Florence Nightingale created the nursing profession based on her belief that dirt was at the root of all all sickness, and cleanliness=good health. Interestingly enough though, she rejected the germ theory of disease. Perhaps she would have liked this story:
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My patient had a bug in her urine.
Escherichia coli? Proteus mirabilis?
Try Pediculus humanus, more commonly known as “lice.”
Lice?
Yes, lice. At least that’s what the night nurse told me. I had collected a urine sample from my patient before the end of my shift. The patient had been presumed anuric (unable to make urine) but when I found evidence to suggest otherwise, we placed a foley in her and naturally sent some urine off for cultures and analysis.
The microbiology lab had called during the night to say that there was “lice in her urine.”
“What?” I said to the night nurse.
“Lice in her urine,” He said.
“Come on.”
“That’s what they said.”
I went to the resident. “So what do you think about this supposed lice in the urine? Are we doing anything about it?”
She started laughing. “I don’t think it’s real. I’ve examined her and I’ve found nothing to suggest lice.”
I went in to do my assessment. I didn’t find anything either. I also didn’t find any documentation from microbiology about the lice. But I still had the willies.
During AM rounds it was discussed and the medical team had decided that it was a fluke. Okay, I could get on board with that. I quickly forgot about the whole incident.
Until later that day…
When microbiology results are available they pop up in our computerized chart.
Here’s what it said:
Urine specimen:
A small bug jumped out of the specimen cup.
Recommend lice check.
At this point I was on the verge of freaking out. I went to the fellow. She too was laughing. “It can’t be real,” she said.
I thought about it. I’m the one who collected the sample. I certainly didn’t see any kind of a bug but MAYBE it could have jumped in during the short moment before I twisted the lid on. Or MAYBE the microbiology lab technicians could have been taking acid. I just don’t know.
I continued on with my business but the hair on the back of my neck was standing up. I really started thinking. I did notice that the patient’s son had dreadlocks. Hmmm. Also, this patient had been in the MICU for 90 days. We have cleaning people who go in and clean the rooms twice a day, but how thorough is this cleaning? Not very. They collect trash bags, wipe down a few surfaces, mop the floor. I’ve mentioned before how small the rooms are. If there is a continuous dialysis machine in the way of the sink, is the cleaner going to jump over it to clean the sink? Probably not.
It’s kind of like this: You know how if you have an old, shabby house you can clean and clean and clean but it somehow never really looks clean? Our unit is an old shabby unit. I started to take a good look around. There are so many nooks and crannies that never got cleaned. I looked at the ventilator arm in my patient’s room. It had a blackish green substance growing on it. Yuck. Probably mold.
So it got me thinking. What if a patient who’s length of stay exceeded 30 days was transfered to another room just so they could give the old room a good, thorough cleaning? Wouldn’t it be interesting if the patient actually improved after this thorough cleaning?
This is probably just wishful thinking on my part. Currently the MICU has far too many patients who have been there for greater than 30 days, and it doesn’t look like any of them are getting any better.