Here Come the Bugs

Here is an excellent discussion on hospital infection rates in today's New York Times, Doctor Leads Quest for Safer Ways to Care for Patients.

I remember a situation back when I worked in the hospital. We had a patient with a bad wound, and the resident would go in, remove the dressing without washing her hands first OR putting gloves on. She'd then go on to do things to the wound, then leave--again, never washing her hands before going to the chart to write her note.

Our therapy team finally approached the resident and told her she was going to have to start washing her hands before and after seeing this patient. She was shocked that a bunch of lowly therapists and social workers would dare confront her on this issue, and told us she was the RESIDENT and knew better. When we threatened to get the infection control nurse involved, she backed down and started washing her hands.

I've also seen a nurse fool with a patient's IV, again with no gloves, get blood all over her hands, and go on to the next patient without washing her hands.

So, you are well within your rights to always ask medical personnel to wash their hands and put gloves on before they do anything to you. And don't even get me started on neckties!

The ABCs of Social Work

March is Social Work Month, so in case you're not sure what we do (no, we don't plan social activities, at least not all the time), here is my version of the ABCs of Social Work.

As Social Workers, we:

Advocate for marginalized people;
Bend over backwards to get the job done;
Create services where none existed before;
Deliver meals to people at home;
Educate others on social issues;
Field all kinds of unusual questions;
Grief counselors;
Hear every side of every story;
Insist on client confidentiality;
Jump to action;
Know how to network;
Love what we do;
Mend broken hearts;
Never say never;
Observe everything;
Play with kids;
Quick to add our voices to a cause;
Refer, refer, refer;
Solicit donations;
Teach parenting skills to teenage parents;
Unify neighborhoods;
Volunteer;
Watch out for the disenfranchised;
Xerox queens and kings;
Yearn for a better world for all;
Zoom around hospital corridors.

Dementia vs. Delirium

I thought it might be a good idea to review dementia and delirium (it helps that it's something I'll be addressing in class soon).

If you don't remember what dementia is (no pun intended), it is a syndrome that includes many cognitive deficits that include memory problems. Most people are familiar with Alzheimer's type dementia, but dementia can also be caused by vascular problems, Parkinson's disease, substance abuse, as well as other causes.

While the different types of dementia do look a little different from each other, in general there is a gradual decline in memory and thinking ability.

Delirium, on the other hand, is an acute, or sudden onset of change in consciousness that can't be explained by a pre-existing dementia. Delirium can change or fluctuate over the course of a day, and can include changes in sleep patterns.

Even people with dementia can experience delirium; if a person with dementia demonstrates a rapid change in behavior or memory, delirium should be ruled out.

So what can cause delirium? There are several medical conditions that can cause delirium, including urinary tract infections, pneumonia, or even a mild heart attack. Medications can also cause symptoms of delirium.

Any time you see a sudden change in mental status of an older adult, be sure to consider some of the causes of delirium, and seek medical treatment.