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Terri Bogue

The Impact of Clinical Nurse Specialist

In a world where health care is focused on improved outcomes and safety the Clinical Nurse Specialist (CNS) is a light in the darkness. The role of the CNS is frequently one of the least understood of all advanced practice registered nurses (APRN). APRNs include nurse practitioners, nurse anesthetist, nurse midwifes and CNS. Of the approximately 350,000 APRN in the United States the CNS population in the United States is numbered at nearly 72,000.

The CNS specialist brings together three separate spheres: the patient, nursing, and the healthcare system. They practice within these spheres to create the best opportunities for patients to have optimal outcomes and for nurses to be supported to be able to provide the level of care they desire to give by working with systems to find better ways to support process that provide the best outcomes.

This week is national CNS week. I am proud and humbled to be among the amazing CNS’ that improve healthcare every day; not only for the patients but for everyone involved in their care.

Happy CNS week!


Cinco de Mayo aka World Hand Hygiene Day

Happy Cinco de Mayo! May your hands be washed well frequently and help prevent the spread of infection. I know this is not the typical toast to go with the annual Margarita splurging day that celebrates the Mexican army’s victory over the French army at the Battle of Puebla is 1862. I promise the intent of my toast is pure and full of hope for your good health.

The 5th of May is not only Cinco de Mayo it is also World Hand Hygiene Day. It is possible that World Hand Hygiene Day may never be as eagerly or widely celebrated as the Cinco de Mayo. It is likely that the simple act of cleaning your hands at the appropriate times will save more lives and prevent more infections than any other action we can take. The battle against pathogens and the development of antibiotic resistant bacteria is literally in our hands.

When we look at the data it is apparent that there is reason to celebrate World Hand Hygiene Day and take a stand to stop the spread of infection.

Let’s look at a bit of data related to hand hygiene:

  • A large percentage of foodborne diseases are spread by hands that were not cleansed well
  • Handwashing can reduce the risk of respiratory infections by 16%
  • Up to 80% of common infections are spread by hands
  • 10% of people do not wash their hands at all after going to the toilet
  • Only 1 in 20 people wash their hands appropriately after going to the toilet
  • In the United States, some healthcare providers clean their hands less than 50% of the times they should
    • These healthcare providers may need to clean their hands 100 times per 12-hour shift
  • According to UNICEF, one in every four childhood deaths, approximately 1.4 million globally, result from diarrhea and pneumonia. Handwashing with soap and water could reduce the death rates from these diseases up to 65% (Sam Stevens, Clean the World Foundation).

Effective hand hygiene takes less than 20 seconds and is truly an action that saves lives and changes the world. We spend millions of dollars looking for ways to keep humans safe from infection. The first line of defense is found in appropriate hand hygiene. Doing the right thing takes a small time commitment combined with the awareness of when it is important to perform hand hygiene.

There are very specific times when washing your hands is imperative:

  • After going to the toilet
  • Before eating or preparing food
  • Before and after taking care of someone who is ill
  • Before and after treating a cut or injury
  • After changing diapers
  • After blowing your nose, coughing, or sneezing
  • After touching animals, their food or waste
  • After touching garbage

There are five simple steps to washing your hands:

  1. Wet your hands
  2. Lather your hands with soap
  3. Scrub your hands for at least 20 seconds
  4. Rinse your hands
  5. Dry your hands

If soap and water is not available, you can use an alcohol-based hand sanitizer to clean your hands. It is important to remember that alcohol-based hand sanitizers are not as effective if your hands are visibly dirty or greasy. When using alcohol-based hand sanitizer be sure to follow these steps:

  1. Apply the product
  2. Rub your hands together
  3. Rub the product all over your hands and fingers until they are dry

Researchers in London estimate that if everyone routinely washed their hands, a million deaths a year could be prevented. Think about that, if it was your loved one that was still alive because we all washed our hands. We can’t live forever, but we shouldn’t die because someone didn’t wash their hands. Each time you wash your hands you could be saving a life, what could be more important than that. May you wash your hands well and frequently and have a very healthy Cinco de Mayo.

#HandHygiene #HealthForAll

Conflict Resolution and Infection Prevention

Conflict is a natural part of life. We learn to resolve conflict so that we can be a part of the human condition that is designed to be social – so that we can be in relationship with others despite the conflict. In the emotionally-laden environment of healthcare, conflict consumes significant time and energy for the IP. In this brief conversation, we’ll explain the foundations of conflict resolution. Effective conflict resolution and communication skills can transform organizational culture and leadership and improve efficiency, reduce preventable errors and adverse events, and improve staff and patient satisfaction.

Rob and I are presenting Conflict Resolution for the Infection Preventionist: Improving Collaboration and Patient Outcomes at the national APIC convention in Minneapolis on Tuesday, June 13th. APIC is always an exciting conference to present at and attend. As infection preventionist there are so many opportunities to improve patient outcomes. The magic comes when you can improve patient outcomes and not add burden to the rest of the healthcare team. This transformation requires compromise to find ways to deliver the level of care that creates the best outcomes for patients in a sustainable and time effective manner.

Together we can eliminate healthcare associated infections.

Happy National EMS Week!

This week has been set aside to show our appreciation for all EMS providers who step into a problem with knowledge, compassion, and respect for those they care for.

Many years ago, I started my journey in healthcare as an emergency medical technician (EMT). It was not long before I entered nursing school with the goal of becoming an emergency room nurse. Some 35 years later, I still have a soft spot in my heart for EMS and emergency room nurses.

Our eldest son is a paramedic. I hear his stories and recognize the impact he has on the people he cares for. He provides care in the unexpected, emergent world we all hope to never experience. When we do experience it, the event is a potentially life-changing moment. Having someone willing to step in and provide the care you require is life giving.

When we teach about therapeutic boundaries, we discuss the care continuum of empathy, compassion, and altruism. Empathy is the ability to understand what someone is feeling. This is an important skill but is not enough to provide the level of care we require in healthcare. Compassion is a step further: it is an understanding of how someone feels and a strong desire to alleviate their suffering. At the far end of the continuum is altruism. The willingness to help another at a risk to oneself. We tell most healthcare providers that compassion is the place where you want to operate from; altruism is a step too far for most of us. For those who are part of the EMS team, it is normal to operate from altruism. The risk is calculated: the team has prepared and trained to limit their risk, but each rescue has a risk that is willingly accepted to provide for those in need.

Even though we only celebrate EMS week once a year, we are all thankful for every EMS provider and offer you our thanks and prayers.

Nurse’s Week Gift

Some of the nurses were talking about how nice it was that many restaurants had Nurse’s Week specials. It is wonderful to have people acknowledge the special work we do as nurses and to celebrate this with us each year.

This year, I want to offer all nurses a different gift. Each of us became a nurse for different reasons, and our practices differ dramatically. One commonality I see among nurses is the gift of compassion, not just the “I want to take care of you” style of compassion. It is the “by the book” definition of compassion I see over and over again. According to Merriam-Webster, compassion is defined as the sympathetic consciousness of others’ distress together with a desire to alleviate it. This depth of compassion is seen in nurses around the world every day. This compassion is what gives nurses that sense of accomplishment at the end of a hard day, knowing that they made a difference in someone’s life. To be able to truly alleviate someone else’s pain and distress is an incredible gift. If I had to guess, compassion is the basis that makes nurses the most trusted of professions.

While it is normal to see nurses show compassion to their patients every day, it is rare to see these same nurses be compassionate with themselves. Too frequently, we think that taking time for ourselves or doing something just for ourselves is selfish or unnecessary and should not be valued. Nurses in general, myself included, are not steeped in the tradition that it is necessary to care for yourself.

Rick and Forrest Hanson (authors of Resilient: How to Grow an Unshakable Core of Calm, Strength, and Happiness) tell us that compassion for yourself is fundamental. By being more compassionate with ourselves, we learn to recognize our own distress and work to alleviate it. This self-compassion feeds our souls; it helps us to find and keep the joy that life has in store for us. In the end, self-compassion gives us the strength to be compassionate to others. Being compassionate with ourselves not only helps us to be more compassionate towards other, it can help reduce compassion fatigue.

We are starting to see more encouragement for nurses to care for themselves. The ANA’s Healthy Nurse, Healthy Nation encourages nurses to take better care of themselves and be good role models for society. The first step in caring for ourselves is to develop self-compassion.

This Nurse’s Week, I ask you to be compassionate with yourself. If you can’t see a way to do this for yourself, do it for your patients, family, and friends. As we experience self-compassion, we will be better prepared to encourage one another; the ripples of compassion will grow to include not only ourselves and our patients, but also our families, friends, and co-workers.

Happy Nurse’s Week to an amazing group of people, I am honored to be a nurse with you.

Washing Hands

Cinco de Mayo

Cinco de Mayo; what does this date make you think about? Many people will think about their favorite Mexican food or beverage. History tells us that May 5th is set aside to commemorate the Mexican Army’s unlikely victory over the French Empire at the Battle of Puebla on May 5, 1062. Cinco de Mayo is not Mexican Independence Day as many believe.

Cinco de Mayo has special significance this year: May 5th is World Hand Hygiene Day! The World Health Organization (WHO) has declared May 5th as World Hand Hygiene Day to encourage patients and family members to join healthcare professionals in the practice of appropriate hand hygiene. According to the WHO, hundreds of millions of patients are affected by healthcare-associated infections (HAIs) every year. More than half of these infections could be prevented if caregivers properly cleaned their hands at key moments in patient care. Everyone has a role in encouraging each other to clean their hands.

Imagine an entire day across the globe to celebrate and remember the importance of hand hygiene. If only we were celebrating the incredible job that we as a species do at effective and timely hand hygiene. Recent data shows that on average, healthcare providers clean their hands less than half the times that they should. Alas, it appears that it is our failure to clean our hands that leads to this observation of World Hand Hygiene Day.

Too often, we only consider the importance of healthcare workers cleaning their hands at the appropriate time to prevent the spread of HAIs. The Joint Commission has stated that hand hygiene is the most important intervention for preventing HAIs. We know one out of every twenty hospitalized patients has an HAI; appropriate hand washing is the solution we somehow cannot succeed at. Hand washing in healthcare is a life-saving activity, but it is not the only place that hand washing is crucial. All of us need to clean our hands at the appropriate times, not only to protect ourselves but to protect our loved ones and society as well.

If you work in healthcare, you know there are five moments (according to the WHO) that you need to wash your hands:

  • Before patient contact
  • Before aseptic tasks
  • After body fluid exposure risk
  • After patient contact
  • After contact with patient surroundings

If you are a patient or have a loved one in the hospital or other healthcare facility, there are key times for you to wash your hands as well. These moments are not as widely broadcast but are essential in the prevention of HAIs. The CDC list patient/family hand hygiene moments as:

  • After using the restroom (use soap and water)
  • Before eating (use soap and water)
  • After touching bedrails, bedside tables, remote controls, or phone
  • Before touching your eyes, nose, or mouth
  • After touching doorknobs
  • After blowing your nose or sneezing
  • Before and after changing bandages

Hand washing, also known as hand hygiene, has two separate methods. First, washing your hands with soap and water; second is the use of an alcohol-based hand sanitizer. If the hand sanitizer contains at least 60% alcohol, alcohol-based hand sanitizers are more effective and less drying to your hands than using soap and water. This is true except after using the bathroom, times when your hands are visibly soiled, or when caring for a patient with C. difficile. At these times, soap and water is the best option because the C. difficile spores are not removed by alcohol-based hand sanitizers.

When completing hand hygiene with soap and water or alcohol-based hand sanitizers, be sure to clean your fingertips, thumbs and between your fingers. Hand sanitizer should be used in a quantity to keep your hands wet for 20 seconds. Hand washing should include take at least 20 seconds as well, with 15 seconds spent rubbing hands together.

Whether you are a healthcare provider or a healthcare consumer, you can impact HAIs through appropriate hand washing. It is time to wash out HAIs and improve all our lives.

Happy World Handwashing Day!!!!

Sick Man in Office

Personal Bioterrorism – Going to Work with the Flu 

Every day, thousands of bioterrorists go into work.  They are normal people like you and me, but they are also harboring a biological contaminant that kills up to 650,00 people.  Despite this threat, little is being done to stop these bioterrorists and protect our health. 

As the prevalence of the flu increases, we have come to expect hospitals to implement flu restrictions for visitors.  This may mean that people younger than 18 years old or anyone other than immediate family members are not allowed to visit patients in hospitals.  This restriction is implemented to help reduce the risk of the flu for patients, visitors, and staff.  These restrictions can be bothersome, but in general, they have become an expected part of the flu season. 

The flu, also known as influenza, is a respiratory illness caused by one of the multiple and ever-changing influenza viruses.  These viruses infect the nose, throat, and lungs, making them very different from stomach illness we all grew up calling “the flu.” 

Influenza has a season that is unpredictable and varies by year and geographic location.  It typically starts in late fall and continues through winter, although sometimes it can continue through the spring.  The flu is not just a bad cold, the flu can result in hospitalizations and even death.  According to the World Health Organization, up to 650,000 people die of respiratory diseases linked to seasonal flu each year. 

The flu is spread by tiny droplets that spray when people cough, sneeze or talk.  These droplets can land in the mouth or nose of nearby people, causing them to develop the flu themselves.  Less commonly, you can contract the flu by touching an object or surface that the flu virus has landed on and then touching your own mouth, nose, or eyes.  The flu is contagious beginning one day before symptoms develop and up to seven days after becoming sick.  The period of greatest risk of spreading the flu is the first three to four days after symptoms begin.  Once exposed to the flu, symptoms begin within one to four days if you are susceptible to the specific influenza virus. 

One way we can protect ourselves from the bioterrorists is by getting a flu vaccination.  While the vaccination will not guarantee you will not get the flu, it does mean that, if you get the flu, it should be less severe than it would be had you not been immunized.  Remember, the flu can cause hospitalizations and death for a significant number of people. 

At this point, you should be wondering how the flu relates to bioterrorism.  Bioterrorism is the deliberate release of viruses, bacteria, toxins or other harmful agents to cause illness or death in people, animals, or plants.  When you have the flu, you are releasing the influenza virus with every cough, sneeze, and possibly every word you speak.  Many of us continue to work, shop, and interact with others when we have the flu.  Some of this feels like a necessity; we are expected to show up to work, we have important meetings, we may not have the time available to take off work, we need to keep our jobs.  This is all true; however, showing up to work or meetings or other events places everyone you interact with at risk to contract the flu.  Knowing that we are contagious each time we interact with others we put them at risk of illness, thus the idea of working with the flu as bioterrorism. 

The second way we can protect ourselves from the flu is by encouraging our friends, coworkers, and family members that caring for their health and those they come in contact with is more important than the work they do.  Too frequently we are taught that not missing a commitment or a day of work/school is imperative.  This has led to all of us taking medication to treat the symptoms of the flu so that we can do the things we need to do without feeling as ill.  While we may feel better when we take these medications, they do nothing to reduce the risk of spreading the flu.  While we are told that work and attendance is extremely important, we also are told that we need to be compassionate and caring to our fellow man.  Somehow these two beliefs come into conflict when we are sick.  We feel compelled to work, and we do not want to make others sick.  How do we balance these issues? 

Staying home and taking care of yourself when you are sick is the best thing you can do for yourself and those you come in contact with.  This gives your body the time and rest it needs to recover and prevents the spread of the flu.  What about the stress of missing work?  Some employers have started allowing extended sick time when employees have the flu.  While this is not widespread currently, it definitely is a benefit to the employee, the company, and society.  Requiring or even encouraging people to work with the flu supports bioterrorism in your own community.  We must find ways to support one another and our society. 

The flu can be a very serious illness.  Preventing the spread stops the bioterrorism that is rampant in America today. 


737 – The Faces of HAI

This morning I was talking to my husband and shared that I was a bit nervous about my flight later in the day. His immediate response was that it was safer to fly than it was to be in a hospital. While I know that is true, and I was happy that he has become so well-versed in healthcare-associated infections (HAIs), the thought did not make me feel any better.

By the time I arrived at the airport, I forgot this conversation. Suddenly, as I was lined up to board the plane and heard that the airplane was a 737, I not only remembered our conversation but I really started thinking about the impact of HAIs. Months ago, as I was reviewing the data related to HAIs, I calculated the number of people that died each year in the United States related to HAIs compared to the number of people on a 737. The average 737 seats 150-200 passengers. In the United States, 75,000 people die as a result of HAIs each year. My calculations resulted in the fact that the number of people that die from an HAI is equivalent to a 737 crashing and everyone on board dying every day of the year.

As I contemplated the impact of HAIs not only on hospitals and patients, I started to wonder about the impact to families, friends, and society in general. I looked around at the people waiting with me to board the plane. They all had families and friends, they all had plans for their futures, and some might have significant impact on our society through their work, innovations, and lives.

If our plane crashed, it would be a major news story. All the people related to or friends with any one of the passengers would be impacted. Society would miss the positive impact that the passengers might have had. Could it be that the person responsible with curing cancer or some other burden on our society would die before they had the opportunity to discover the cure?

I traveled down this pathway to try to gain a better understanding of the impact HAIs truly have on our society. I started to wonder: what kind of impact does one person have? I started with Robin Dunbar’s research, which theorized “Dunbar’s number”, a suggested cognitive limit to the number of people that a person can maintain stable social relationships with. Dunbar’s number is most frequently quoted to be 150. That is a start to the number of people impacted by the death of a single person.

Beyond social relationships, each person has a family that will be impacted by the death of one of its’ members. If you only consider a limited version of family, from the individual’s grandparents to their grandchildren, and only allow for two children in each family, you quickly arrive at a number close to 40, excluding cousins, aunts, and uncles. If you include your parents’ siblings and their children, you quickly arrive at approximately 70 people impacted by the death of a family member.

Combining family and friends the death of one person easily impacts the lives of 200 people in some degree. My plane crashing today is very unlikely. If it does, the 150-people sharing this journey will impact 30,000 peoples’ lives. That is really sad, the fact that I am writing this today signifies that my plane did not crash. The impact of one life or one plane crash is staggering.

The impact of HAIs is greater than the impact of this one airplane crashing. It is much more closely related to the impact of 365 airplanes of this same size crashing in a single year.

When you consider the individual people, who contract an HAI and die each year, each with family, friends, plans for their future, and undiscovered potential, the impact is significant. When you include the family and friends of these people, you quickly realize that there are over 15 million victims of HAIs each year in the United States.

If one 737 crashes today, the nation demands to know why. How can we not feel that it is a national crisis that the number of people who succumb to HAIs is equal to a 737 crashing every day?

My husband was incredibly insightful this morning. It is much safer to fly than it is to be a patient in a hospital. We all have work to do to find better ways to keep patients safe every day.

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