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“Fish Tank is not Allowed” ??!!


Fish Folk
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May, 2021 and later on I September, 2021, I was so excited to donate fish and plants to our local hospital Cancer Treatment & Oncology Center. The tank is in the patient and family waiting room. Here’s what it looked like then…

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And here is the very happy nurse who cares for cancer patients all day, every day, who 100% understands what a simple but profound joy this aquarium brings to her patients…

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So, today, she messages me quite upset:

So I have some bad news, [the hospital]  has informed us that a fish tank is not allowed in oncology waiting rooms. To say I'm heartbroken is an understatement. And even though [our hospital] has had this tank for 15 years, apparently it's a problem now. So do you know of anyone that would want to take the fish?”

What on earth happened? You and I both ask…

Apparently a hospital accreditation group called the JOINT COMMISSION  did a mock run-through with the hospital administration, and to quote the nurse,  “…they said it exposed the patients to a certain bacteria.”

Whaaaaatt???!!!

The hospital admin literally told her to tear it down by Friday. This week. A 120-gal. tank. She went to the hospital admin, who tried to raise it with the JOINT COMMISSION, but to no avail. Fish tank is not allowed.

I called my LFS Owner to ask if he had tank space. (I don’t!) He was… not happy…

Tonight I called to talk about this with an expert aquarist friend in my fish club who may or may not have worked in the CIA for many years. He had never heard of anyone ever raising this concern before.  His line was, “Sounds like they’re smoking it…”

Has anyone got a clue what in the world these people are on about? What bacteria? What published scientific studies support this decision? 

At 7:15 am Thursday morning I am meeting this nurse 75 minutes before her shift starts to catch all the fish and pull all the plants, bag them, and take them to my LFS. Now, I promised her I’d not risk getting her fired by calling the local paper, or something.

But… someone really needs to explain this. Or at least pick up after their 🐂

Edited by Fish Folk
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My daughter spent the first several months of her life in the NICU in Chicago and at the time my son was 4. The Shedd Aquarium of Chicago maintains a large Reef tank in the hospital and that was on of my sons favorite things to do during our extended stays in the hospital. SO many of the kids would gather there and it was such a source of joy. It saddens me to hear this but unfortunately makes all to much sense that some corporate rube would pull something like this. Good on you for having made this gesture in the first place and for continuing to help as much as you are. Sorry this is happening.

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I've heard many joint commission stories from various people.  My basic understanding from what I've heard is they let stuff slide for a long time and recently they've decided to be more strict.  Its also my understanding that the rules are often vague and interpretation varies.  They often also mandate either nonsensical or impractical things in some cases and it can depend on the person, how they're feeling, and what they ate for lunch that day.

 

That said, a thing that you can't sterilize in a waiting room full of possibly immunocompromised people (like someone undergoing chemo) can be, at least in theory, and maybe by the letter of the law, dangerous---even if its all in a glass and wood box.  In my work whenever we want a piece of equipment that has the potential to aerosolize liquids (the threshold for that is VERY low), it means extra paperwork and procedure.

 

This is all to say, yeah it sucks, its kind of arbitrary and they'd rather just ban something than understanding the good it does if its not directly medical.  😞

 

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Awoke at 3:00 am thinking about this still.

Did some searching.

@CT_ says it well above. Buried in this document from the CDC on page 123 is a section outlining cautions about aquariums and immuno-compromised individuals.

In a bit less rigorous, but more straightforward platform, here is a link to a statement from the CDC about potential bacterial infections associated with aquariums and their care.

I am calling another friend tomorrow about this. Expert aquarist. Works at the NIH.

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Honestly, there isn’t more practically to say about pet care by cancer patients than this here. And really, the only applicable line is:

“Ask others to clean fish tanks and cages of birds or other pets.”

Seriously, wouldn’t things be largely  solved if someone else was hired to maintenance this aquarium on a weekly basis?

Though I don’t want to be a bother to them, I’d like to hear some perspectives from @Cory who did work in an adjacent medical field before CoOp, and @Zenzo who did a a fair bit of aquarium maintenance — for some medical locations, if I recall correctly.

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You can't fight Joint Commission. If hospitals don't comply with their rules (no matter how silly) the hospital can lose their accreditation which means losing big bucks. It's not hospital leadership making this decision, but they have to enforce the rules.  I worked in a procedural area of a hospital and we would all get really nervous when it was Joint Commission time.  The last time we got "dinged" in my department was because the person doing the "pause for the cause" didn't speak loudly enough. I mean, the "pause" was done-the JCAHO people were in the next room (procedure room is sterile) and listening over a speaker,  the patient was sedated by then and everyone else in the room knew what was going on, so???? It wasn't a huge deal, but we had to promise to comply the next time around. (and they did come back to observe us...)

 

Edited by dmurray407
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On 2/17/2022 at 9:32 AM, dmurray407 said:

You can't fight Joint Commission. If hospitals don't comply with their rules (no matter how silly) the hospital can lose their accreditation which means losing big bucks. It's not hospital leadership making this decision, but they have to enforce the rules.  I worked in a procedural area of a hospital and we would all get really nervous when it was Joint Commission time.  The last time we got "dinged" in my department was because the person doing the "pause for the cause" didn't speak loudly enough. I mean, the "pause" was done-the JCAHO people were in the next room (procedure room is sterile) and listening over a speaker,  the patient was sedated by then and everyone else in the room knew what was going on, so???? It wasn't a huge deal, but we had to promise to comply the next time around.

I love cancer patients fighting for their life. And their nurses and medical staff who go the extra mile to help them.

I hate bullies. And people who yield to them without a fight. 

Edited by Fish Folk
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I've worked in nursing administration for the past few years and often assist with surveys when accrediting bodies come in. How the survey goes, what you get cited on, how severe the penalties are...almost all of it is highly subjective and almost entirely dependent on that particular surveyor's personality and pet peeves. It is maddening.  My favorite surveyor-related rule: we can no longer use tape to hang signs or flyers because of the "infection risk". 

I'm sorry this happened to the Cancer Center patients and staff. Thank you for helping them.

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On 2/17/2022 at 10:02 AM, dmurray407 said:

You can't fight JCAHO-it's their way or the highway.....

 

Thanks. I believe you. But still, I will bring this up with the NIH at 12:00 pm ET when I speak my friend,  expert aquarist, and former president of NANFA who works there. I taught in college for 12x years. Accreditation is stressful. But there should be some sort of way to report misconduct.

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On 2/17/2022 at 9:22 AM, Fish Folk said:

there should be some sort of way to report misconduct

Agree. Sometimes I think it depends on what kind of a mood they are in on the day(s) they come....In my opinion, I'm sure the fish tank did more good for the patients and families than any possible harm. If it was that big of a risk for someone, maybe they could just stay away from that area and let other people enjoy the tank. You are a nice person 🙂

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FishFolk, you raise a good point. JCAHO rules about no boxes on the floor are annoying in our setting but I can see the logic in other settings and boxes stored on the floor aren't actually benefitting anyone The fish tank does have actual benefits as anyone who has had to spend lots of time in scary medical settings can attest. So if JCAHO is gonna have the rule, they should at least suffer the hassle of hearing about it.

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There certainly are a variety of bacteria that can live in a fish tank and could potentially cause infections, particularly in immunocompromised individuals.  But they would almost certainly need to stick their hands/arms into the fish tank with broken skin (cut or scratch), or put their fingers in their mouth, or drink the water, etc, etc.  If you had an air stone, it might be more likely to aerosolize bacteria since bubbles breaking can fling bacteria into the air, but with canisters or HOB’s, that’s very unlikely.  With a full, wooden canopy like you have on that tank, it’s extremely unlikely that anything aerosolized would be an issue.  I can understand if that nurse was doing fish tank stuff, not washing her hands, and then treating patients barehanded (unlikely).  If she did the work after closing, it should be a non-issue.  If you had a company come in to do the work it should really be a non-issue.

I’m so sorry your having to deal with this.  If I was closer I would help even though I certainly don’t need another big tank, but I could find a home for it.  That’s a beautiful tank and stand/canopy.  It’s a real shame that you’re having to take it down.

Thank you for doing what you could to make patient’s lives a bit happier.  Very sad that someone had to be petty and nit-picky and make a rule like that and someone else had to be petty and nit-picky and enforce a rule like that.  The world is a better place with people like you in it, @Fish Folk.  Remember that.

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Bureaucrats do bureaucratic nonsense. They have rules for everything and if they want to get nit-picky, they can nail you for something. It's what they do. My local hospital had a similar (not as well maintained) tank in the outpatient registration area. They were made to remove it. I sometimes suspect they hire OCD germophobes who should be housed in an institution rather than judging an institution. It's just a question of time until they decide therapy dogs are too dangerous to be used in a sterile hospital setting. "You're bringing a filthy animal into the hospital? No!"

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I can understand the POV that immuno-compromised people (especially cancer patients) need to protect themselves from exposure. However, like @Mmiller2001 very accurately pointed out with the inside/outside air....there is NO way cancer patients are going HOME to sterile environments. We also should point out hospital environments are often where people pick up the nastiest of the nasties- more likely from the person sitting next to them. Likely NEVER from a fish tank in the doctor's office. When you are as sick as a cancer patient small joys like that are a welcome sight- it is a proven fact that mental state directly effects physical health- fish tanks are beautiful and peaceful and a distraction from a terrible illness. Better than a TV with the news constantly streaming through. 

I'd bet all my money they'll get complaints from the patients about it having been removed. 

Edited by xXInkedPhoenixX
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