I walked into a patient room, knowing the patient was there because of cellulitis of her foot and diabetic foot ulcers. Also by this time it was known that she had osteomylitis. What she didn't know at this point was that she would most definatley be losing part of her foot before this hospital stay was over.
Anyway, as I was saying. . . I walked into her room and immediately smelled it. MRSA!! She wasn't in isolation yet, I guess they were waiting to get the wound cultures back to confirm what we already knew. It was MRSA in that foot! I backed out of the room and went ahead and called for an isolation cart for the room. Once it arrived I gowned, and gloved and went in to see what the smell was all about. The closer I got to her bed the stronger the odor was. I thought I was going to lose my lunch! I could see blood stains on her sheets around her feet. I uncovered them and the odor just about knocked me on the floor. There were two large wounds on her right foot. Her big toe was about twice the size it should be, and very red and the reddness was halfway down her foot. On the back side of the toe it was all black and oozing clear/pink drainage (serosangous). There was no dressing on this wound just left open.
There was another wound just below the toe on the bottom of the foot. This was about the size of a dime and I could see bone inside it. If you picture it like a bullseye, it would look like this: immediately around the opening is a thin, hard black ring, then a hard white ring, then the rest of the foot is red and hot. This wound had thick, yellowish, puss draining from it (purulent). It did however have a dressing over it. It had a dry 4x4 gauze that was STUCK to it. I took that off and cleaned it all.
I asked her what she used at home as a dressing and she said usually she got out of the shower and would dry it off and put toilet paper on the bottom one. She didn't know about the one on her toe. She didn't know it was there and had not seen it. She just knew her toe was red and hurting. So, I guess that explained why I was digging toilet paper out of that wound huh? GROSS!!!!
I put a wet to dry dressing on it because there weren't really dressing orders and I knew the podiatrist was doing to be seeing her in the morning and hopefully telling her what the plan was. She was really wanting to get home. She had no clue how serious this was. The xray showed definate osteomylitis. She was on 2 different antiboitics and she was going to leave the hospital, minus one toe.
I felt bad for her because she was in such deniel. She was non compliant with her diabetes. She didn't take her medicines at home, she didn't eat right, she had poor hygeine. All of this leading to the condition her foot was in now. AND. . . she was in her mid 50's!!!
About two hours after I did all the work on her foot, I went to help her to the bathroom and low and behold. . . . C-DIFF!!!! She had been on antibiotics evidentally just long enough to cause her to have C-Diff. Now not only did I have to smell the wound infection in the room. . . . I could smell the C-diff all the way to the hallway.
At the end of this shift. I was wishing we had a staff shower that we could use. I so didn't even want to get into my car or come into my house I was feeling so grimey! Poor lady, had to live in that room with that smell! And she was still going to lose her toe! AND. . .ALL cultures came back positive. She did in fact have C-Diff and MRSA!
Moral of this story~~~~
If you are diabetic, take care of yourself. Keep your sugars in control, take your medicine and pay attention to your skin. And for goodness sakes DON'T DRESS A WOUND USING TOILET PAPER!!!
**If you dont' know what C-Diff and MRSA are let me know. I will do a little more education in another post!