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Communities also rely on nurse epidemiologists
for information in the same way patients at a
clinic would look to their nurses for education.
Teran-Maciver works for the CDC’s Agency
for Toxic Substances and Disease Registry, which
investigates communities near hazardous waste
sites that have been put on a national priority
list.
In 1999, she flew to Libby, Mont., where a high
proportion of residents was dying of lung problems.
The Environmental Protection Agency had discovered
asbestos in the air from a mine that had closed,
and Teran-Maciver’s team’s job was
to alert residents, present and former, to come
in for testing as well as to disseminate information
about the problems.
National media helped spread the word about testing,
but her team also went door-to-door, held meetings
at senior citizens centers, schools, and the Veterans
of Foreign Wars meeting sites.
Sending a letter to everyone in town is not enough,
Teran-Maciver said. Health officials must repeat
the message often before people hear it. Later,
her group handed out pamphlets and set up counseling
sessions for people diagnosed with asbestosis,
a fibrosis or scarring of the lung tissue due
to asbestos exposure.
“A lot of people thought if they were diagnosed
with asbestosis that was a death warrant, but
we wanted them to know there were ways they could
take care of themselves and live a fairly healthy
life,” she said.
Her group distributed a fact sheet that advised
patients to drink plenty of fluids (to keep secretions
loose and incapable of blocking airways), to exercise
(to build lung capacity), and to see a doctor
regularly.
In the field
Not all outbreaks garner national media attention
or require the aid of the CDC. Many nurse epidemiologists
can be found in state health departments.
Neil Pascoe, RN, BS, CIC, works for the Texas
Department of Health, Infectious Disease Epidemiology
and Surveillance division. Two years ago, he was
called to investigate an outbreak of methicillin-resistant
Staphylococcus aureus among cadets at a police
training academy. About 43 of the 110-member class
suffered soft-tissue infections, and two had bloodstream
infections.
MRSA can kill, so administrators were eager for
the state to discover the problem, though not
so eager to spend the time getting to its root.
Nevertheless, Pascoe and his colleagues looked
at all aspects of the police training academy.
They watched cadets wielding knives and guns,
and subduing “violent suspects.” They
inspected locker rooms and laundry facilities.
Pascoe learned that recruits sometimes were injured
while training for defensive tactics. The recruits
passed around protective equipment without sanitizing
it, passing along the infection. Clothes were
laundered in water that wasn’t hot enough
to kill infections.
Pascoe and his colleagues set up measures to
combat the infection: They recommended the laundry
be washed in bleach and hotter water; they instituted
handwashing measures and placed bottles of alcohol-based
sanitizer around the facility. Eventually, the
spread of MRSA stopped.
Pascoe is one thesis short of a master’s
degree in public health, but much of his experience
comes from working as a nurse. He has worked in
med/surg, burn and surgical ICU units in hospitals,
in home health, in a jail, in a long-term rehab
for head-injured patients, and in a neuro intensive
care unit.
His role at the state health department means
he spends a lot of time using what he has learned
to stop infections in various settings to teach
others.
“I talk about specific practices they can
do in their environment,” he said. He gives
talks to jail administrators and nurses who work
at schools. He also does television interviews
and puts information on the state’s website.
“I tell as many people as possible about
respiratory hygiene and hand hygiene every chance
I get,” he said.
Pascoe, who wears a sanitizer on his belt so
he can “walk the talk,” admits he
may be a little different from most people.
“I’m probably a little more compulsive
than others because I hear the stories,”
he said.
Yet he hasn’t missed a day of work due
to illness in more than two years, despite spending
plenty of time with his seven grandchildren and
with sick people in the community.
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