A Nurses Perspective
Antibiotic resistance is a threat that healthcare professionals are all too familiar with. I recently sat down with a nurse from Kirkland, Washington to gain insight into what antibiotics mean to nurses and their patients.
Initial interest in the field of nursing
Her mother and grandmother were nurses, so she was familiar with the career from an early age. She eventually ended up in medical-surgical nursing and is now transitioning into the labor and delivery unit. Throughout her career she has witnessed a myriad of complications related to infections and antibiotic resistance. She treats patients with MRSA (Methicillin-resistant Staphylococcus aureus) and C. diff (Clostridium difficile) infections at least once a week, commonly treats patients with bacterial pneumonia, and frequently interacts with patients on contact precautions due to highly contagious infections.
What do antibiotics mean to you as a nurse on the front lines of patient treatment?
“In the med-surg world, antibiotics are the difference between life or death. If you don’t have access to them, you can die. I’ve seen patients become septic while waiting for diagnostic results.”
Antibiotics are tricky because while they do save countless lives, they come with risks and side effects. She continues, “the risks associated with these drugs are very real. There is a risk of severe allergies, receiving too high of a dose...we monitor our patients very carefully when they’re receiving antibiotics.”
How would your job change if antibiotics no longer worked?
“Well, for example, on the labor and delivery side we have patients that when their water breaks, it's called rupture of membranes. If it’s been more than 18 hours since the rupture it increases the risk of chorioamnionitis (intra-amniotic infection). If chorio is called, the mom automatically gets antibiotics (commonly gentamicin or ampicillin) for at least 24 hrs. If her infection continues, they'll do further work up and adjust the antibiotic as needed.”
This brings up the concern of slow diagnostics and the immediacy of a serious infection like chorioamnionitis. “Sometimes I feel like we overprescribe, but it's the only thing we can do while waiting for diagnostics. We need faster diagnostics that are accurate.” If a woman is diagnosed with chorioamnionitis, her and her baby’s life are in danger so the doctors must act fast and administer antibiotics. They must make what is really no more than an educated guess as to which antibiotic to prescribe while they wait for lab tests to return. Improved diagnostics are a very important topic and will be discussed in further detail in a coming post.
Have you ever been on the care team of a patient who had an infection that antibiotics were no longer working for?
“Yes, vanco [vancomycin] is the first antibiotic we give for sepsis [when the infection spreads into the blood]. We've seen patients who don't respond to vancomycin and we have to move to stronger antibiotics that have additional side effects.”
As a nurse, what would you tell the public about antibiotics?
“I would tell them that there is a difference between bacterial infections and viral infections, and that antibiotics do not treat viruses. Also, the most important thing you can do for your health and body is to finish your full course of antibiotics! Patient education is very important, so we try our best to simplify instructions upon discharge, and to chart everything in patient documentation. Nurses double check everything, nurses are the last line of defense. I’m absolutely an advocate for my patients.”