Nevada RNformation - December 2020

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Page 10 • Nevada RNformation December 2020, January, February 2021 Antimicrobial Stewardship – Infection Prevention SARS-CoV-2 and Infection Prevention - Stop the Bleed By Norman Wright, RN, BSN, MS – Infection Preventionist It is Thanksgiving Day 2020. SARS-CoV-2 (Coronavirus) infections and Covid-19 hospitalizations are surging for the third time this year, and the wave is building with no crest in sight. During the first wave back in April 2020, Nevada’s highest seven-day running average of SARS-CoV-2 infections was only 161. The second wave peaked on July 20, 2020, when the 7-day average of daily infections increased to 1,171. We are now experiencing the third wave, and it is hitting hard. We have blown past last summer’s numbers, and on November 26, 2020, Nevada’s 7-day average of infections more than doubled to 2,415. Before the election, people attended packed campaign rallies, many without masks, and street demonstrations continue. CDC’s recommendations are ignored, and people crowd into airports traveling to spend Thanksgiving with family. Continuing to disregard basic infection prevention guidelines will result in infections, hospitalizations, and deaths, to increase astronomically. Graph #1 Nevada’s Daily Infections https://www.worldometers.info/coronavirus/usa/nevada/ Graph #2 Nevada’s Hospitalizations https://covidtracking.com/data/state/nevada/hospitalization It is Thanksgiving, and to date, 2,092 Nevadans have died. Yes, treatment options are improved, and the percentage of deaths vs. the number of infections has decreased; the only problem, infection rates are skyrocketing. I pray I am wrong, but I fear deaths will increase at a blistering pace in the coming months. The Institute of Health Metrics (IHME) latest estimate is that by February 2021, Nevada’s death toll will be over 3,700. The unfortunate reality, deaths peak about a month after the number of infections begins to decrease, and Nevada's daily infection numbers continue to escalate. At NNA’s 2019 annual convention, a “STOP The BLEED” educational session was taught. Without going into details, the most important takeaway was, “When someone is bleeding, do something, anything, to stop the bleeding." Tear off your sweaty shirt or your belt, use anything at all that can compress, or acts as a tourniquet, to stop a person from bleeding out. That said, an infection prevention article telling you to press an unsanitary towel or to tie your shoelace above an open wound seems to be a non sequitur, but it is not. First Aid Basics are ABC (Airway, Breathing, Circulation). Bottom line, if the person dies from bleed out before getting to the hospital, infection prevention recommendations and antimicrobials are of no concern nor useful. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html When someone is bleeding out, immediate action must be taken, or death quickly occurs. Yesterday's 7-day average of SARS-CoV-2 deaths in the United States was 1,708, and the CDC estimates that the numbers will increase. September 11, 2001, when 2996 Americans died after four hijacked airplanes crashed into the World Trade Center, the Pentagon, and a field in Pennsylvania - is a date burned into my memory – and now, every two days, more Americans die from COVID-19 than died on 9/11 - think about that for a minute. The daily tally of COVID-19 deaths has continued for so long that many have become numb to the reality and are experiencing “COVID Fatigue." Some of us, too many, refuse to wear masks, shelter in place, or take other necessary precautions. Despite the increase in hospitalizations and deaths, mixed messaging has caused confusion. Some still don’t believe SARS-CoV-2 is real, while others are letting their guard down. Media emphasis has been on a "cure," not prevention. Ineffective remedies such as hydrochlorothiazide were hyped, and mitigation efforts were minimized, even discounted. The result, infections are spreading like wildfire. Vaccine development has been politicized and hyped for months. Vaccines are now in the process of being approved, and indications are, before the New Year, there will be at least two different vaccines available, some claiming a 95% immune response. Hopefully, by February 2021, we will be vaccinating health care professionals, first responders, vulnerable senior citizens, and others with comorbidities. But it will take many more months before a large percentage of our population can be vaccinated. The term “Herd Immunity” is being discussed in the media as a way out of our dilemma, but between 70 to 90 percent of our population must be infected or vaccinated before “Herd Immunity” is achieved, and this probably will not occur until early summer, if at all. A problem with “Herd Immunity Theory” is that immunity to Coronavirus may not last long. Unlike smallpox and polio vaccines, SARS-CoV-2 immunity may last only a year or less. (1) (2) (3) (4) The trajectory of how quickly Coronavirus infections spread is frightening, and this is where the analogy of comparing the "slow-motion pandemic" we are experiencing is equated with the quick action that must be taken to preserve a life when witnessing someone bleeding after a car accident, or a mass shooting. — (See accompanying article Stop the Bleed Training). SARS-CoV-2 is a novel virus that spreads rapidly. Every day we learn more about it, and older data that is less accurate gets mixed in. Since last January, we have been fed a constant barrage of information and misinformation regarding COVID-19. It is on TV, in newspapers, the Internet, Twitter, and various other media sources. Masks help to stop spreading infection from the wearer to others, and masks also protect the wearer from being infected, but wearing a mask has become politicized. Many media sources continue to spread doubt, causing confusion and noncompliance. The result, the number of infections is soaring into the stratosphere. (5) Basic infection prevention practices, wearing a mask, social distancing, hand hygiene, and doing other preventative measures is how we stop the slow bleed of hospitalizations and deaths from COVID-19, and this is where the analogy of saving the life of someone who is bleeding out differs from the unified approach that must be taken to stop the spread of the infection. Mitigation requires buy-in from society as a whole, and if we fail, tens of thousands more will unnecessarily die. But viewing the pandemic only in terms of the number of hospitalizations or deaths is shortsighted. Ignoring the societal, economic, and psychological impacts, many recovering from a SARS-CoV-2 infection, even those who were not hospitalized, have a different form of "COVID fatigue," which is one of the many post-infection symptoms that “Long Haulers” have. (6) Today is Thanksgiving, and 2020 is a year we will all remember. Let’s be thankful for all we have because looking at what is lost only creates negativity that generates a downward spiral. After the October 1 Las Vegas shooting occurred, the term “Vegas Strong” resounded, and we recovered. It is time for us to work together, and when we do, Nevada Strong, indeed USA Strong, will echo around the world. Ultimately the actions we take today determine our future. Not just your future, but a future that our children and their grandchildren hopefully will enjoy. Ultimately infection prevention is an individual responsibility that everyone must practice. If we don't deal with COVID-19 locally, it is impossible to control it anywhere. Onward to 2021 – and the future! Citations: (1) https://www.niaid.nih.gov/research/immune-response-covid-19 (2) https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#COVID-19-Risk (3) https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunityand-coronavirus/art-20486808 (4) https://apic.org/monthly_alerts/herd-immunity/ (5) https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-coverguidance.html (6) https://www.mayoclinic.org/coronavirus-long-term-effects/art-20490351
December 2020, January, February 2021 Nevada RNformation • Page 11 Healthy Nurses By Tracey Long PhD, APRN-BC, CDE, CNE, CCRN Nurses educate patients about the value to get vaccines all the time, but how many nurses actually get those same vaccines for themselves? The annual influenza vaccination is often a requirement for healthcare professionals to reduce absenteeism and reduce influenza-related morbidity and mortality, however only approximately 78% of health care personnel actually comply with the recommendations for themselves (CDC, 2018). Coverage was lowest among nurses working in longterm care settings. According to a qualitative study, the reasons why nurses decline influenza vaccination included mistrust of safety, overuse of vaccinations and even rebellion over being told what to put in their own body and wanted decisional autonomy (Pless et al. 2017). And yes, nurses do have a right, just like anyone, to choose. However, nurses hold a responsibility to deliver complete and objective information when providing patient education. Research proves a nurse’s opinion sways the advice they give patients and vaccinated nurses are more inclined to recommend vaccination than those who are unvaccinated (Smith et al, 2016). Interestingly, the more highly educated the nurse is, the higher the incidence they will be vaccinated. Just as each nurse has unique values and beliefs, each healthcare professional is an individual who may decide their position about personal vaccination. It is also true that nurses may deliver a healthcare intervention they do not believe in, yet still administer the care or medication the Provider orders. Regardless of which side you take, every nurse has the right to choose for themselves their habits of health and balance that with their nursing duties. We also have seen polar opposite opinions from nurses during the COVID-19 worldwide pandemic and face mask use in the past nine months. With the production of hoped-for vaccines against COVID-19, nurses will be asked by friends, family and colleagues what to do. Regardless of a nurse’s personal or political opinion, current health counsel against COVID-19 should still be given by nurses and includes the following based on the CDC guidelines: wash hands frequently with soap and water or any alcoholbased sanitizer, dispose of used tissues and masks into a plastic-lined waste bin instantly, use a tissue to cover your mouth and nose while coughing or sneezing, don’t touch your mouth, eyes, or nose, avoid close contact with any individual having cold or flu-like symptoms, clean surfaces often, avoid sharing utensils, food, or drinks, avoid crowded places and stand six feet apart from others. If you are unwell, seek medical attention immediately, stay at home and avoid contacting others. There is no doubt that despite adherence to the CDC guidelines, people are still getting sick and nurses are exhausted. The media reports higher anxiety, suicide and depression in America in 2020 because of the long-term consequences of COVID-19 and social distancing. As people rely on the opinion and education of nurses, we can make a difference in the possibly worse virus the world is experiencing- fear and depression. Beyond the prudent CDC guidelines against COVID-19, the next level of patient education for health care guidelines for mental health may include the following for yourself and those you educate: Media Distancing If media is creating or worsening your anxiety, stop consuming it. Distance yourself from the negativity of media and fear (ADAA, 2020). You can still stay informed by catching major headlines on an occasional review of weekly highlights, but you don’t have to bombard yourself with the plethora of negativity and focus on racism, hatred, crime and distress most news cycles focus on. Take Control of Your Thoughts The more your mind focuses on worst-case scenarios, the more anxious you will feel. Rather than allowing the very normal negative and fearful thoughts that pass through your brain to stay and destroy your energy, take action into problem solving. Much of anxiety and stress comes from fear of the unknown and lack of control. Rather than allowing your mind to entertain doomsday thoughts, be proactive and focus your thoughts on actions you can take that are in your control. Proactive action towards your own goals is a great way to crush pessimism. Focus on Being Productive and New Ways of Enjoying Life Although you cannot control a worldwide pandemic or political crisis, you do have control over your response to the crisis. Among the many humorous posts on social media was the comparison of two women who each announced, “I’m using this quarantine time to better myself by developing a new skill at home,” while the other quipped “I just ate carrot cake with my bare hands.” Life isn’t what happens to you, but rather how you choose to respond to it. A good sense of humor helps a lot. Pass the carrot cake. Fork is optional. Engage in Stress Reducing Activities Train your mind to manage stress by employing a variety of strategies including focusing on gratitude, exercising your body, guided meditation, yoga, writing gratitude notes and more, which can lower stress. Find something new you’ve been wanting to do but could never find the time to learn or do. Life will never be stress-free, but your actions can help make it manageable and not destructive. Do Not Go Beyond CDC Guidelines Nurses can help decrease the anxiety and stress of our patients by confirming that people do not need to be compulsive about handwashing, taking off clothes before entering a house, and washing off groceries before allowing them into the home. These are anxiety measures, not the CDC measures. Preserve a Sense of Normalcy When social distancing is still recommended, you can still maintain a routine by making your bed in the morning, getting dressed for work even if you work from home, exercise at home instead of a gym, and have a scheduled dinner as usual but maybe invite friends over a video chat platform. Social distancing doesn’t mean social isolation. Seek Out Professional Help For many people, distressful times can reveal underlying medical or mental health conditions that do require professional help. Nurses can help people recognize if what the patient is experiencing is normal or if they need additional resources and help. This includes being in-tune with the mental health of your own colleagues and nurses you work with. After the Twin Towers in New York City fell September 11, 2001, nurses were there at the side of the firefighters and rescue crews to assess and strengthen them in their work. Nursing is a team sport and we need to watch out for each other. In the year of the Nurse, nurses really did shine and continue to earn the title of most trusted profession. People rely on nurses for good health education and by being well-informed, presenting information and resources objectively, we can collectively be a strength to the well-being of our communities. For ideas to help yourself, your family and your patients, feel free to share the Coping Calendar designed by www.actionforhappiness.org. References Anxiety and Depression Association of America, (ADAA) (2020). COVID-19 anxiety reduction strategy. Retrieved from https://adaa.org/learn-from-us/from-the-experts/ blog-posts/consumer/top-ten-covid-19-anxietyreduction-strategies Centers for Disease Control and Prevention (2018). Influenza Vaccination Coverage Among Health Care Personnel- United States, 2017-2018. https://www.cdc.gov/mmwr/ volumes/67/wr/mm6738a2.htm Pless, A., McLennan, S., Nicca, D., Shaw, D. and Elger, B., (2017). Reasons why nurses decline influenza vaccination: a qualitative study. BMC Nurse 2017; 16:20. Retrieved from https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5410084/ Smith, s., Sim, J., and Halcomb, E., (2016). Nurses’ knowledge, attitudes and practices regarding influenza vaccination: an integrative review. Journal of Clinical Nursing Oct;25(19-20). Retrived from https://pubmed. ncbi.nlm.nih.gov/27206347/
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