contact precautions (as practiced back home) are a little bit of overkill, but that policy seems to have prevented entire units from closing down.  I realize I’m not an infection control expert and, certainly, am not up to speed on the latest literature, but I’m seriously questioning the current policies.  It’s going to be interesting to see how this entire situation plays out and if it incites any policy changes.  Don’t worry… I will be sure to keep you posted.