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How many times have you heard someone who said something that is mean, vindictive and hurtful — or committed a violent and/or destructive act  — justify it by saying the recipient had ‘made’ the perpetrator mad?

That’s an example of using blame to excuse your own bad behavior.

Unfortunately, blame is like anger in that it dulls one sense of empathy. It allows a person to act in a hurtful way to another human being. It isn’t the act itself, but it often clears the road. This is a small, but important point. Ordinary humans have inhibitions that serve as a buffer against what we know is bad behavior. Blame is not the act itself, but it either erodes or outright removes these inhibitions, often both . It develops a thought pattern that allows the person’s emotions to override his/her self-control in order to achieve an often selfish end — including sustaining dysfunctional patterns.

While this may seem like an overly harsh statement, also realize the kind of mindset that so quickly adopts blame as a defensive posture for emotional/ego protection is exactly the  same one that will put you in front of, otherwise avoidable, physical danger.

Blame Action Loops
It is not uncommon for people who engage in blaming behavior to also engage in selfish behavior. And as long as they are getting benefit from it — whether monetary, emotional, comfort, entertainment or psychological stability — they will continue to engage in those actions. But realize that most of the time the person is too busy doing the behavior to see their actions in this context. Look at the diagram below:

What this illustrates is a simplified action loop model of how humans interact with the world around them. When functioning on this basic level, ‘stimuli’ comes in from the ‘world,’ it is evaluated and an ‘appropriate’ action is taken. An example is you come to a corner with a traffic light. The stimuli coming in is the signal is red and cross traffic is passing. The evaluation is, according to the laws, wait. That’s your action. That keeps you from getting run over. The light turns green,  the cross traffic stops and you cross. We do this kind of looping process all the time, adjusting as the results of that action come in.

I believe we are here to learn lessons along our life’s journey. Once we learn a lesson we move on to the next one. However, if we fail to learn a lesson, we keep finding opportunities to learn it again and again.

Isn’t it weird that the woman who can’t leave her old unhappy relationship without starting a new one is always in an unhappy relationship? Or the man who quits his job because he can’t stand his overbearing and ungrateful boss lands a new job with a boss who seems even more overbearing and ungrateful?

Life will continue to throw us the same lessons until we learn from them.

1. Believe there is a lesson to be learned and consent to learn it.

This is probably one of the most important steps. Unless you’re really willing to learn the lesson, even if it feels uncomfortable at times, you can never move forward. Consent to view the situation as something that can help you grow.

2. Admit that you might have helped create the problem.

Warning: This does require you to immediately quit playing the blame game! Just consider the possibility that you somehow contributed to your current situation. This doesn’t mean no one else played a part; it just means perhaps you did, as well.

3. Take some alone time and review the situation.

I’m sure you’ve done this multiple times. It’s time to do it differently. Try to view the situation from a different perspective. Get objective and see it from someone else’s eyes. Is there another way to interpret what happened and how it all played out?

This requires you to be really honest with yourself about your choices and actions. If you’re willing to change your perspective you may immediately see what lesson needs to be learned and exactly how to learn the lesson.

4. Let go of your attachment to the problem.

Trying to control the problem—your boss, your spouse, or your circumstances—will only keep you more attached to it and the more you “leech” onto a problem, the more it “leeches” right back on you.

You will never be able to see the lesson or the solution if you dwell on all the little details about what seems wrong. Letting go could come in many forms: seeing the good in the person who seems difficult, accepting a situation for what it is, or seeing the other side of the story.

Any time we let go of our attachment to what went wrong or what should have happened, we create the possibility of growth—and we pave the path for more positive results.

My personal favorites were step three and four in dealing with my challenges in life.   I admitted the role I played, forgave myself, and was finally able to move forward.

Dropping blame allowed me to let go and move on.

Quitting the blame game and learning life lessons has allowed me to be in a loving, equal, and, best of all, relaxing relationship. It’s allowed me to build my dream career. It’s also allowed me to look at each obstacle I’m facing and find something positive to take away from it.

If you’re having an issue then there is a lesson to be learned. Learn the lesson then you get to move forward. That’s how a game should work!

“Effective gas exchange depends on uniform distribution of function throughout the lung.”

American Lung Association

“Stroke is the third leading cause of death in the United States behind heart disease and cancer and stroke is the leading cause of long-term disability.”

J.L. Wiley Foundation

“In MS-Multiple Sclerosis, the immune system attacks the protective sheath (myelin sheath) that covers nerve fibers for protection but since the myelin gets attacked it causes communication problems between your brain, the spinal cord & the rest of your body due to the obstruction of the transmission of messages.”

MAYO CLINIC

“Of all the causes of death in the US, the leading top 10 causes account for nearly 75% of all deaths and the top 3 causes account for over 50% of all deaths in the country, with the main culprits remaining relatively consistent for at least the last five years.”

CDC Center for Disease and Prevention

“According to the Center for Disease Control (CDC )the 2014 Ebola epidemic is the largest in history, affecting in West Africa.”

CDC Centers for Disease Prevention and Control

What is Ebola and how does it spread?

According to the Center for Disease Control (CDC )the 2014 Ebola epidemic is the largest in history, affecting in West Africa. One imported case from Liberia and associated locally acquired cases in healthcare workers have been documented. CDC and partners are taking precautions to prevent the further spread of Ebola within the United States.  We should have taken action with making limitations a long time ago but again our government seems to worry about other countries more than our own or else we would not have this potential epidemic.  Look at what is finally being doing in airports at least in New York regarding visitors coming from Africa, they are being checked for disease in someway, that should have started years ago with the increase or population into our country from people unfortunately in other countries with more disease due to less protection or action due to their economy and what they can afford.  Yet, in the end our government needs to protect us the US citizens and have a regulation much more tighter than it was if US citizens for whatever the reason is leaving this country to other countries for business (EX. News Report Employees.) or vacation is allowed; which it has been going on for ages.  The key factor like to almost any disease or infection in or out of hospitals is:  Prevention!

MSF (Médecins Sans Frontières) health staff in protective clothing constructing perimeter for isolation ward.

***Background of the disease Ebola

***The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

The outbreak in West Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976.  Well its back again There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.  God willing we do something fast enough with all the medical technology we have in America and fine a way to control it in our own country; we came through in controlling the flu and so many other epidemics.

The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability.   On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.  Well the US better do something fast to prevent both me and many others in this home land to keep us safe.  By the way I am RN 26 years and this topic Ebola concerns me terribly.

 A few years back when Ebola hit America according to the CDC this is this episode, “there were about 8,900 cases of Ebola infection worldwide with almost 4,500 deaths as of this week. And, the World Health Organization that we may see 10,000 new cases per week by the end of that year.

Transmissiono of Ebola

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest that picked up this virus.

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced or taught to the medical workers through detailed and concise information with written instructions,  proper demonstration, with most important follow up by health care worker superiors like managers to nursing education depts.

For further information on this go to my reference http://www.who.int/mediacentre/factsheets/fs103/en/The World Health Organization. ***

There is no FDA-approved vaccine available for Ebola, unfortunately but like most after damage occurs in enough quantities (which is the case) in time most diseases come up with one regarding the many over the few diseases we haven’t seem to have invented yet.  So the key for this disease right now is PREVENTION of it.

Keep in mind through the CDC we are in the U.S. working on a treatment. Let us take a look.

“Experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness.

Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It isn’t known if people who recover are immune for life or if they can become infected with a different species of Ebola. Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.”

Here are some tips given by the CDC (Center for Disease Control):

If you travel to or are in an area affected by an Ebola outbreak, make sure to do the following:

• Practice careful hygiene. For example, wash your hands with soap and water or an alcohol-based hand sanitizer and avoid contact with blood and body fluids.
• Do not handle items that may have come in contact with an infected person’s blood or body fluids (such as clothes, bedding, needles, and medical equipment). In a hospital patients with contaminating diseases through blood, secretions or fluids of the body is when contact isolation is used to prevent the spread of diseases (EX. MRSA, VRE)that can be spread through contact with open wounds, urine, blood, simple secretions of the body (even tears or fluids coming from the eye).  Health care workers making contact with a patient on contact isolation are required to wear gloves, a gown, even a mask if one wants (which I without question do for any contact isolation a pt is on for their contaminating disease to prevent spread on me or others).  With Ebola it may even go into further restrictions with disease to PREVENT further contamination which is only watching the safety of all citizens and visitors in this country or hopefully this will be carried out in Africa and anywhere else at this point.
• Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.
• Avoid contact with bats and nonhuman primates or blood, fluids, and raw meat prepared from these animals.
• Avoid hospitals in West Africa where Ebola patients are being treated, if .not needed. The U.S. embassy or consulate is often able to provide advice on facilities.

How bad is it elsewhere? In West Africa, pretty bad. Lack of resources and a slow global response has let the virus run wild. Over at Nature, they used WHO data to illustrate just how terrifying it’s getting. For an on-the-ground perspective, see what Karin Huster, a healthcare worker who just got back from treating Ebola in Liberia’s clinics, told R29. We’re also beginning to feel the first economic effects of the crisis.

What is the CDC doing to stop the spread of Ebola? Well, the first thing to remember is that the U.S. is not in the middle of the same kind of outbreak those in Guinea, Sierra Leone, and Liberia have been dealing with for months now. Ebola has not spread to the general American population, and those who have contracted the virus here have been in close contact with someone who was already severely infected. Complicating matters, the nurses who cared for Duncan report that they were forced to do so without proper training or equipment. And, Vinson says that she called the CDC before getting on her flight with a low-grade fever, but was told her temperature did not surpass the dangerous threshold (100.4 degrees Fahrenheit). However, the CDC has learned from its slow response to Dallas and has vowed to dispatch an Ebola response team to any hospital in the country with a confirmed case of the

How contagious is Ebola? Compared to other diseases you are more likely to get (such as enterovirus D68, the measles, and the flu), Ebola is not very contagious. It has a long incubation period (21 days) during which an infected person may begin to show symptoms. But, as far as we know, that person is not contagious until he or she is symptomatic. Ebola can only be spread by: direct contact with the bodily fluids of someone who is contagious (e.g., blood, urine, vomit); objects that have been contaminated with those fluids; or infected mammals, such as bats.

What are the symptoms of Ebola? Fever, headache, muscle pain, severe vomiting, and bloody diarrhea, among other unpleasant things. These symptoms hit hard and and they hit fast. They also get worse the longer you’re infected. So, if you feel kind of icky but are still dragging yourself to work, you’re probably Ebola-free.

Can we treat it? Not in every case. We have several experimental options, such as ZMapp, that have worked for some human cases or in animals. But, American scientists are still working on a cure that can save as many people as possible — and get approved by the FDA, too. Chinese and Russian scientists are on the case too, reportedly working on a cure and vaccine, respectively. But, Ebola is not necessarily a death sentence. About half of the people who have contracted it worldwide have lived to tell the tale. The CDC says whether or not you survive depends on your immune system and the quality of care you’re getting. And, when a person recovers from the virus, he or she will have antibodies that will protect against Ebola infection for at least 10 years.

Can we protect against it? Yes — with proper hand hygiene, basic public health tactics, a vaccine on the way, and a ramped-up CDC response.

Finally,  I reinforce that unless you have had direct contact with the bodily fluids of someone with Ebola when that person was contagious (or if you’ve eaten some bushmeat recently), then your risk for Ebola are low and you don’t need to worry about getting it.  Really, even Fox News says so. Instead, you should probably just get yourself a flu shot with how much higher you are at risk of getting the flu as opposed to the disease Ebola but our country should take strict action in preventing a disease epidemic in travelers coming back or from Africa to the US or any other country that has this disease in their country, safety for the people in America.

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Personal Protective Equipment

Healthcare professionals are both barriers to and carriers of infection. To avoid distributing infection among patients, healthcare professionals must remain diligent in the use of personal protective equipment, or PPE. Gloves, gowns, shoe covers, caps, masks, respirators, hair covers, face protection, and eye protection are all vital in preventing the spread of infection. Nurses who use PPE effectively help prevent the spread of infection through the touch of a hand, through contact with their uniform, and through air and droplets from their respiratory tract. In turn, they are personally protected against any organisms the patient may carry.

Gloves are the most frequently worn item of PPE. Gloves reduce the opportunity for microbes on healthcare workers’ hands to be spread to patients during care or invasive procedures. Removing gloves between patients prevents the transmission of bacteria from patient to patient. It is important for healthcare professionals to understand that gloves should not be used in place of handwashing. After removing gloves, healthcare professionals should always follow handwashing guidelines.

Gowns and masks also help prevent HAIs. Gowns worn in patient rooms and in operating rooms prevent infectious microbes from being carried from patient to patient on healthcare workers’ clothing. Masks are used to prevent microbes from being transmitted via the respiratory tract. In 2011, the Food and Drug Administration (FDA) approved a new type of N95 respirator for single-use that kills methicillin-resistant Staphlococcus aureus (MRSA), Streptococcus pyogenes, and Haemophillus influenzae. This specialty mask incorporates an antimicrobial agent into the fiber of the mask. The mask eliminates 99.99% of bacteria on its surface within 1 hour and traps and kills additional microbes in the mask’s middle filtration layers.

Transmission-Based Precautions

The topic of PPE is not complete without a review of contact, droplet, and airborne precautions. Most nurses are familiar with the types of precautions used to prevent infection transmission. Even so, nurses, as well as other healthcare professionals, can become lax in their use of precautions, increasing the incidence of HAI.

Contact precautions are designed to reduce the risk of transmission of infectious organisms by direct or indirect contact with the patient or the patient’s environment. Transmission can occur through direct skin-to-skin contact from an infected person or host or through indirect contact of a susceptible host with a contaminated intermediate object or fomite in the environment. To comply with contact precautions, healthcare professionals should follow these guidelines:

• Wear gowns and gloves for all patient contact or contact with potentially contaminated areas of the patient’s environment (e.g., bedrails, furniture, medical equipment).
• Put on PPE before entering the patient’s room and remove it before leaving the room to contain any potential microbes.
• Whenever possible, patients on contact precautions should be admitted to private rooms. Infection control personnel should be consulted before cohorting patients if a private room is not available.
• Transport patients only when necessary for diagnosis or treatment and weigh the risk of infection against the need for transport. When transporting a patient, place the patient in a clean gown and cover the patient with linen per facility policy.

Transmission of microbes by droplet involves contact of conjunctivae of the mucous membranes of the nose or mouth of a susceptible person with large particle droplets. Droplets are generated from the source patient primarily during coughing, sneezing, or talking or during certain procedures, such as suctioning and bronchoscopy. Transmission of infection by large particle droplets requires close contact between the source patient and the susceptible host. Droplets do not remain suspended in the air and generally travel only short distances–up to 3 feet. For this reason, special ventilation systems and air handling are not required for droplet precautions. To properly follow droplet precautions, healthcare professionals should follow these guidelines:

• Wear a surgical mask for close contact (within 3 feet) with patients on droplet precautions; respirators are not necessary.
• Admit the patient to a private room, if possible. Infection control personnel should be consulted before cohorting patients if a private room is not available.
• When transporting patients on droplet precautions, place a mask on them and instruct them in proper cough etiquette.

Airborne precautions are designed to prevent transmission of infectious organisms that remain infectious over long distances if they become suspended in the air. Airborne transmission occurs when there is dissemination of either airborne droplet nuclei (small particle residue of evaporated droplets) or dust particles containing the infectious agent. Airborne organisms are transmitted by air currents and may be inhaled or deposited on a susceptible host within the same room as a source patient or even a long distance away from the source patient. To prevent airborne transmission, healthcare professionals should follow proper airborne precautions:

• Admit the patient to a room with special air handling and ventilation systems. These airborne infection isolation rooms (AIIRs) use negative airflow relative to hallways or surrounding areas to prevent air from escaping the room. The rooms complete 12 air exchanges per hour in buildings with new construction and renovation or 6 air exchanges per hour in existing facilities. Air exhausted from AIIRs must be directly exhausted to the outside or put through a HEPA filtration system before returning to the building.
• Don the proper PPE when entering an isolation room, including an N95 mask–a mask approved to filter 95% of airborne particles. Healthcare professionals must not confuse N95 respirators with surgical masks. They are not the same. Surgical masks cannot filter small particles and do not prevent leakage around the edges when the user inhales. To identify an N95 mask, look for the manufacturer’s name, part number (P/N), the protection provided by the filter, and the letters NIOSH or the NIOSH logo written on either the outside front, the exhalation valve, or the straps of the mask.
• Be sure to be fit-tested for an N95 mask before you care for anyone requiring airborne precautions. Facilities that have AIIRS must have a facility-wide respiratory protection program that includes education of workers on respirator use with appropriate fit testing and user seal checks.
• Limit patient transport to medically necessary procedures only. If the patient must be transported, skin lesions must be covered and the patient must wear a surgical mask and observe respiratory hygiene/cough etiquette.

Environmental Decontamination

Some bacteria do not need a living host to survive. Microbes such as MRSA, vancomycin-resistant enterococci (VRE), and C. difficile can survive for long periods on environmental surfaces, such as bedrails and phones. After being contaminated, these environmental surfaces become the source of infection. A clean healthcare environment is essential for prevention of infection from these organisms.

Cleaning and disinfection of the patient environment includes high touch surfaces, such as bedrails, carts, toilets, and doorknobs, as well as general housekeeping surfaces, such as floors, walls, and blinds. Proper disinfection and sterilization of medical and surgical instruments and devices are also vital in the prevention of HAIs.

Agents used by facilities that are designated by the Environmental Protection Agency (EPA) as hospital-grade detergents/disinfectants must be able to inactivate specific organisms, such as staphylococci and streptococci. These agents must be chosen carefully to determine if they are effective in killing pathogens.

Nurse Staffing and Burnout and HAI

A recent study in the American Journal of Infection Control showed a correlation between nurse staffing ratios, nurse burnout, and HAIs. According to the researchers, the higher the nurse-patient ratio, the higher the likelihood of occurrence of a HAI due to increased demands on nurses and resulting burnout. The study showed that increasing a nurse’s patient load by one patient increased the incidence of urinary tract infections and SSIs. The authors of this study suggest that healthcare facilities decrease nurse burnout to decrease the incidence of HAIs.

Surveillance of HAIs

Infection surveillance helps experts identify infectious disease, spot trends in infections, and create treatment and eradication goals. The federal government provides resources to estimate and track HAIs affecting patients and healthcare personnel. The National Healthcare Safety Network (NHSN), the largest HAI reporting system in the United States collects data from participating institutions, including acute care hospitals, long-term acute care hospitals, psychiatric hospitals, rehabilitation hospitals, outpatient dialysis centers, ambulatory surgery centers, and long-term care facilities. Currently, more than 9,000 institutions participate in the NHSN to share infectious disease data in a timely manner. As the scope of HAI reporting is extended, it is the goal of the NHSN to target prevention, improve patient outcomes, and reduce healthcare costs, with the ultimate goal being elimination of all HAIs.

Another national resource, the Emerging Infections Programs (EIP), consists of a network of state health departments and their academic medical center partners. These agencies collaborate to answer questions regarding emerging HAI threats, advanced infection-tracking methods, and antibiotic resistance in the United States.

Conclusion

The medical profession has come a long way in its progress toward elimination of HAIs, but there is still a long way to go. Understanding common pathogens, knowing risk factors of HAIs, and implementing preventative measures are key ways healthcare staff can help keep patients safe. Diligence and attention to proper hand hygiene, environmental disinfection, use of proper transmission-based precautions, and the correct use of PPE will help prevent the spread of these infections. With perseverance, healthcare workers can be instrumental in reaching the ultimate goal of zero HAIs.

Resources for Part I throught V.

For more information on isolation precautions including standard and transmission-based precautions, refer to the NCCE course titled Science of Infection Control Principles available at www.nursece.com.

For general information on common HAIs, visit the CDC’s website at www.cdc.gov.

For more information on prevention strategies for VAP, refer to the publication Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals, available at http://www.jstor.org/stable/10.1086/591062.

For more information on isolation precautions, see Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007, available at www.cdc.gov.

For more information on infection control in the LTCF, see the SHEA/APIC Guideline: Infection Control in the Long-Term Care Facility, available at http://www.jstor.org/stable/10.1086/592416.

For more information on developing strategies for measurement of hand hygiene, refer to the Joint Commission’s monograph titled Measuring Hand Hygiene Adherence: Overcoming the Challenges, available at www.jointcomission.org.

For more information on the selection and proper use of disinfection and sterilization materials, see the Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, available on the CDC website at www.cdc.gov.

Top recommendations and detailed tool kits for preventing healthcare–associated infections, including urinary tract, surgical-site, Clostridium difficile, and central line–associated bloodstream infections outside the ICU are available at http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.