The Devastation of Healthcare-Acquired Infections – I am a Survivor, Part II
Mary Millard, a former L.P.N, serves on the board of the Healthcare Surfaces Summit. As a patient advocate, who is living with a chronic healthcare acquired infection, she shares her story to help raise awareness of the devastation that these infections cause and how surfaces play a large part in spreading pathogens in a healthcare setting. More information on her case and speaking history can be found on her website: https://marymillard.org
Welcome to part two of my patient story.
In the previous article, I took you on the journey of how I acquired an HAI. This story will go into a bit more detail and focus on how a surface caused my infection.
In late September of 2014 and after the CT scan, I was admitted for repair of the aneurysm and a valve replacement. Even though I had never been in a hospital at any point in my life, I knew the system well as it was a local research hospital where my husband had worked in the university side for years. I was calm and set for surgery. I was confident in my cardio thoracic surgeon and his team, as well as in what I could expect. I understood that I would be home in about ten days. It sounds silly now, but my biggest fear was choosing a tissue valve, as I did not want to be on Warfarin the rest of my life.
It turns out that my last memory for many weeks would be the morning before the surgery. I remember getting up early to use the restroom. As I was returning to my bed, I remember a sudden feeling like a dagger was being thrust into my chest, doubling me over in pain. I remember the excruciating pain. It happened again and again as I lunged towards the bed to hit the call button, all the while screaming in pain. I remember a flurry of white coats surrounding me. I remember seeing my husband standing, with a confused look in the doorway and holding a folder that contained our pet pictures so that my patient room could be more comforting for me. The last thing I remember is being held down on the CT table and told not to breathe.
I only know what had happened after the CT room from seeing my medical records and hearing the accounts as told by my doctors, PA’s, and my husband. Apparently, they started to take me to the Cath lab on my floor because they feared that my aneurysm had burst.
They were wrong. It did not.
Seconds that last a lifetime.
When I was placed on the table, a code blue was roared. My heart had stopped. A cardiologist tried the paddles three times, but no luck. My code lasted four and a half minutes as they scrambled to get ECMO equipment together. A cannula for blood flow was placed in my groin and in my jugular. What they did not know then, was that when the cannula packet was unsheathed, it was laid on a nearby counter next to the sink for only a few seconds. Just seconds. But long enough for some water left on the counter, containing Pseudomonas, to contaminate the surface of the cannula and later my body. This I learned later from my Infectious Diseases doctor.
Pseudomonas loves damp, dark places and sink traps are ideal living quarters as it creates a sticky biofilm and stays there until interrupted. Therefore, surfaces such as traps and sink basins are so dangerous, as they cannot be properly cleaned. New innovations such as splashless sinks or straight drains along with better monitoring of surface disinfection are essential to preventing infections.
Hindsight is 20/20.
Apparently, my valve had been collapsed for a few months causing backwash that clotted up in one of the heart’s arteries. During the ECMO procedure they blasted the clot apart. According to my husband (who was there every day) the ECMO was in place for three days. On the fourth day, the nurse informed him my heart had started beating on its own! He thought, “this is finally over,” and felt immense relief that surgery was finally coming. To help with recovery, they kept me in a medically-induced coma. My only memory is waking up and asking my husband and niece, who were silhouetted in the window, if the surgery was over. They informed me that I had not even had surgery yet and I simply said, “oh my,” and closed my eyes once again. During this period of recovery, aggressive physical therapy was necessary to prepare me for the surgery, scheduled for two weeks later. More days of no memory.
According to my frightening medical notes, my white blood count was off the charts even before surgery, but this was explained as normal and blamed on the ECMO. Surgery went on as planned and took place in mid-October. Things went smoothly and quickly. Within hours I was in recovery and brought to the ICU for just a ‘few days’ before progressing to a final “step down” in preparation to go home.
Back to the ICU.
However, my groin wound was red and not healing. Something was wrong. My medical team disregarded my white blood count and didn’t even consider that I was septic during the open-heart surgery, and even the Vancomycin did no good as it is ineffective against Pseudomonas.
As explained in my first article in this series, the acute septic shock led to being placed in the ICU once again. After a week of duo antibiotic therapy with Tobramycin and Cefepime, it was decided to reopen my sternum and remove as much residue from the infection as possible. My cardiothoracic surgeon performed the debridement, and then a Plastic Surgeon removed a part of my abdominal wall lining to place around the graft and on the sternum for nourishment. This is called an Omental Flap procedure. I do recall waking up briefly a day after this and being in extreme agony. Words drifted back to me from weeks before, when my surgeon compared open-heart surgery to “being hit by a Mack truck.” That was an understatement and thank goodness for pain medication. I was once again placed into final step down.
I remember fear.
On my first night of stepdown I began to become somewhat conscious. This was bittersweet because it brought crippling fear…. confusion. I still had no concept of date or time at this point and the feeling of dread was deep as I became more aware of what had transpired; also realizing with dread that my legs would not work. I could not stand.
I know that the last eighteen days were indescribable for my loved ones. They had stood on the periphery as I fought for life, not knowing how to make the best decisions for my care. Fear, guilt, anger and frustration were their only advocates. Look for the third article in this series for their side of this journey.