Health-Care-Associated Confusion by Bina Simon, RN

I don’t think I like this business of changing the name “nosocomial’ to “health-care-associated.” Yes, I get the point: to also include all health care settings, and not just hospitals, under one heading. But see, first of all, this new name is in plain old, you know, English! Health care consumers can even understand the term, which is supposedly the exact opposite goal of medical lingo. And worst of all doesn’t the term say outright, in that plain old understandable English, that basically we health care providers messed up?

You never hear patients, including your Aunt Helen whose gall bladder was removed last January, talking about their ‘nosocomial infections.’ They may know they ‘got an infection in the hospital,’ and maybe even realize it’s sort of related to the hospitalization itself. But that’s it. ‘Nosocomial infection’ is—oops I mean WAS– a term kind of shrouded in mystery. Thank goodness for that.

But now? Good grief! It’s like we’re announcing that it’s our fault!! “Health-care- associated- pneumonia?” We may as well wear t-shirts proclaiming “I am carrying germs right into your lungs.” It’s telling the entire mankind that we, members of the most highly thought of and trusted professions in the world (at least until now), are the cause of these bugs.

I can already see the guy with the stuffy nose in bed 3052– who really only came in with intractable back pain but now has this uncomfortable nasal congestion that we all get every allergy season, now telling all his friends and neighbors and maybe even his lawyer that he has a “health-care-associated pneumonia.”

Boy am I glad I have my own malpractice insurance. I suggest you get your own.

Granted, I may have once or twice been the source of a nosocomial– I mean healthcare associated- infection or two myself. I really never told this to anyone before, but once we’re announcing this health-care- associated pneumonia bit, I may as well be the first to give my confession: I definitely recall only scrubbing my hands vigorously for only 14.2 seconds instead of JCAHO- required 15 in between taking the BP of the guy in E.D. Room 3 (c/o sprained arm r/o fx) and checking on the lady in bed 8 (c/o cephalgia).

Who’s next? Come on, it’s coming out in the open anyway. Let’s all let our hair down. (Although loose and/or long hair breeds germs and should really be kept short or pulled back away from the face.)

And now that the world will be hearing that “health-care-associated” infection bit, you can imagine what will be going on in hospitals health-care-associated sites now. Patients will be suspiciously studying every single health-care-associated staff member. Not just the nurses and MDs and CNA’s but now every housekeeper and mop, every dietary worker bringing trays and clearing them off, maybe even the volunteers bringing their mail. Can’t you see these patients tucking details in their heads as they mentally note, “Thaaaaaat’s what’s causing all this ‘health-care-associated pneumonia’ I hear about. That volunteer just delivered my get-well card–without gloves!!”

Actually, once we’re embarrassing ourselves and being completely honest with this confessional new term, let’s go all the way. That physician who doesn’t wash his hands between one patient and another– and you find it unsurprising that his patients get MRSA more than the rest of the unit….well, we could name the infection “Dr X- acquired MRSA,” but there’s always that libel and defamation of character suit. (Which is probably not covered under your malpractice insurance policy.) How about ‘poor-handwashing-technique-acquired infection?’

How about some other stuff we see– will they be named things like “Poor-suture-technique associated wound dehiscence?”

And what about us? How about ‘insufficient-betadine–pre-Foley-insertion -associated UTI?’ ‘Faulty -IV-technique-associated phlebitis?’ And something a few of my own patients might have suffered during my first six months out of nursing school: ‘Poor- injection -technique-associated ecchymosis?’

Then again, maybe it wasn’t my fault. Some of them- especially those geriatric ones- were really “insufficient -subcutaneous- tissue- associated ecchymosis.” That’s better. See, it’s not always the fault of the health-care- associated-providers, is it?

And waittttttttttttt a minute. Now that I think about it, lots of conditions are not our fault. Why do we have to be honest about our health care flaws, but the patients don’t have to be? Why can’t we ALL be honest here? Patients included?

For example, I think it’s time for a NEW classification of MIs. ‘STEMI,’ ‘Non Q,’ ‘Subendo,’ ‘anterior wall,’ blah blah– outdated. Let’s go for it: The guys who sit home for 3 days not believing it’s an MI: Denial-associated MI. The chain-smoker who eats at McDonald’s every day for lunch after breakfast at Burger King– is Unhealthy-lifestyle-acquired MI. And the poor folks who really take care of themselves but have MIs mostly because of family history: “No- fair- it’s- only-DNA-associated MI.” Insurance companies could have a FIELD day with this.

OK well, um,………So maybe this idea is NOT a good thing. Well, then….. how about making up a NEW term that would include all health-care-associated-settings, without publicly humiliating ourselves? Let’s think. Um, well….. maybe some acronym or something? Oh hey, I’ve got it! How about “NOSOCOMIAL?”

Now they’ll all be happy at JCAHO (Just Clean All HOspitals), and HCFA (Hospitals Cause Fevers and Ailments). Oops my mistake– I think the idea was the CDC ‘s(Caregivers Don’t Contaminate). Of course we still get to keep that nice mysterious hard-to-understand-and-even-spell ‘nosocomial’ term, and no one will know what it stands for, except us. You know, the guilty parties. Nurses/Nursing homes, Offices/Outpatient Settings, Other Caregivers Or MDs Infecting ALL.’ See, that’s more all-encompassing.