Tom Sharon
Using shortcuts & developing sloppy work habits


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Vein Catheter Sterility

Indwelling intravenous catheters are another major problem in dealing with hospital-acquired infections. This includes peripheral and central intravenous lines. Once the nurses or doctors place these objects into the arm or chest, they attach a fluid-filled plastic bag to the catheter with a long tube and a connector at the insertion site. The inside of these tubes must remain sterile because we use them to inject fluids directly into the bloodstream. The danger is that nurses have to open these systems at regular intervals to add medication and replace the empty fluid bags. The initial setup also carries with it a risk of infection. The intravenous tubing has a cap on the connecting end that the nurse or doctor has to remove just before attaching the line to the vein catheter. He or she has to do this quickly because there is blood pouring out of the opened vein. If this person pulls off the cap with his or her teeth, you must consider the intravenous tube to be contaminated. In that case, you will have to stop the procedure and ask for a restart.

Several years ago, I went to a community hospital emergency room with a case of food poisoning. The doctor decided that I should have an IV, so one of the nurses came over to start it. She inserted the short catheter into a vein in my right wrist. Then she pulled the cap off the tubing with her teeth. I immediately told her that she could not connect that tube to my vein. She insisted that it was fine because her mouth only touched the cap. I didn't back down, and eventually, after giving me some dirty looks, the nurse got a fresh tube and opened it properly.

Although this was an unpleasant encounter, this woman was actually a competent professional. She was using a shortcut that reduced the length of time required for that job. It made her more efficient with regard to the number of tasks she could perform in given time period. It is quite common for nurses to learn such short cuts from each other. Consequently, some of them develop sloppy work habits (from an infection control perspective) and unwittingly cause catastrophic outcomes. These kinds of incidents happen very fast, and usually no one notices. That is why you, the hospital user have to be ever diligent in watching the people providing the services. Most of the time, you are encountering total strangers. You know nothing of their character and work habits. You have no idea whether the nurse, doctor, or therapist standing before you is conscientious or burned out. Therefore, you need to carefully observe their actions and ask many questions about any dealings that decrease your comfort level. Whenever you suspect that something is awry, trust only your intuition until you receive a satisfactory answer. You may not want to be rude, but do you want to risk a serious infection because someone else is hurrying?

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