Gina Schnathorst (Host): Welcome to the Iowa Specialty Hospitals and Clinics ISH DISH podcast; practical health advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life.

Our guest today is Nicole Nachazel. Nicole is a BSN RN and she has CIC as a designation behind her name and she is the Infection Preventionist at Iowa Specialty Hospitals and Clinics. And in this role, she consults on infection prevention and control policies, procedures and practices, and provides staff training on various infection prevention topics.

Nicole has been a nurse for almost 20 years and has worked in various health care settings. Welcome, Nicole.

Nicole Nachazel, BSN, RN: Thank you, Gina.

Host: So, you have a big job at our system.

Nicole Nachazel, BSN, RN: Yes, I'm an Infection Control Nurse here at Iowa Specialty Hospital, and I've been in this role for just about two and a half years.

Gina Schnathorst (Host): Where did you come from before that?

Nicole Nachazel, BSN, RN: Like you said, I've worked in various areas of health care. I've done some hospital work, some nursing home. I was a school nurse, actually, before I came here, and during my time as a school nurse, I worked, PRN, so as needed, I would pick up on our med surg units, And then when this infection control position opened up, I applied for it and, I got it. And like I said, I've been here now for a little over two years, over five years altogether at Iowa Specialty.

Host: Wonderful, and we are so happy to have you. I, I cannot myself imagine being in your role, so I'm so thankful for people like you that want to take this on. And I am very curious, what is the CIC designation that you have?

Nicole Nachazel, BSN, RN: Yep. So I went and got a certification in infection control. So I just, this last summer, actually, I took a large test. I studied for months and thankfully I passed and now I'm a Board Certified Infection Control Nurse.

Gina Schnathorst (Host): That is wonderful. I know you worked really hard at that and we were all super happy that that came to fruition for you.

Interestingly enough, I was laying in bed last night reading the November issue of Prevention magazine and on the cover, it says, How Not to Get Sick. Well, I was all in, of course. So there was a specific part in the article and I want to read it because I think it's a good jumping off point to some topics that we can cover.

It says many pandemic precautions used to contain COVID-19 cases, including social distancing, mask wearing, and hand washing, have mostly gone away, lowering their impact in suppressing other illnesses. At the same time, flu cases have spiked by the millions since the height of the pandemic, according to the CDC.

And there's been a huge rise in the incidence of 13 communicable diseases in 44 countries compared with before the pandemic, according to an analysis by London researchers. These include less common illnesses such as polio and tuberculosis, as well as familiar ones such as influenza and RSV, which may suggest that our baseline immunity has shifted in recent years. A theory known as immunity debt contends that isolation society experienced during the pandemic led to a weakened immune system in many people. Because ordinarily we would all be exposed to a variety of viruses in the usual course of activities. So I'm curious as to what your thoughts are behind that.

Nicole Nachazel, BSN, RN: Yeah, I think we did see an increase of respiratory illnesses over the last few seasons. I think just because we have that, those years of COVID where we did social distance, we wore masks, we stayed home when we were sick. And now then people came out in the communities more, we were sharing all those germs again, and we probably did see an increase in those respiratory illnesses.

 I know in the United States they did. I think this year it's supposed to be a little bit better, is the prediction. So less flu, less RSV, and hopefully less COVID cases this winter as well. And I think just people weren't traveling during that time either, and then all of a sudden you could go anywhere you wanted again, and people are, sharing all those germs in new places.

Host: Yeah, I kind of liken it to, we all know that there's going to be a spike in illnesses the minute, and I mean like the minute the kids get back into school, right?

They've been doing their own thing, they've been staying home all summer, and now we're all in close quarters, and yeah, that makes complete sense. So, how does that, what does that look like when we talk about getting your vaccines? I know we're doing a really big push right now, so.

Nicole Nachazel, BSN, RN: Right. It is that time of year we're all inside, the windows are shut, we're in close quarters, people are coughing, spreading those germs. So, yes, flu, COVID vaccines, they are out right now. We definitely encourage vaccinations as a way to prevent illnesses, in all populations, all people, all age groups, we definitely want those vaccines to be given. And it's just a good reminder also to remember to stay home if you're sick. Don't go out. Don't send your kids to school if they're sick. Don't go to work if you're sick. Stay home, protect yourself. Coughing into your elbow is another key as well and then of course hand hygiene is also the biggest and best thing we can do to keep safe.

Host: That was actually one of the questions that I had here were, you know, what are the common misconceptions about infection prevention that patients and their families should be aware of? And it makes me think about a lot of people are still carrying around hand sanitizer. That's, you know, was a big thing during COVID especially.

I know that they say that that's effective, but hand washing is better. What's your thought on that?

Nicole Nachazel, BSN, RN: Yep, actually they say that alcohol based hand rub is preferred method, to use unless your hands are busily soaked, so especially in the hospital system, we have that hand sanitizer dispensers everywhere you go. We want our staff to use it, it's important to prevent the spread of infection, so washing your hands is fine, alcohol based hand sanitizer is fine too, just make sure you're doing something to keep yourself safe.

Host: And I don't think that we can stress enough about the, because I see this all the time, and I just want to say something, and I know it's not kosher to do so, but people, it's good to cover your mouth. You know, we've all been taught that since we were little, cover your mouth, but coughing into your hand versus coughing into your elbow, huge difference. Correct? Unless you're going to sanitize immediately after.

Nicole Nachazel, BSN, RN: Yeah, because you're coughing all those germs into your hands, and then who knows what, how many different things you touch before you do that hand hygiene. So just, yes, cough into your elbow. You can cough into a tissue. Just make sure, again, you wash your hands. And I always say it feels kind of basic, like you said, we all should know how to wash our hands and cover our coughs, but it's two very simple, important things that you can do.

 At New Employee Orientation every other week, I cover both of those topics and I always say, I feel like you all should know this, but it's just important to, important to review. Just a simple thing, but it's important.

Host: Yes. I still remember when COVID very first came to be and I was at the mall in Ames and people were wearing their masks at that time. It was still very new and I remember looking at a lady in a clothing store who removed her mask to sneeze.

Nicole Nachazel, BSN, RN: Right.

Host: And I think about it now and I think, no, I wanted to run over there but that's not the point.

Nicole Nachazel, BSN, RN: Right. Yes, it was hard to watch sometimes. The community, yes, with all their masking and...

Host: Yeah, it is. And now it seems, almost alarming a little bit when you're out and about and you see somebody with a mask on and, and I still feel like there's an obvious difference between I'm wearing the mask to protect you.

So you're not getting what I'm getting or they just somebody who may have a weakened immune system and they just don't want to be exposed to the germs out and about.

Nicole Nachazel, BSN, RN: Right, which is completely acceptable. And yes, if that's what you need to do, that's completely acceptable.

Host: So I wanted to cover the hand sanitizer, hand washing thing at the very beginning. The other question that I have right off the top is what do you think about antibiotic use? And especially I don't think people necessarily still know the difference between taking antibiotics for something that's bacterial versus not taking them for something that's viral and then the importance of continuing to take all of them.

Nicole Nachazel, BSN, RN: Correct. Yes. Antibiotic use, it's a big hot topic. We have actually an antimicrobial stewardship team. So we, at the hospital, we look at antibiotic usage and follow and try to follow best practice. And we try to share and make sure providers are educated on that best practice and are following it themselves.

So antibiotic overuse is kind of an issue, which led to antibiotic resistance. When you're over taking antibiotics, not the prescribed way, when you don't need antibiotics taken for something you don't necessarily need to take them for.

So like I said, you want to take the antibiotics as you're prescribed. You want to take the full, full dose, even if you start to feel better. Like you said, antibiotics are used for bacterial infections and not viral infections, so there are things such as influenza, like the common cold, you probably don't need antibiotics for those, so just making sure you're following the provider's recommendations and knowing that just because you're sick doesn't mean you necessarily need an antibiotic, to treat what's going on with you, so just talking to that your provider about that.

And like I said, we, this is something we focus on hospital wide. We look at this throughout our organization just to make sure we're following best practice, for what our providers prescribe to their patients.

Host: That's really good to know because I've always thought that, you know, when people talk about antibiotic overuse, I cannot go and prescribe myself antibiotics. So it really does start with the provider. And I'm sure that they come up against some patients who just beg for an antibiotic because they think that that's going to be the only thing that will make them better. So I understand that, but to have some education behind that for the providers at our facility, that makes me really happy to hear.

Nicole Nachazel, BSN, RN: Right, and we are actually enrolled in a program right now. It's a quality improvement program. One of the things we're focusing on is antibiotic usage in our, especially our clinic settings, and it's kind of one of the things that talks through is just different ways you can educate your patients on that as well, because people in the community might not understand that. So just providing that community education and antibiotic best practice is key as well.

Host: Good. I have some other questions here that I want to tackle and we'll go back to, I just wanted to get those common misconceptions kind of out of the way. But now if we switch to more of a healthcare setting, what are the fundamental procedures that healthcare facilities should implement to prevent the spread of infection among patients and staff?

Nicole Nachazel, BSN, RN: We have several processes we do every day at the hospital just to prevent infections with our inpatients. And those are just obviously back to the basic things, hand hygiene. We monitor that throughout the organization. We track and see how well our employees do at hand washing, cleaning and disinfection.

Our EDS staff is fantastic on keeping everything clean and disinfected. And again, that's something we audit and monitor. Vaccinations. We're doing that right now, with our Flu and COVID vaccines for all of our employees. And again, pushing those out to the community as well. PPE, personal protective equipment.

So if you come into the hospital and see an employee in a mask, or if they're taking someone and wearing a gown, that's just another thing we do, to prevent those germs from potentially reaching other patients, or employees. Respiratory etiquette, we have signage up at all of the facilities, all of our entrances, if you're coming to our clinic, you feel like you have some respiratory symptoms, there's masks at every entrance, grab one, put one on, we strongly encourage you to mask, we don't judge, we want you to, again, cover that cough, cover those secretions, so you aren't exposing other patients, and then injections, again, just getting all your, all the recommended vaccines outside of even COVID and Flu, for pediatrics, age appropriate vaccines, anything that the provider recommends for you.

We encourage, ask any questions that you have so you understand what they're for and why you're, why we want you to get them, but, those vaccines are very important as well.

Host: Yeah, so if I end up with an illness, a pneumonia, something like that, and I have to be hospitalized. How can I as a patient or my family participate in infection prevention during hospital stays and then at home when the discharge takes place?

Nicole Nachazel, BSN, RN: Right, again, just make sure your hand hygiene. I'll keep going back to that, but it's so basic and so simple. You can even make sure your staff are washing their hands. We want our staff to wash their hands anytime they go in and out of a patient's room. So making sure they're doing that, again, just we'll probably give you antibiotics if it's necessary in the hospital.

 Make sure you, when you go home, you know what your, the patient instructions are, whether that's for respiratory hygiene, antibiotics, making sure you're following those discharge instructions as well so you can make sure you continue to get better even after you're discharged from the hospital.

Host: And I think we've done a really good job too of empowering our patients. And this should probably be a thing everywhere that if you don't see your practitioner or your provider washing their hands, I think it's okay to ask them to do so.

Nicole Nachazel, BSN, RN: Absolutely, yep, we encourage it. We have signage up that talks about that throughout the hospital as well. Absolutely.

Host: And it's not a, it's not a bad thing. It's just, hey, we want everybody to be safe and we'd rather do it that way than, risk an infection or something else.

Nicole Nachazel, BSN, RN: Yes, exactly.

Host: Are there any new technologies or innovations in infection prevention that general practitioners should be aware of? One of the things that I thought was really fascinating, when we built our new surgical, area, you know, a whole new wing for surgeries, and especially when they do orthopedics, we had these lights installed that actually help with infection prevention. And I thought, I didn't even know such a thing existed.

Nicole Nachazel, BSN, RN: Yes, so we have UVC lights, they're ultraviolet C lights, that help clean and disinfect. We use those any time a patient's in isolation, our EVS staff will use those to clean a patient's room, before or after they go in cleaning. We will use it also in orthopedic cases, for joints, our knees and hips, I believe they use it for.

So it's just special lights that help disinfect the air, and surfaces. So it's kind of a neat thing that we have at our specialty. Not every hospital has that. So, we use it well. We use it often and it helps disinfect and clean as well.

Host: We take specific measures, I know, to prevent hospital acquired infections, and I am going to assume, and correct me if I'm wrong, that those are actually measured and reported. What are they? What does that even mean?

Nicole Nachazel, BSN, RN: Any infection that occurs while the patient is in the hospital, whether that could be like a surgical site infection. We have a lot of patients will have urinary catheters, or central lines, like IV lines into their arm while they're in the hospital. And we want to make sure all those areas stay clean, people don't get sick from those. So we track compliance with those measures. I monitor every patient that comes in with that just to make sure, we're taking appropriate care of those areas, whether it's a catheter, I do audits on that to make sure our nursing staff is taking care of that and documenting that and the patient has it for the appropriate reason.

If, for some reason, there would be an infection on one of those, which doesn't happen often, then we would report those, into CMS basically is who tracks that for us. And then again, we do a lot of education on prevention for all of our clinical staff. Surgical site infections, we do a lot of education on that.

And then our patients get a lot of pre op education for like CHG bathing. That's something a lot of our patients do prior to surgery. So we make sure they have the appropriate education, and they're doing that appropriately as well.

Host: Perfect. And I think to the general public, walking into a hospital this time of year is probably just a little bit daunting and maybe scary because you think, oh my gosh, there's all these germs floating around and I'm going to walk out of here with something, but I would assume that it's probably just the opposite. I've never seen a more clean, because we have all of these protocols and systems in place. Would you agree?

Nicole Nachazel, BSN, RN: Yes, I agree. And we have, like I said, if a patient comes in with a respiratory illness, our clinic staff does a great job about immediately getting them to a room so they're not in the waiting room exposing people. Our EVS, our housekeeping staff, they do a fantastic job about cleaning. If we have a outbreak of something, they increase their cleaning.

They clean daily all the patient's rooms and then they also audit that to make sure their cleaning is appropriate. They do a fantastic job, no concerns there, but we I think we a great job about keeping our patients and then our visitors even, safe when they come to our healthcare facility.

Host: Good. So, on that, the article that I read in Prevention Magazine said, it has a little section that says your immunity refresher course and we covered a lot of the covering your mouth matters, don't starve a fever. We didn't touch on that but I'm assuming that that is an old wives' tale.

Nicole Nachazel, BSN, RN: Yes, yes, I think just a normal, healthy, yes, yes, exactly. Yes, don't, and make sure you're getting enough fluids, all the vitamins and nutrients that you need to stay healthy.

Host: And then obviously this one says hand washing beats hand sanitizer, but again just to recap, as you said, hand sanitizer is...

Nicole Nachazel, BSN, RN: In the healthcare setting, yes, we use that hand sanitizer. Just, yes, making sure you use a good, a decent hand sanitizer. And hand washing is never wrong.

Host: Right. Is there anything else from an infection prevention perspective that you would like to tell our audience?

Nicole Nachazel, BSN, RN: No, I think the last thing, stay home if you're sick. If you can stay home, you're not critically ill, stay home until you're well. Make sure, again, you're getting those fluids, the rest you need at home in a safe environment away from other people. Take care of yourself, get those vaccines you need, and eating those healthy, well balanced diets, plenty of healthy fluids as well.

Host: Good. Perfect. If anybody would have any questions about infection prevention, would you be a good person to reach out to, or is there information on our website that they could look at?

Nicole Nachazel, BSN, RN: Yes, you can always reach out to the hospital or your provider with any questions. We always refer people to, if you have questions at home and you have, want good information, the CDC is always a safe place to go and look for that information as well. That's where we follow a lot of our recommendations and guidelines come from the guidance from the CDC. So that's who we follow. That's who we recommend. And again, reach out to your provider, ask your provider if you have any questions or concerns.

Host: All right. Perfect. Well, thank you so much for being our guest today.

Nicole Nachazel, BSN, RN: Yes. Thank you for having me.

Host: I'm just going to leave everybody with one message. Wash your hands. I think that seems to be the overarching theme is just wash your hands and just don't sneeze into your hands, sneeze into your elbow and just try to remember all of those good preventative things that we learned back in kindergarten.

Nicole Nachazel, BSN, RN: Right. I know. Just continue to use them. Yes.

Host: Yes, and don't be a hero if you get sick. Nobody wants you to be at the office. Just stay home.

Nicole Nachazel, BSN, RN: Exactly.

Host: Thank you, Nicole, very much for being our guest today. And, that concludes today's podcast.

Nicole Nachazel, BSN, RN: Thanks, Gina.

Thank you for listening to Iowa Specialty Hospitals and Clinics ISH DISH Podcast. For more information on the topic we discussed today, visit us on the web at iowaspecialtyhospital.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer. For the ISH DISH Podcast, I'm Gina. Thanks for tuning in.