- Most of us will have to go into the hospital some day.
Here are specific steps you can follow to protect yourself from deadly
hospital infections
-
- 1. Ask that hospital staff clean their hands before treating
you, and ask visitors to clean their hands too. This is the single most
important way to protect yourself in the hospital. If you're worried about
being too aggressive, just remember your life could be at stake. All caregivers
should clean their hands before treating you. Alcohol-based hand cleaners
are more effective at removing most bacteria than soap and water. Do not
hesitate to say: "Excuse me, but there's an alcohol dispenser right
there. Would you mind using that before you touch me, so I can see it?"
Don't be falsely assured by gloves. If caregivers have pulled on gloves
without cleaning their hands first, the gloves are already contaminated
before they touch you. [1]
-
- 2. Before your doctor uses a stethoscope, ask that the
diaphragm (the flat surface) be wiped with alcohol.Stethoscopes are often
contaminated with Staphylococcus aureusand other dangerous bacteria, because
caregivers seldom take the time to clean them in between patient use. [2]
-
- 3. If you need a "central line" catheter, ask
your doctor about the benefits of one that is antibiotic-impregnated or
silver-chlorhexidine coated to reduce infections.
[3]
-
- 4. If you need surgery, choose a surgeon with a low infection
rate. Surgeons know their rate of infection for various procedures. Don't
be afraid to ask for it.
-
- 5. Beginning three to five days before surgery, shower
or bathe daily with chlorhexidine soap. Various brands can be bought without
a prescription. It will help remove any dangerous bacteria you may be carrying
on your own skin [4]
-
- 6. Ask your surgeon to have you tested for methicillin-resistant
Staphylococcus aureus (MRSA) at least one week before you come into the
hospital. The test is simple, usually just a nasal swab. If you have it,
extra precautions can be taken to protect you from infection. [6]
-
- 7. Stop smoking well in advance of your surgery. Patients
who smoke are three times as likely to develop a surgical site infection
as nonsmokers, and have significantly slower recoveries and longer hospital
stays. [7]
-
- 8. On the day of your operation, remind your doctor that
you may need an antibiotic one hour before the first incision. For many
types of surgery, a pre-surgical antibiotic is the standard of care, but
it is often overlooked by busy hospital staff. [8]
-
- 9. Ask your doctor about keeping you warm during surgery.Operating
rooms are often kept cold, but for many types of surgery, patients who
are kept warm resist infection better. This can be done with special blankets,
hats and booties, and warmed IV liquids. [9]
-
- 10. Do not shave the surgical site. Razors can create
small nicks in the skin, through which bacteria can enter. If hair must
be removed before surgery, ask that clippers be used instead of a razor.
[10]
-
- 11. Avoid touching your hands to your mouth, and do not
set food or utensils on furniture or bed sheets. Germs such as "C.
Diff" can live for many days on surfaces and can cause infections
if they get into your mouth.
-
- 12. Ask your doctor about monitoring your glucose (sugar)
levels continuously during and after surgery, especially if you are having
cardiac surgery. The stress of surgery often makes glucose levels spike
erratically. When blood glucose levels are tightly controlled, heart patients
resist infection better. Continue monitoring even when you are discharged
from the hospital, because you are not fully healed yet. [12]
-
- 13. Avoid a urinary tract catheter if possible. It is
a common cause of infection. The tube allows urine to flow from your bladder
out of your body. Sometimes catheters are used when busy hospital staff
don't have time to walk patients to the bathroom. If you have a catheter,
ask your caregiver to remove it as soon as possible.
[13]
-
- 14. If you must have an IV, make sure that it's inserted
and removed under clean conditions and changed every 3 to 4 days. Your
skin should be cleaned at the site of insertion, and the person treating
you should be wearing clean gloves. Alert hospital staff immediately if
any redness appears.
-
- 15. If you are planning to have your baby by Cesarean
section, follow the steps listed above as if you were having any other
type of surgery. [14]
-
- Ideally, you would choose a hospital with a low infection
rate. Good luck getting that information. It's impossible. Many states
collect data on infections that lead to serious injury or death, but nearly
every state-with the exception of 6-has given into the hospital industry's
demands to keep the information secret. The federal Centers for Disease
Control and Prevention also collect infection data from hospitals across
the nation, but refuse to make it public. Government is too often on our
backs, instead of on our side.
-
- What's the answer? Hospital infections report cards.
Hospitals object that comparisons would be unfair because hospitals that
treat sicker patients, such as AIDS, cancer, and transplant patients who
have weakened immune systems, will have a higher infection rate. True,
but the data can be risk adjusted to make comparisons fair. What is unfair
is preventing the public from knowing which hospitals have infection epidemics.
Keeping infection rates secret may help hospitals save face, but it won't
save lives.
-
-
- [1] Studies show that, nearly three quarters
of patients' rooms are contaminated with MRSA and 69% with VRE. In one
study, 42% of gloves worn by hospital personnel who had no direct patient
contact but who touched contaminated surfaces became contaminated. Boyce
JM et al., "Environmental contamination due to methicillin-resistant
Staphylococcus aureus: possible infection control implications," Infection
Control and Hospital Epidemiology 18.9 (1997): 622-627. A Concensus Statement
by a multidisciplinary group of experts asked by the American Medical Association
to provide guidelines for infection control cautions that: "In some
cases caregivers actually go from patient to patient without changing their
gloves, apparently confusing self-protection" with patient protection.
Goldmann DA et al., "Strategies to Prevent and Control the Emergence
and Spread of Antimicrobial- Resistant Microorganism in Hospitals,"
JAMA 275.3 (1996): 234-240.
-
- [2] Routine disinfection of stethoscopes
between patients is recommended by the American Medical Association. Salgado
CD, Farr BM, "MRSA and VRE: Preventing Patient-to-Patient Spread,"
Infections in Medicine 20 (2003):194-200; Marinella MA et al., "The
stethoscope: a potential source of nosocomial infection?" Archives
of Internal Medicine,157.7 (1997): 786-90; Zachary KC et al., "Contamination
of gowns, gloves, and stethoscopes with vancomycin-resistant Enterococci,"
Infection Control and Hospital Epidemiology 22.9 (2001): 560-564; Noskin
GA et al., "Recovery of vancomycin-resistant Enterococci on fingertips
and environmental surfaces," Infection Control and Hospital Epidemiology
17.12 (1996): 770-772.
-
- [3] The Agency for Healthcare Research
and Quality recommends use of antibiotic catheters as one of its eleven
patient safety practices. Making Healthcare Safer: A Critical Analysis
of Patient Safety Practices. AHRQ Publication 01-E058, 2001. Also see:
Darouiche RO et al., "A comparison of two antimicrobial-impregnated
central venous catheters," New England Journal of Medicine 340.1 (1999):
1-8; Raad I et al., "Central venous catheters coated with Minocycline
and Rifampin for the prevention of catheter-related colonization and bloodstream
infections," Annals of Internal Medicine 127.4 (1997): 267-274.
-
- 4]The following four studies support
this suggestion : (1) Vernon MO et al., "Chlorhexidine gluconate to
cleanse patients in a medical intensive care unit," Archives of Internal
Medicine 166 (2006): 306-312. (2) Hayek LJ et al., "Preoperative whole
body disinfection - a controlled clinical study," Journal of Hospital
Infection 11, Suppl. B (1988): 15-19 This study showed that two chlorhexidine
showers reduced total infection rate by 30% and Staph aureus infections
by 50%. (3) Byrne DJ et al., "Rationalizing whole body disinfection,"
Journal of Hospital Infection 15.2 (1990): 183-187. This study shows that
a single shower does not maximize skin disinfection. The authors conclude
that three showers should be recommended. (4) Daryl S. Paulson, "Efficacy
Evaluation of a 4% Chlorhexidine Gluconate as a Full-Body Shower Wash,"
published by the Association for Practitioners in Infection Control (1993).
This study found that showering for five days with chlorhexidine yielded
maximum results for reducing bacteria on the skin, and keeping it low for
24 hours or more. "A 1 or 2 day presurgical application period is
simply too short to establish the necessary levels of residual antimicrobial
properties to be of value in reducing post-surgical infection rates."
-
- [6] Worcester S, "Hospital system
takes on MRSA," Internal Medicine News 38.19 (2005): 1-2.
-
- [7] Kurz A et al., "Perioperative
Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten
Hospitalization," New England Journal of Medicine 334.19 (1996): 1209-1215.
-
- [8] The Institute for Healthcare Improvement
guidelines for improving infection prevention state that: "Administration
of prophylactic antibiotics beginning 0 to 1 hour prior to surgical incision
decreases the risk of surgical infection. http://www.ini.org/IHI/Topics/PatientSafety/
- SurgicalSiteInfections/ImprovementStories (accessed 10-14-02).
See also: Burke JP, "Maximizing appropriate antibiotic prophylaxis
for surgical patients: an update from LDS Hospital, Salt Lake City,"
Clinical Infectious Diseases33, Suppl. 2 (2001): S78-83.
-
- [9] Ibid., the Institute for Healthcare
Improvement Guidelines for improving infection state that "surgical
patients with core temperatures greater than 36 degrees C./ 98.6 degrees
F are less likely to get an infection."
-
- [10] Ibid., the Institute for Healthcare
Improvement states that "clipping instead of shaving results in decreased
infection rates," and recommends that patients be told "not to
shave the surgical site for 72 hours prior to surgery."
-
- [12] Pittsburgh Regional Healthcare Initiative,
"PHRI Executive Summary," (June, 2005).
-
- [13] Urinary tract infections are the
most common hospital-acquired infections. Limiting the use and duration
of urinary tract catheters reduces risk of infection. See: Puri J et al.,
"Catheter Associated Urinary Tract Infections in Neurology and Neurosurgical
Units," Journal of Infection 44.3 (2002): 171-175; Stephan F et al.,
"Reduction of Urinary tract infection and antibiotic use after surgery:
a controlled, prospective, before-after intervention study,"Clinical
Infectious Diseases 24 (2006): 1544-1551.
-
- [14] Killian CA et al., "Risk Factors
for Surgical-Site Infections Following Cesarean Section," Infection
Control and Hospital Epidemiology 22.10 (2001): 613-7.
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