I am a probably a better germ freak than you are!

Having worked in ICU’s with all their “documented” superbugs––and ER’s with all their equally scary “not-yet-diagnosed” bugs––I’ve actually come close to calling out sick before, for a simple superficial finger lac or even just a modest paper cut. Here’s why: because, hospital populations often include a large prevalence of Hep C and HIV. Yes other bugs scare me; but Hep C and HIV are the big deadly two on my list. Actually, in terms of what is more contractible, Hep C (while curable now with a ~ $100K pill) scares me a little more just because it is so much easier to catch and there is no post exposure prophylaxis (PEP) for known Exposures. 

Hep C is a just a more durable virus and, therefore, can survive much longer outside the body than HIV can. I.e., subsequently, this makes us more susceptible to Hep C via urine and blood splashes, and generally any contaminated surfaces, contingent upon the contamination time and other factors beyond our scope.

Ok, the above was essentially, a very low tech explanation of why Hep C is easier to catch than HIV; i.e., this is likely why so many more IV drug users come down with Hep C more often than HIV, even though they may have been exposed to both.

Moving on, HIV is a less stable virus and, therefore, does not survive as long outside the body as Hep C does. HIV is, subsequently, theoretically harder to catch than Hep C, but obviously not impossible. And while HIV may be harder to catch, I would rather not tempt fate by having one of my fresh paper cuts immersed in potentially HIV infected bodily secretions I can or cannot see.

This is why I want to “yell at” or maybe “baby-shake a little” some of my more clueless, bullet-proof staff, every time I see them grabbing test tubes full of blood with their bare hands. This is why it royally pisses me off every time they have test tubes in their hands one minute, don’t wash their damn hands, and then they go to grabbing and fingering the same damn phones, doorknobs, keyboards, and mouses, that at some point, I will later touch with my own, pristine clean, pure as a winter-driven-snowy white hands.  People, just because you can’t see blood splatter, doesn’t mean it’s not there. Do you really think you were so gifted as to not have gotten at least a few microscopic blood products on the sides of those tubes after you just vampired that blood from your squirmy sketchy patient?

And what do you think happens when those invisible Heb C virus particles come in contact with your fresh paper cut or some unbeknownst micro tear in your skin that you don’t even know you have yet (until that purell starts burning like a binotch)? Well, kiss your sex life goodbye for a while; and get ready for some good ‘ole hepatomegaly and that $100K Havoni pill.  And here is the kicker: that $100K pill may or may not even be provided by your hospital (contingent upon how well you documented your said exposure). So yeh….. pinpointing when you were exposed: was it at that “one sketchy patient”… or was it that one drunk’n, ecstasy-tainted “best-night-of-your life at Coachella”?…. good luck on that one.  Ok, that was a bit harsh…… but good luck just the same.

And then, there are slightly less scary but much more common pathogens such as MRSA/ORSA, VRE, staph, necrotizing fasciitis and other flesh eating pathogens, thereof, all ready to invade your paper-cut nightmares…

So the next logical question people often ask me, “Why the Hell did you go into this field again”? Well, that’s a damn good question and one that is a matter for another discussion; but nevertheless, I have quite often contemplated calling out sick for work for no less than a superficial finger laceration I did not want to expose to my sometimes filthy job.

Ok, tangential self-discussion and ranting complete!  And I really don’t even know what the word tangential means, but it sounds cool when the evaluators use it when placing a 5150.

So all that just to say this: today, I saw a post in a facebook group where a person by the name of Nick Hartman was asking how to deal with finger lacs at work and still keep yourself safe. Yes, that picture above, is Nick Hartman’s very own bird shooting finger (see what I did there?), in the flesh; thanks, Nick, for so graciously consenting to let me use your picture in my slightly offensive blog post (yes I asked permission). And that brings us to the real purpose of this post. The problem faced every day by thousands risk taking healthcare workers is how do you create a water tight bandage that can survive washing your hands between patients?  I just assumed everyone was as obsessive compulsive as I am and had just figured this out… or I would posted this a long time ago; my bad. Why was this not taught in nursing school? Because they hate us, that’s why.

So Here is my solution: and since I’m a better germ freak than you are, I suggest you follow this to a T or a V (video will be coming soon):

1. First, wash the cut with soap and water. If the lac it’s still open, you might consider dousing it with a mixture of 1:1 hydrogen peroxide and water and then rinse. Note: once the lac starts healing, you want to back off the peroxide because it can degrade good tissue.
2. Next, pat dry with a sterile gauze––not the filthy paper towels your housekeeping staff just stuffed into the dispenser with the same dirty gloves he just emptied the trash with (yes it’s a thing).
3. Next, preferably score some of your hospital’s expensive dermabond instead of the OTC liquid skin products because dermabond has the word bond in it (get it? …it’s stronger); but at least use one of them! You can get some dermabond from your OR or ER. Honestly, it should really be provided by our budget-conscious nursing units. It’s not cheap and we should have the tools to protect ourselves from our patients and our patients from ourselves (did you not pick up on the part above about some nurses being filthy?).
4. In lieu of dermabond, you can use butterfly band-aids if it needs tension to proximate the edges, and then cover with a fabric flexible band-aid over antibiotic ointment for a shallower lac.  If you are extra careful with the next steps, you can leave out the dermabond or liquid skin products.
5. Next, get a finger condom (sorry could not find a non-latex finger condom) or pop a snug fitting finger off a nitrile glove just below the second knuckle (for a cut located in the image above). Slide your finger into the piece of glove or roll the finger condom over your cut. Yes, roll it right over your band-aid or butterfly too.
6. Next, take a small tegaderm, and perpendicularly wrap it around the upper part of the finger. Half of the tegaderm will go around the upper finger (bare skin portino) and the other half will overlap and cover part of the glove or finger condom.
7. In between patients, you will wash it just like you would your intact skin. You’ll just wash it a little gentler; and most importantly, hold the finger upside down to keep water from carrying germs inside (should the bandage be compromised…. and it will be at some point).
8. Change your “Jody Germ Freak Dressing” twice a shift and PRN. Regardless, and usually around lunch, I would give the whole finger and bandage a good washing, remove the bandage, and then wash the whole finger and hand again. It’s also a good idea to keep this petri dish of a bandage (I never said it was a perfect process) away from your lunch.
9. Before returning from lunch, replace the whole bandage as described above.

It’s not a perfect process. And yes you have to be gentler with washing than you normally would; but overall, this process strikes a good balance between patient safety and personal safety… or you could just call out sick for work:)

To your success,

Jody Heath

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