Infection Controlby
Robert Klassen I just Googled the words "infection control" and got 26,100,000 citations. That’s a bit too many for me to investigate so I will leave it to your curiosity, and move on to my own observations and suggestions on the subject. The issue did not exist in the 60s. The fabled killers of the past, like cholera, smallpox, polio, and tuberculosis were no more. Huge strides forward in hygiene, diet, pharmacology, and medical care had succeeded in eliminating these scourges. Then a strange and unanticipated thing happened. As medical technology advanced in life-support systems, new killers emerged. What was happening? Let me describe what I experienced in the early 70s. After seatbelts were introduced we stopped seeing frequent chest injuries from traumatic encounters with steering wheels. Instead we started seeing frequent head injuries from traumatic encounters with mother earth by motorcycle riders. Those who survived the ER, surgery, and ICU were often still unconscious and attached to ventilators – breathing machines – and the question was, what to do with them? The hospital where I worked established a step-down unit, a kind of way-station between ICU and the wards. There the patients could be weaned off the machines, hopefully restore consciousness, and move on. We had nine patients in one large room. Suddenly, almost overnight, all nine patients acquired pseudomonas infections in their lungs. Now this is one of those everyday bacteria, like staph, that we live with, but it’s not supposed to get into the lungs, where it becomes a killer. The stench was awful and it spread throughout the hospital. So did the bacteria. When it hit the orthopedic ward, the doctors went ballistic and persuaded the hospital administration to apply draconian infection control procedures. Strict isolation meant one patient per room, door closed, mats saturated with disinfectant at the door, gowns, gloves, mask, hat, and booties, and a basin of disinfectant for the hands. No exceptions. It was a chore, it was expensive, and it worked. That outbreak was stopped. Hospitals then started building special isolation rooms on wards that included an anteroom for putting on and taking off the gear and for washing up. Fine, but they removed the booties and the floor mats, so now we tracked stuff in and out on our shoes. In ICU we stopped treating patients in an open ward and put them in separate rooms that could be isolated if need be. Yet overall the infection problem continued to grow. Why? Where was it coming from? Now I want to tell a story that I know you’re not going to like, but here it is. In the mid 90s, a middle-aged man in seeming good health keeled over in a shopping mall. Some passersby tried to help. One started CPR, another called 911. An emergency crew arrived, took over, and transported him to the ER. There he was stabilized and sent to ICU on life-support. His electrocardiogram, echocardiogram, and blood work all showed massive heart damage and he was not stable enough for invasive diagnostics or surgery. He was also not conscious. The man survived his heart attack, but his electroencephalogram demonstrated brain death. What on earth do we do now? That man’s heart actually got better as the months passed, and his brain stem still worked enough so he could be removed from the ventilator. So now we had a living, breathing body with zero higher brain function. Brain dead. The controversy about what to do next waxed hot and furious. The healthcare system had already spent hundreds of thousands of dollars on this case, way beyond any possible insurance coverage or asset recovery. The family refused to let him die. And nature was going it’s own way: Infection after infection attacked this body. Doctors ran through their armory of antibiotics, vitamins, dietary supplements, consultants, you name it. Nature beat them every time. I ran into this patient in his third year of living death. I will spare you a description. However, I found him on my assigned list of patients on a busy medical-surgical ward where the new post-op heart surgery patients recovered after ICU. He was there because they had a heart monitoring system. He was in an isolation room. I knew better than to take short-cuts with this patient, I could smell him down the hall, yet I saw staff doing just that. His wife ignored the isolation procedure altogether. Later I encountered him on the medical ward which took care of sick old people and cancer patients. Still later I found him on the remodeled orthopedic ward. These wards did not have isolation rooms, but only a notice on the door that usually remained open. Staff largely ignored the rules, and breezed in and out of the room. He finally came to rest back in ICU, where nature won the battle.
November 28, 2006 Robert Klassen [send him mail] retired from a forty-year career in critical-care respiratory therapy. He is the author of five books, including Atlantis: A Novel about Economic Government, and Economic Government, which describe a solution to the problem of political government. Here's his web site. Copyright © 2006 Robert Klassen |
I
am proposing something here that apparently doesn’t exist, so please
allow me to repeat. I am not talking about patients who are conscious
and responsive. I am talking about patients who are both brain-dead
and chronically, repeatedly infected. Nobody wants to cope with
these patients. Their existence challenges us emotionally, spiritually,
scientifically, and technically, yet they offer us an opportunity
to understand another aspect of nature’s mysteries: the source of
new and dangerous bacteria. Let’s absolutely isolate them, and come
to understand. This would be an effective step toward humane infection
control.