Excuse me, is that MRSA on your neck?

So after my last post about expecting the unexpected, I was reminded about leaving personal equipment in my car. My four year old grabbed my stethescope, which I apparently had flung into the back seat after an exhausting day, and started playing with it. Granted, he was using it properly, which made me both proud and absolutely terrified at the same time. Nonetheless, after watching him for a minute, I suddenly got this overbearing sense of fear, looked into the rearview mirror to confirm what I'd seen, and shouted "Get that off of you!" It was sufficiently loud enough to cause my wife to cover her ears and give me "the look." You know the one I mean.

I realized that my son was playing with a potentially infectious object. Granted, I try to be cautious with my medical instruments, cleaning them when possible and tossing when not. Considering the recent uptick in respiratory emergencies cropping up (tis the season to be sniffling), I realized not only was the bell of my scope carrying potentially dangerous materials, but while being around the coughing, hacking, and sneezing (oh my!), there was a good chance there were particles all over the tubing as well.  In the heat of everything, I couldn't recall whether I'd wiped the scope after my last shift.

We all know that regular, frequent handwashing helps keep the spread of diseases down. But how often do you clean your stethoscope? How often do your colleagues, the RN that just took your report, or the doctor that walked in to asses the tube placement clean theirs? Your scope should be cleaned after every patient contact. If not, the potential for spreading potentially fatal diseases is considerable. Don't limit your cleaning to just the scope. The handles of your trauma shears, penlight/flashlight, and any other re-usable equipment you touched during that patient contact should also be wiped clean prior to using again.

In New York State, the Department of Health's Bureau of EMS issued a policy statement in 1998 allowing agencies to place limits on what equipment individual providers can carry and use. It states that "Services may issue their members/employees certain items of EMS
equipment such as penlights, stethoscopes, and blood pressure cuffs, or may permit
members/employees to carry their own similar equipment." Okay, so what's the issue?

It goes on to say "Any service which issues or permits the use of personal equipment by its members/employees must have written policies in effect which clearly define which items of equipment are personal issue, and the responsibility of each member/employee for the availability, cleanliness and operational condition of each item when on duty. The service may limit what equipment members/employees may carry." For those who were waiting fo the italics to end, it essentially says that both the service and individual are responsible for maintaining their equipment. And remember...with responsiblity comes liability. Though it is probably near impossible to determine the origin of a community-acquired infection, remember that taking a few extra minutes to ensure the cleanliness of your equipment can save you a lot of trouble in the future.

Expect the Unexpected

Is it just me, or has the use of personal protective equipment seemed to have gone by the wayside? It seems no matter where I go, I see more and more responders conducting patient care without basic protection, including the use of gloves. Ask yourself this: do you "glove up" only when the patient is grimy, dirty, bloody, or puke-y? How about when the patient is sitting in a pristine living room in a house you could only afford after winning the lottery, is superbly groomed and dressed to the nines, and is only complaining of stomach discomfort? Are we letting our eyes deceive us?

Count me among those who have trended away from the "I have my BSI on" mentality...until now. A recent encounter left me asking myself why I've been taking these risks, not only for my own health but for the well-being of my family. Let's put it this way...you never know when a patient's condition is going to deteriorate and you end up performing airway maneuvers and suctioning without gloves or goggles. I was lucky that nothing splashed and that my hands were (relatively) unscathed from the coming slaughter of dry skin caused by winter. But the situation still left me wondering "what if?"

Remember this: your agency is required by OSHA to provide you with personal protective equipment necessary to perform your job. There is no requirement that you use it, unless you count common sense among requirements. I typically carry my "blood pouch" with me while I'm on duty. It has a pair of goggles that fit over my prescription glasses, extra gloves, a gown, hand sanitizer, and a MyClyns spray. The day of the crashing patient, it was in the back seat of my car, just when I needed it most. You bet your bottom I won't forget it again.

There's a reason we're taught the mantra about body substance isolation, but I want to take it one step further. As EMS practitioners, we are routinely exposed to contagions of varying lethality on a daily basis. When we come home at night, do we step into a "clean room" to dispose of our work uniform and put on clean clothes before hugging our family? Do our boots lay on the hallway floor where the family dog chews on them? Does your stethoscope lay on the kitchen counter?

Without getting paranoid, think about the potential contagions you are carrying on all of these items. Now think about how you can modify your daily routine to better protect yourself, your family, and your friends. Until next time...glove up, and expect the unexpected.