What are some highly contagious diseases

Intensive care nurse about highly contagious diseases : "Gloves do not protect against viruses"

Ricardo Lange, 38, is an intensive care nurse in Berlin. Here he reports every week on the fight against the coronavirus - and on the troubles of everyday hospital life.

The corona pandemic has taught us a lot over the past few months. Even people who do not work in clinics have learned to wash their hands properly, sneeze into the crook of their arms and ventilate rooms. We are now all trying to touch each other less often.

We shouldn't forget about these behaviors right away. Experts estimate that up to 30 out of 100 infections could be avoided through hygiene measures. If we hold on to bars in the subway, eat sandwiches on park benches, do not wash our fruit properly or use our cell phone while we are in the toilet, we often come into contact with pathogens. We pass them on when we shake hands. Many people carry multi-resistant germs and do not know anything about them.

"We cross off every patient"

It gets dramatic when they end up in the clinic, where they encounter patients who are already weakened. Every year around 500,000 people in Germany develop such nosocomial infections, i.e. those that they pick up somewhere in the medical system. In my work in the intensive care unit, I have to deal with these multi-resistant pathogens again and again. We say MRE.

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That is why we cross off every new patient who is admitted to our clinic several times. First with a cotton swab in the mouth up to the throat, then both nostrils. Then we take a rectal swab with another cotton swab. If the patient comes with a tracheostomy tube, we suck off secretions and catch them in a so-called "trap". We also remove conspicuous wounds.

Until the result of these tests, the patients are usually looked after by doctors, therapists and nurses without expensive protective clothing. Only when it turns out afterwards that they carried such a germ do we isolate them.

Patients with super germs

Some clinics automatically isolate high-risk patients, for example from retirement homes, until the test result. It would be better if we could do it this way with all patients - this is the case in the Netherlands. But overall more money is being invested in the health system there and the hospitals do not have to charge flat-rate case fees.

The Acinetobacter baumannii bacterium is particularly tricky and can cause pneumonia or sepsis. A patient with such a super germ needs 1: 1 care. I stay in his room all day, I am protected from head to toe: smock, hood, respirator, washable shoes.

[You can read the other episodes of the "Out of breath" column with Ricardo Lange here, here, here, here, here, here and here]

Because it would take too long to change my clothes completely so as not to spread the germs, my colleagues look after more patients in such shifts. Sometimes there are up to four that you then have to wash, store and mobilize, including ventilation tubes and drains. If there is a shortage of staff, it is of course easier to make mistakes.

The main route of transmission is always the hands. We usually disinfect them thoroughly before and after each patient contact. We practice this in training courses, keep them under black light in order to get to know our weak points. Dry skin makes it easier for germs to settle, which is why lotion is everywhere.

Gloves, as we also learn from Corona, do not replace hand washing. They only protect against gross contamination such as blood, excrement or saliva - not against viruses or bacteria and also convey a deceptive security.

We also clean the work surfaces on which we mix medication and dispense infusions in every shift. A hygiene specialist checks regularly whether we are properly disinfecting our hands and whether the medication is adequately labeled or properly cooled.

More and more resistances

I see with concern that more and more bacteria are becoming resistant to antibiotics, 3MRGN or 4MRGN means that the germs have already positioned themselves against three or four groups of antibiotics. As a result of factory farming, we eat meat that already contains antibiotics and some doctors prescribe it for cold symptoms, which are caused by viruses anyway, or use broad-spectrum preparations for simple bladder infections.

Many patients also stop treatment too early. What if at some point we run out of effective antibiotics? Not only Corona can be life-threatening.

The clinic in which RicardoLong works, is one of the 16 facilities in Berlin with a corona focus. His column "Out of Breath" always appears in print on Saturdays in "Mehr Berlin".

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