Being an EMT is scary!

[MSDeltaFlt]

Just about everybody here has been puked on, spat on, snotted on, pissed on, and shat on. You name it, it's been done to us.

Do like Rid said, get more education. Be and stay vigilant. Downgrade the self-admitted paranoia to caution. God created antibodies for a reason. Trust them, but do not rely soully(?sp) on them. Wash properly, follow ALL your company's policies and procedures, and the odds of you being just fine are better than you think.

 

[Stn2Emtb]

I was merely trying to convey that MRSA and VRE are not something to be afraid of. Most everybody if not everybody carries the virus. Its just weather or not your body chooses to react to it or not. I was very aprehensive myself, Especially when I was Pregnant. The more I learn about it the more I understand. I don't like it and I don't want it but because I work in the health care field I'm at higher risk than Joe Schmoe down the street. Mainly what I want to say is Relax and use your head you will be fine. Becareful out there everyone.

 

[VentMedic]

Afraid, no. But, you need to have great respect for the potential harm these bacteria and viruses can do to you and to your patients if you get laxed with cleaning and BSI. Infection control should not be taken lightly.

Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE) are bacteria and not viruses.

Tuberculosis, TB, is caused by bacteria called Mycobacterium tuberculosis.
Multi-drug resistant tuberculosis called MDR-TB is also prevalent in some areas.

Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) are viruses.

HCV can live outside the body on surfaces for several days.
HIV is a very fragile virus and does not survive long outside the body.

Colonization is the presence, growth, and multiplication of the organism without observable clinical symptoms or immune reaction.

MRSA - Colonization may occur in the nares, axillae, chronic wounds or decubitus ulcer surface, perineum, around gastrostomy and tracheostomy sites, in the sputum or urine. One of the most common sites of colonization in both patients and employees is the nose (anterior nares). While personnel may become colonized with MRSA (as they may with susceptible S. aureus), they rarely develop infections.

Enterococci are normally found in the bowel and the female genital tract. When exposed to antibiotics for any reason, the drug-resistant bacteria may survive and multiply, resulting in an overgrowth of drug-resistant enterococci in the bowel, referred to as colonization.

Infection refers to invasion of bacteria into tissue with replication of the organism. Infection is characterized by isolation of the organism accompanied by clinical signs of illness such as either fever, elevated white blood count, purulence (pus), pneumonia, inflammation (warmth, redness, swelling), etc.

Mode of Transmission - MRSA is transmitted primarily by contact with a person who either has a purulent site of infection, a clinical infection of the respiratory tract or urinary tract, or is colonized with the organism. Hands of personnel appear to be the most likely mode of transmission of MRSA from patient-to-patient. MRSA can be present on the hands of personnel after performing such activities as wound debridement, dressing changes, tracheal suctioning, and catheter care.

Reservoirs for MRSA - Colonized and infected patients are the major reservoir of MRSA. MRSA has been isolated from environmental surfaces including floors, sinks, and work areas, tourniquets used for blood drawing, and blood pressure cuffs. Evironmental surfaces should be routinely disfected to reduce the bacterial load.

Reservoirs of VRE - Enterococci are part of the normal flora of the gastrointestinal tract and female genitourinary tracts. Most infections with these microorganisms have been attributed to the patient's endogenous flora. However, a recent study found VRE is capable of prolonged survival on hands, gloves, and environmental surfaces. E. faecalis was recovered from countertops for 5 days; the E. faecium persisted for 7 days. Thus environmental surfaces may serve as potential reservoirs for nosocomial transmission of VRE and need to be considered when cleaning equipment.

Healthcare workers can have skin lesions infected with MRSA and should be treated. Decolonization should be considered for those employees with persistent MRSA nasal carriage (ex. chronic sinusitis), especially if the healthcare worker had contact with patients who were subsequently found to be positive for the same strains.

This information is to educate and not to frighten. Most of the bacteria and viruses mentioned may not affect a healthy individual but can be deadly to the next patient you transport if you do not take a few simple precautions. Patients trust you and it is up to you to see that you do them no harm. That means learning about and diligently practicing good infection control.

Also, if you have small children, don't let them play with your stethoscope. Don't keep your stethoscope around your neck directly on your skin. Change your clothes and wash well before entering your living quarters especially if you have elderly or very young children in your household. Don't take your work home with you by way of bacteria and viruses.

If your place of employment does not offer adequate infection control information, check the continuing education classes for healthcare professions at the local community college (or online). Most will offer inexpensive 2 -3 hour classes on various infection control issues.

If, after you get much more education and you still have concerns about patient care and contracting a disease, you may need to re-evaluate your career choice. Healthcare is not for everyone and for some reason future EMTs (and Paramedics) don't always realize how much patient care and contact is involved when they enter these very short training programs. A healthcare worker must be able to provide quality patient care and if personal concerns prevent that, then the patient may suffer.

 

[Arkymedic]

duplicate post please delete.

 

[Arkymedic]

Afraid, no. But, you need to have great respect for the potential harm these bacteria and viruses can do to you and to your patients if you get laxed with cleaning and BSI. Infection control should not be taken lightly.

Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE) are bacteria and not viruses.

Tuberculosis, TB, is caused by bacteria called Mycobacterium tuberculosis.
Multi-drug resistant tuberculosis called MDR-TB is also prevalent in some areas.

Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) are viruses.

HCV can live outside the body on surfaces for several days.
HIV is a very fragile virus and does not survive long outside the body.

Colonization is the presence, growth, and multiplication of the organism without observable clinical symptoms or immune reaction.

MRSA - Colonization may occur in the nares, axillae, chronic wounds or decubitus ulcer surface, perineum, around gastrostomy and tracheostomy sites, in the sputum or urine. One of the most common sites of colonization in both patients and employees is the nose (anterior nares). While personnel may become colonized with MRSA (as they may with susceptible S. aureus), they rarely develop infections.

Enterococci are normally found in the bowel and the female genital tract. When exposed to antibiotics for any reason, the drug-resistant bacteria may survive and multiply, resulting in an overgrowth of drug-resistant enterococci in the bowel, referred to as colonization.

Infection refers to invasion of bacteria into tissue with replication of the organism. Infection is characterized by isolation of the organism accompanied by clinical signs of illness such as either fever, elevated white blood count, purulence (pus), pneumonia, inflammation (warmth, redness, swelling), etc.

Mode of Transmission - MRSA is transmitted primarily by contact with a person who either has a purulent site of infection, a clinical infection of the respiratory tract or urinary tract, or is colonized with the organism. Hands of personnel appear to be the most likely mode of transmission of MRSA from patient-to-patient. MRSA can be present on the hands of personnel after performing such activities as wound debridement, dressing changes, tracheal suctioning, and catheter care.

Reservoirs for MRSA - Colonized and infected patients are the major reservoir of MRSA. MRSA has been isolated from environmental surfaces including floors, sinks, and work areas, tourniquets used for blood drawing, and blood pressure cuffs. Evironmental surfaces should be routinely disfected to reduce the bacterial load.

Reservoirs of VRE - Enterococci are part of the normal flora of the gastrointestinal tract and female genitourinary tracts. Most infections with these microorganisms have been attributed to the patient's endogenous flora. However, a recent study found VRE is capable of prolonged survival on hands, gloves, and environmental surfaces. E. faecalis was recovered from countertops for 5 days; the E. faecium persisted for 7 days. Thus environmental surfaces may serve as potential reservoirs for nosocomial transmission of VRE and need to be considered when cleaning equipment.

Healthcare workers can have skin lesions infected with MRSA and should be treated. Decolonization should be considered for those employees with persistent MRSA nasal carriage (ex. chronic sinusitis), especially if the healthcare worker had contact with patients who were subsequently found to be positive for the same strains.

This information is to educate and not to frighten. Most of the bacteria and viruses mentioned may not affect a healthy individual but can be deadly to the next patient you transport if you do not take a few simple precautions. Patients trust you and it is up to you to see that you do them no harm. That means learning about and diligently practicing good infection control.

Also, if you have small children, don't let them play with your stethoscope. Don't keep your stethoscope around your neck directly on your skin. Change your clothes and wash well before entering your living quarters especially if you have elderly or very young children in your household. Don't take your work home with you by way of bacteria and viruses.

If your place of employment does not offer adequate infection control information, check the continuing education classes for healthcare professions at the local community college (or online). Most will offer inexpensive 2 -3 hour classes on various infection control issues.

If, after you get much more education and you still have concerns about patient care and contracting a disease, you may need to re-evaluate your career choice. Healthcare is not for everyone and for some reason future EMTs (and Paramedics) don't always realize how much patient care and contact is involved when they enter these very short training programs. A healthcare worker must be able to provide quality patient care and if personal concerns prevent that, then the patient may suffer.

Very well written post as always Vent. Thank you.

 

[SC Bird]

Obviously there is a greater risk of exposure working in the environments that we do... But it's something that I think one really has to be 100% aware of...but do not let it consume you. It may begin to hinder your ability to properly care for your patient.

....but if you really want to get down to it....just think about the possibilities of exposure at the hotel rooms you stay in are (DO NOT TOUCH THAT REMOTE!!!!!) or on the door handles to bathrooms at rest stops or just everywhere.

That's why I love me some handwashing....

-Matt

 

[MyLoveIsMyBaby]

Okay I heard enough. The nursing homes and facilities don't know everything. I have dry skin and I begin to think it's MRSA, my son hasn't got it nor my fiance, it's probaly not MRSA. Yesterday I brought a pt to a continuing care facility in a hospital from dialysis, dispatch sent text stating pt has MRSA in urine and blood. Took precautions, and got there, once on scene stated to nurse that pt has MRSA, showed text from dispatch and said yeah dialysis said take precautions. They had no record of pt having MRSA. In a room with another pt w/o MRSA. They started flipping looking for a history and all. BE careful. ALWAYS ALWAYS WEAR GLOVES. I don't know if MRSA is airborne, or if gloves are suiteable, cause I recently went to a few, still trying to find out if I was at risk or not. Why not wear gloves? ALWAYS wear gloves, u never know. Goes to show that our worst enemy in the field can b the healthcare providers next to us.

 

[VentMedic]

Okay I heard enough. The nursing homes and facilities don't know everything. I have dry skin and I begin to think it's MRSA, my son hasn't got it nor my fiance, it's probaly not MRSA. Yesterday I brought a pt to a continuing care facility in a hospital from dialysis, dispatch sent text stating pt has MRSA in urine and blood. Took precautions, and got there, once on scene stated to nurse that pt has MRSA, showed text from dispatch and said yeah dialysis said take precautions. They had no record of pt having MRSA. In a room with another pt w/o MRSA. They started flipping looking for a history and all. BE careful. ALWAYS ALWAYS WEAR GLOVES. I don't know if MRSA is airborne, or if gloves are suiteable, cause I recently went to a few, still trying to find out if I was at risk or not. Why not wear gloves? ALWAYS wear gloves, u never know. Goes to show that our worst enemy in the field can b the healthcare providers next to us.

I am going to suggest you do some serious reading and enroll into one of the many programs at a health care facility or college. You obviously do not have a clue what MRSA is.

There are such things as a new diagnosis of a MRSA infection that can be treated and/or is colonized.

Wear gloves, wash hands and get an education about medicine or at least enough knowledge to know how to approach the subject at a professional level. There are many, many different bacteria, viruses and spores out there just waiting for the unsuspecting EMTs and their patients. At this point I would say your patients may have more to worry about since you have no clue about infection control. YOU can do them more harm.

 

[jerellem]

"I came home., I told my mom I had a HIV+ pt. she freaked out and she was like. How am I gonna throw your clothes in the washer tomorrow. I am like, I don't know." - Classic! LMAOOOOOO if you're THAT scared you need to try something else. I'm super paranoid of that kinda stuff too but thats too paranoid. My gf's mom is possible HIV+ and I see her all the time ride in the car with her, etc. Its not like germs are just chasing people down and relentlessly hacking into their system and taking over the world lol. Just remember BSI and stay educated.

 

[BossyCow]

I'm still trying to wrap my head around his mother doing his laundry for him! I work in a vollie agency and there has been more than a time or two that I've changed into scrubs at the ER and carried my clothes out of there in a biohazard bag for laundering at the station.

You should have a clean set of clothes at the station that you can change into as well as laundry facilities there.

 

[Ridryder911]

"I came home., I told my mom I had a HIV+ pt. she freaked out and she was like. How am I gonna throw your clothes in the washer tomorrow. I am like, I don't know." - Classic! LMAOOOOOO if you're THAT scared you need to try something else. I'm super paranoid of that kinda stuff too but thats too paranoid. My gf's mom is possible HIV+ and I see her all the time ride in the car with her, etc. Its not like germs are just chasing people down and relentlessly hacking into their system and taking over the world lol. Just remember BSI and stay educated.

Hmm... a little cross infection? Maybe a little education is really in order. I am far not a germ phobic but as well educated enough to know that mixing clothes with contaminated clothes is a good way to expose everyone. As well many health care providers are MRSA + as carriers also Hep B.

If you don't believe that "germs" are not getting into more into systems than usual, you need to read up in geriatric care and microbiology. Yes, health care providers need to understand that there are more and more resistant bacteria. Hence there is NO cure as they mutate and become resistant to antibiotics. Even simple hand washing with anti-bacterial soap has consequences.

It is one thing to be paranoid and another to be laxadazical in infectious diseases.

 

[Bosco578]

I burn my uniform after evey call and then take an acid shower......I then blow the ambulance up just in case..........

 

[Code 3]

I burn my uniform after evey call and then take an acid shower......I then blow the ambulance up just in case..........

Sounds costly...:blink:

I'm not nearly as paranoid as some that are posting in here; however, I'll be the first to admit of my OCD when it comes to the rig. I will wipe down the CPU, door handles, mic, window/lock buttons, radio, etc. I think cross-contamination is a huge problem that people often overlook. You'll also get a swift boot the to butt if you try and get inside the cabin with your gloves still on.

 

[Oregon]

I burn my uniform after evey call and then take an acid shower......I then blow the ambulance up just in case..........

I hear acid showers are great for reducing those fine lines and wrinkles!

As I was gloving up a day or two ago (to wrap up a nasty thumb lac. on another EMT) I was considering what might be on my gloves...and in his wound, now. I think I'm going to start carrying my gloves in a ziploc or something, not just shoving a wad of 'em into my pocket before I go out. Not that my pockets are full of cow poo or anything, but still.

 

[MagicTyler]

My dad was an x ray student in the late 80's and had indirect contact with an AIDS pt, he touched her shirt with his ungloved hand. She had no open wounds, there was no blood, he simply touched her shirt ... He ended up in a full procaution room for 24 hours while they made sure he wasn't HIV positive.
:wacko:
A few weeks ago he got an AIDS pt's blood on his arm while he was starting an IV... He just went and washed his hands...
^_^
Education can change things...

 

[reaper]

A lot of it is how the media blows things out of proportion. In the 80's and 90's they had everyone scared to touch an AIDS pt. Then it was Avian Flu,SARS and now MRSA.

You are in the healthcare field. Take the time to research the different diseases and take universal precautions. There is no reason to live in fear! Most of these have been around for a long time and we have dealt with them before the hype.

 

[VentMedic]

A lot of it is how the media blows things out of proportion. In the 80's and 90's they had everyone scared to touch an AIDS pt. Then it was Avian Flu,SARS and now MRSA.

It wasn't totally the media when it came to AIDS. In fact the media was kept in the dark for quite some time about the seriousness. We were kept in the dark at the beginning. That was the only time in my career I was not allowed to open the chart for transfer information and was literally dressed by the hospital staff. All info was passed through the top.

We got our hospital isolation advice from the same centers (CDC) that advises on Ebola. The initial isolation rooms and practices were taken from that. At that time, Ebola was one of the few very deadly diseases known. Only a few people were allowed in the wing that housed "those patients". All supplies used including dishes were disposible and placed in biohazard containers (not just the bags). Some hospital staff were refusing to care for the patients. At first they used the health hazard potential and when the disease was named GRID they cited religious reasons if the health risk didn't get them relied from duty on "that" floor.

Our patient population at that time was very unique if anyone knows the history of Miami in the early 1980s. To be honest, that was a scary time because of the unknown factors but fortunately the education came quickly in our area. It was terrifying to see hundreds of people dying so rapidly from a horrible death. I know I personally lost more than my share of friends and co-workers during that time and the many years to follow.

Florida also has the sad story where firefighters did not want to fight the fire that destroyed the Ray brothers home in 1987 out of fear they would get HIV.

Luckily, universal precautions came out of this and increased education to all disciplines (except for some in EMS). As an RRT, I do have access to some serious filtered respirator equipment for some invasive procedures and certain pulmonary patients.

I do take extra precautions to protect myself and those around me with intubated or any patient I'm using a BVM with by placing a filter between the patient and bag exhaust valve. If running CPAP/BiPAP on some patient with suspicious CXRs, I'll try to get them to an isolation room quickly. Portable CPAP was thought to be the star player in the event of a serious respiratory disease outbreak but recent white papers on the subject have presented a different view from a contamination point of view.

If on a ventilator, I make sure anyone breaking the circuit has protection from spray. Single limb circuits on transport ventilators get an HME filter to protect all crew members on the team as well as any members of the general public they pass. Too few CCT teams fail to realize how easy it is to contaminate a portable ventilator by not placing a filter by the circuit port and can literally infect every patient that machine comes in contact with.

In the ambulance, you can always wear a mask with any respiratory patient that has purulent secretions and cough. Keep yourself healthy. Don't over tire by working too many hours. A healthy body and universal precautions should protect you. Just be mindful of where your clothes and shoes have been. I have yet to wear either home in 30 years regardless of how good I look in them. I definitely cringe when I see any EMS/Fire employees handling the fruits and veggies at the market.

 

[Emtint08]

understood!!

I have start my job as an EMT for week now. The job is pretty scary I had a MRSA pt. and a HIV+ patient. After the call I believe I have caught everything. I am so paranoid. For the MRSA pt. we have to t/p her back to his nursing home. When you enter the room we have to have a full body BSI gowns, masks, and gloves. But then we were supposed to throw away all the BSI in the room with the pt. after you are done assessing him. Then I thought to myself, how am I safe with the pt. in his room with all my BSI off. I mean I am basically breathing the same air he is, how am I myself safe?

The next day I had a HIV+ pt. I was like :censored::censored::censored::censored:, cmon I don't a pt. like this. we had to t/p her back to her nursing home so when i went in of course I had gloves on. But the room smelled so bad it feels like you could of caught HIV by breathing the air. After we're done with the pt. we have to take out off our gloves and push the stretcher back to our rig I was so scared that I might have caught HIV by touching the cot. Plus it's winter time. I have minor cuts near my nails and fingers on my hands from dry skin. Her belongings were on the stretcher and I was so scared to touch anything on the stretcher. But then I know HIV is transferred from blood, but then I am still scared that it can be transferred from the things they have touched. I came home., I told my mom I had a HIV+ pt. she freaked out and she was like. How am I gonna throw your clothes in the washer tomorrow. I am like, I don't know.

PEOPLE I AM SO SCARED!!!NOW I FEEL LIKE QUITTING THE JOB!!! ALSO KNOWING THAT THE RIG IS CONTAMINATED WITH GERMS!!!

I understand completely!!!I went through the same thing yesterday in the ER. I have been very good about taking precautions going into the patients room but sometimes with a stat transfer they don't tell you a lot. In the year I have been with the ER I have never had four back to back patients with hiv, hep c, Cdiff and MRSA. I had that day yesterday and it was the only day that I managed to cut myself. I took as many precautions as I could without making the patient feel any worse than they already did. I washed my hands a million times and I didnt walk into the house with my clothes on. I had my husband come out to the car with a bag, stripped in the car, put a robe on, put the clothes in the bag and through them in the washer. The key is to remember, which is difficult to do in this situation, what is contact and what is airborne precautions. If you are gowned and gloved up, and masked in airborne situations, you should have no worries. I was also told on top of this, if you have a good immune system you should not be at risk. I did and felt the same thing yesterday, even though I know what contact precautions are and what to do. Ironically, HIV is really nothing you need to worry too much about because its very difficult to get without real physical contact, or body fluid swap. The virus doesnt last long at all once it is airborne. HEP C on the other hand is a much different story. But still involves some kind of bodily fluid exchange. As long as you are gloved up, you should be okay. Don't worry, I think you'll survive this. But it does make you think, doesnt it?

 

[Emtint08]

nice

I burn my uniform after evey call and then take an acid shower......I then blow the ambulance up just in case..........

LOL. I like that. Hope your kidding!!

 

[Ridryder911]

Ironically, HIV is really nothing you need to worry too much about because its very difficult to get without real physical contact, or body fluid swap. The virus doesnt last long at all once it is airborne.

Actually the HIV virus has been found to stay alive on Formica up to two weeks.

R/r 911