Infection Control

Recently, my partner and I performed a routine inter-facility transport, which turned into a personal nightmare. This error was preventable and could have been life threatening.

The call came in from a local emergency room to transfer a nursing home resident to another ICU several miles away. When we arrived, the patient had a low O2 saturation, was non-responsive, and warm to touch.

When we asked whether the patient was going to be put on a ventilator prior to transport, the attending physician stated that the accepting facility wanted to perform the endotracheal intubation upon arrival. We questioned the choice of waiting to secure the airway and informed the physician that if the O2 saturation dropped any lower, we would indeed intubate the patient en route. I then proceeded to take report from the ER nurse as my partner hooked the patient up to the monitor and took other vital signs, which were all within normal limits.

The patient's history was unremarkable except for the fact that he was in a progressively non-productive state for many months and did not have a DNR. The patient had a saline lock and had no IV medications ordered. We did a more thorough assessment prior to leaving the emergency room and nothing seemed out of the ordinary. I asked the nurse if the patient had any communicable diseases or infections. She stated that the patient had no problems. With this knowledge, we proceeded to load the patient onto the stretcher and into the ambulance.

En route, I observed that the patient's clothes were wet around the stomach and chest area. As I exposed the wet area, I observed a Jackson Pratt drainage device which was leaking and a skin infection surrounding the opening and throughout the abdominal area. After resetting the draining device and drying the area, I skimmed through the rest of the two inches of paperwork, which revealed that the patient had MRSA along with a history of other nosocomial infections.

My problem was: when did I take my gloves off and when did I put fresh gloves on? Did I touch anything non-gloved? The stretcher? The sheets? The patient? Was paranoia settling in? Probably.

I yelled to my partner up front, "The patient has MRSA!" "Where you wearing gloves the whole time?" My partner shouted back that he did.

The CDC defines MRSA as follows:

"Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems."

"MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people."

Several days later, my cheek broke out and was extremely itchy. After purchasing my first tube of Clearasil® since high school and applying nearly half the contents to no avail, I started to believe that it was not ordinary acne. As the week progressed, I commented to my partner that I had excruciating pain in the area of my right nostril. I saw a doctor and there was some debate if I had a nasal abscess or an ingrown hair follicle. The primary care doctor prescribed an antibiotic and suggested that I see an Ear, Nose, and Throat specialist if the condition did not resolve itself. When I awoke the next morning, it looked like I was punched in the nose.

After a few days, the antibiotics seemed to be working because the swelling and pain in my nose subsided. In the meantime, just to be on the safe side and subdue my paranoia, I went to see an ENT physician who informed me that it looks like I had an infection, probably from an ingrown hair. I was told to remain on the antibiotics until finished.