Infection-control basics. A common sense review for EMS personnel

Infection-control principles and practices based on science and common sense have been around for thousands of years. They've proven effective. If you know how a disease is transmitted, then you'll know what PPE to use to block transmission. Viruses don't multiply or survive for long outside a living host, so they may be present on a given surface, but in low numbers--and most often not numbers large enough to cause infection. However, hepatitis B virus can survive up to seven days in the presence of dried blood; that's why contaminated equipment must be cleaned as soon as possible after use. If it's not possible to use PPE in a given situation or it fails, then post-exposure medical follow-up and treatment can protect you. Ensuring there's an effective communication network in place for reporting an exposure to your DO is essential. Your agency should verify that hospitals are aware of their responsibilities under the Ryan White Law to share patient testing information if an exposure event occurs. The DO's role includes working with hospitals to provide proper medical follow-up, rapid patient testing and counseling for the exposed provider. Your DO is your advocate. Each and every component of your department's exposure control plan assists in reducing the risk for acquiring an infection on the job. Risk reduction and risk management are both vital. Ultimately, the responsibility lies with you--the provider--to know infection-control principles and practice good habits.     

Personal protection equipment for biological hazards: Does it affect tracheal intubation performance?

PURPOSE: Personal protection equipment (PPE) is recommended for use during airway management of patients with highly contagious respiratory tract illness. While its use in chemical hazards and its effect on airway management has been assessed previously, there has been no research assessing whether this equipment affects the ability to perform tracheal intubation. It is the intention of this investigation to answer this question. METHODS: Eighteen workers at various level of training were asked to wear three different types of PPE while performing four different types of tracheal intubation. The PPE used included the eye shield, face shield and the "Dustmaster". The intubation techniques were direct laryngoscopy, intubation through the intubating laryngeal mask (Fastrach) and flexible bronchoscopy using the eyepiece and an eyepiece with camera attached. We assessed the time to intubate as well as the incidence of oesophageal intubation. A short questionnaire was used to examine participants' subjective experiences of wearing the various types of PPE. RESULTS: There was no significant effect on the time to intubation for any of the methods studied. However, all subjects found that the face shield was uncomfortably hot to wear. Fibreoptic bronchoscopic intubation using the eyepiece was particularly difficult with all of the PPE used due to the distance of the subjects' eye from the eyepiece. CONCLUSION: Although the use of PPE may not affect the length of time to intubate manikins, certain types of PPE may be uncomfortable to wear and noisy. Further research is needed to investigate whether this could be a problem in the clinical setting or in actual difficult intubations.     

Unconventional patient moves

EMS is a dynamic occupation. Every day, we face new challenges. Without some "outside-the-box" thinking, it is difficult, if not impossible, to keep up. In this article, we have discussed only a few of the "tools" we apply in adverse situations. As members of the only hospital-based EMS heavy-rescue unit in the United States, we believe collectively that our primary mission is safety, first for providers and then for patients. Much of what is carried on an average heavy-rescue unit goes unused or is used only rarely. If we can take tools, equipment and techniques that we would ordinarily only apply for their most obvious use and use them in a unique and unconventional way while promoting the safety of all parties involved, then we have accomplished our primary objective. Don't let your equipment collect dust because you are only willing to use it for obvious reasons. Apply it to every rescue situation you safely can.     

Know your public: the importance of the EMS provider in community and media relations

In the hundreds, and even the thousands, of hours that are spent in EMS training, none of the time is dedicated to community relations and public information. You have learned how to provide a service, but not how to sell the product. We relate to stories about physicians who were unsuccessful because of a poor "bedside manner." The patient's perception of you has very little to do with your score on the final exam or the terminology used as you explain an illness. You are judged by the same rules by which store clerks, telephone operators, waitresses and all others in the field of public service are gauged everyday. You may never do great things, but you can do small things in a great way. Just calling 911 is not enough to save a life. The very idea that we can get everywhere in the nick of time to snatch victims from the jaws of death is a fallacy. You most be concerned with the training provided for the lay public as you are with your own continuing education. There is no better way to make your service more effective than to train your entire community to save lives. There are many reasons why you should know how to deal with the media. A strong relationship can be formed simply by knowing how to make their job easier. Following the golden rules for news releases and interviews help us all appear more professional. The career of an EMT is in metamorphosis. You have been accepted by the patients you served and your fellow members of the medical community. Now you must continue to evolve as practitioners; your skills must change to meet the demands of modern medicine, and your knowledge base must continue to increase as new information becomes available. The one thing that must remain the same is your total commitment to patient care.     

Reduction of adverse drug events and medication errors in a community hospital setting

Keys to success in reducing ADEs have included the support of administrative leaders through their visibility and emphasis on safety as an organizational priority, and financial support for safety projects. Administrative participation was also helpful in promoting safety efforts through the reinforcement of expectations when progress was sluggish. The use of rapid cycle change provided enough early success to serve in motivating staff to push ahead. It allowed staff the opportunity to analyze changes, make adjustments, and retest on a slightly larger scale. Other key success factors included the motivation of teams through continual sharing of progress and success stories; celebrations for achievements are held routinely. As an organization, SJMC has shared its success strategies with other organizations and promoted networking with other organizations to determine what strategies have worked elsewhere. This is helpful as it prevents time from being wasted on solutions that have been tried without success.Within the OSF Healthcare System, the following phrase has been adopted in regard to patient safety, "Safety is like peeling an onion; the more you look, the more you find, and each layer makes you cry."     

Hazardous-materials response

The preceding text has provided some of the basics that you should know to safely operate at a hazardous-materials incident. Unlike other types of emergencies, the plethora of dangers that exist at hazmat incidents may cause the rescuer to delay patient care. The key here is safety first--your safety! I can't overemphasize the need to properly protect yourself at these situations. Remember, you can't help the patient if you become one too! With the significant rise, worldwide, in the number of hazardous-materials incidents over the last 10 years, it has become apparent that extensive and continued training is needed to protect the rescuer and ensure quality patient care.     

The preparticipation physical examination

For decades the preparticipation physical examination (PPE) has been used to screen athletes prior to sports participation to prevent injury or illness. Evolution of the PPE, it is theorized, originated from the need to identify individuals with conditions that may predispose them to injuries or life-threatening situations. However, the effectiveness, practicality, and worthiness of the examination are a matter of debate. As members of a medical team, physicians are responsible for the health and safety of the athlete. The PPE is the first step in satisfying this responsibility. This article discusses the components of the PPE and presents the evidence-based model of knowledge behind the PPE.     

Review of personal protection equipment used in practice

Standard precautions offer a consistent approach to infection control that does not rely on knowledge or suspicion of infection, and contributes to staff and patient safety by reducing the risk of exposure to potentially infectious material. One of the cornerstones of standard precautions is the appropriate use of personal protective equipment (PPE) whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions including correct use of PPE is inadequate. Demographic and epidemiological changes in the U.K., and the drive to provide more complex patient care outside acute hospitals may lead to increased infection risks for both patients and community healthcare workers. This review examines the importance and use of PPE by community nurses and discusses the implications for practice of poor compliance with standard precautions. Recommendations for practice will be made aimed at improving compliance with this important element of standard precautions.     

Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. A pilot study.

ObjectiveIntroducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation.MethodA pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The first step consisted of washing hands, putting on safety glasses and gloves as the first personal protection equipment (PPE) and then covering the victim with an assembled plastic blanket. The second step consisted of 10 min of cardiopulmonary resuscitation (CPR) with PPE and plastic blanket, following the technical recommendations for ventilation during COVID-19.ResultsTen rescuers took part in the pilot study. The average time to wear PPE and place the pre-assembly kit on the victim was 82 s [IC 58–105]. After 10 min the quality of the resuscitation (QCPR) was 91% [87–94]. Quality chest compressions (CC) were 22% better than ventilations (V). Most of the rescuers (60%) thought that placing the plastic blanket on the victim on the beach was somewhat simple or very simple.ConclusionsResuscitation techniques in COVID-19 era at the beach have added complexities for the correct use of PPE. Plastic blanket plus basic ventilations equipment resource could be a new alternative to be considered for lifeguards to keep ventilation on use while reducing risk transmission.     

What is this thing called pain?

To paraphrase Cole Porter's famous 1926 song, "What is this thing called pain? This funny thing called pain, just who can solve its mystery?" Pain, like love, is all consuming: when you have it, not much else matters, and there is nothing you can do about it. Unlike love, however, we are actually beginning to tease apart the mystery of pain. The substantial progress made over the last decade in revealing the genes, molecules, cells, and circuits that determine the sensation of pain offers new opportunities to manage it, as revealed in this Review series by some of the foremost experts in the field.     

When did you last talk with your legislators?

January 2003 marked the beginning of the 108th Congress. If you have not yet spoken with your federal legislators about nurse practitioners (NPs), now is the time to do so. As legislators begin introducing new bills for this session of Congress, it will be important for NPs to inform their legislators about problems and issues facing them and their patients that need to be addressed.
If you have never talked with your legislators, you will want to make an appointment the next time he or she comes home. Most legislators have offices in a centrally located town in their district or, in the case of senators, in the capital and in the larger metropolitan areas of the stat represent. A call to "Telephone Information" should help you to locate their offices and local phone numbers. If you have difficulty finding them, the League of Women Voters or your local Republican and Democratic headquarters should have the information you need. If you have visited your legislator, let them know that you have spoken before and that you would like to talk again. If you had a previous successful interaction the legislator may remember you with pleasure and will want to meet with you again.
If possible, when visiting your congressperson, take a group of NPs with you. Be sure to let the staff know that you are a constituent. Legislators are elected to represent the people in their electoral district in government. As a result, they are particularly interested in the concerns of the population responsible for putting them in office.     

The preparticipation evaluation.

The preparticipation evaluation (PPE) is the first step toward meeting the responsibility of maintaining the health and safety of the athlete. The ideal timing for the PPE is 6 weeks prior to the competitive season to allow adequate time for treatment and rehabilitation of problems. It is suggested that a complete screening evaluation be performed prior to entrance into a new level of school with annual limited reevaluations thereafter. The annual reevaluation should focus on the medical history with the physical examination emphasizing the cardiovascular system and interim injuries and medical problems. Currently, there are no data to support routine screening laboratory, radiographic, or cardiovascular testing in the asymptomatic athlete with an unremarkable history and normal examination. Two different methods for performing the PPE can be used (station-type mass screening and office setting), with each having its own distinct advantages and disadvantages. The most important and difficult decision for the physician screening young athletes is determining clearance for activity. Guidelines based on the demands of the sport and specific medical problems have been established; however, the physician's clinical judgement should be used in interpreting these recommendations for each individual athlete. The PPE is an excellent opportunity for the physician to positively influence the health care and safety of a local sports program. Through genuine interest, thorough evaluation, and knowledgeable counseling, the athlete will develop confidence in the evaluating physician. This confidence can translate into a good relationship and hopefully this interaction will encourage the athlete to trust the physician's judgement and seek early evaluation and treatment for problems that arise.     

Research in physical medicine and rehabilitation. XI. Research training: setting the stage for lifelong learning

This is the summary article in our research series. We have attempted to provide useful information for persons at all levels of research training, from the student to the clinician with a collaborative but not active role, to the new clinical researcher, to the experienced faculty member. But there is much more to be learned than can be presented in a short series of articles. From this series, you should be able to make a reasoned choice about what role in research you would like to take, and seek to maintain or upgrade your research skills to accomplish that. The previous articles, exercises and references presented will guide you in independent study. The focus of this article is to help you choose an environment in which you can continue to learn and develop. Although the "ideal" place as described here may never exist, no institution is totally devoid of research possibilities and you can use this article to help seek or develop local resources you may not have considered. By extracting questions and clues from people around you, you stimulate them to "think research" even if a formal program is absent; at the least, you can ally yourself with a nearby institution which has researchers in other clinical specialties or areas of basic science. Each organization is obviously different, having different strengths and resources. It is up to each chairperson to decide what proportion of limited resources should be invested in research. Once this decision is made, it is the initiative of the individual faculty members that will make a productive department.     

Knowledge of Handling the Personal Protective Equipment by Frontline Allied Health Professionals in COVID-19 Outbreak—A Web-Based Survey Study

Ever since the coronavirus disease 2019 (COVID-19) has emerged, the number of affected individuals has been increasing exponentially. The frontline health workers are in constant risk because of the etiology and mode of transmission of the disease. Thus, the proper use of personal protective equipment (PPE) is very crucial during this pandemic. This study is to assess the knowledge regarding the handling of PPE among frontline allied health professionals who are directly in contact with patients with COVID-19. A standard questionnaire was prepared in Google Forms and circulated within the network of health-care workers via online platforms. A total of 143 frontline health workers participated in the questionnaire survey. It was found that only 44.1% of the total participants had previously undergone training regarding the handling of PPE. About 86.0% of participants gave correct response to the safety etiquette questions. For another knowledge-based question about using the N95 respirator in conjunction with a face shield, 86.7% of participants responded correctly. Only 67.8% of participants gave the right response to the question regarding the sequence of donning and doffing of PPE. The last question was regarding knowledge about the disposal of PPE, where 95.8% of participants responded correctly. Despite the safety precautions and procedures set forth by the Centers for Disease Control and Prevention for handling patients with COVID-19, the health-care workers are still prone to occupational hazards. The only barrier standing between the health-care workers and COVID-19 is the PPE. Thus, in-depth training and education should be imparted on the health-care workers in the present pandemic situation.     

Are new agents used to treat rheumatoid arthritis safe to take during pregnancy? Organization of Teratology Information Specialists (OTIS) study

QUESTION: I have a patient planning pregnancy who has resistant rheumatoid arthritis that will require treatment with some of the "new" medications. Which ones are safe to use during pregnancy, and which ones do we know enough about to tell whether they are safe or not? ANSWER: For most new disease-modifying biologic medications, we have few data on safety. More and more reassuring data are accumulating on azathioprine and cyclosporine. When you treat this patient, you can help in gathering such data by contacting the Organization of Teratology Information Specialists' Autoimmune Disease in Pregnancy study through Motherisk at 877 311-8972.     

JCAHO's safety goals--the clock is ticking, will your ED be compliant?

To comply with new safety goals from the Joint Commission on Accreditation of Healthcare Organizations, use specific processes and policies designed to minimize likelihood of errors. Nurse-to-nurse communication is the preferred method to use when handing off patients. Meet with staff on a regular basis to assess how well you are meeting Joint Commission requirements. Prepackaged medications can help you and your staff meet the new medication labeling goal.     

Military nursing research: translation to disaster response and day-to-day critical care nursing

Where to begin? How do you identify nursing care requirements for military operations, disaster, and humanitarian response, and how do you modify care under these unique conditions? This article presents a framework for identifying areas of critical care nursing that are performed on a day-to-day basis that may also be provided during a contingency operation, and discusses how that care may be changed by the austere conditions associated with a contingency response. Examples from various disasters, military operations, and military nursing research are used to illustrate the use of this framework. Examples are presented of how the results of this military nursing research inform disaster nursing and day-to-day critical care nursing practice.     

Palmar-plantar erythrodysesthesia (PPE): a literature review with commentary on experience in a cancer centre.

Palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome (HFS) is a relatively common side effect of cytotoxic chemotherapy. Many cytotoxic drugs have been reported to cause the condition but it is more frequently associated with 5 fluorouracil (5FU), liposomal doxorubicin and cytarabine. The oral 5FU precursor, capecitabine is frequently associated with PPE and with the recent extension of its use to adjuvant treatment, the incidence of PPE is likely to increase. The initial symptoms are dysesthesia and tingling in the palms, fingers and soles of feet and erythema, which may progress to burning pain with dryness, cracking, desquamation, ulceration and oedema. Palms of the hands are more frequently affected than soles of the feet. This condition is painful and distressing to patients and in some incidences it results in patients not being able to work or perform normal daily activities. It can also result in treatment interruptions which impact on the efficacy of the treatment regimen. Effective and appropriate patient education from a specialist nurse prior to treatment is an essential part of patient management which will facilitate early identification of the symptoms and therefore prevent treatment delays and PPE progression. This article reviews current knowledge of the condition, including classification, and discussion of the findings of a clinical audit in a cancer centre. It includes the incidence, grading, management and impact of PPE on normal daily activities.