16 Steps to Take to Reduce the Chance of a Hospital Infection

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15 STEPS YOU CAN TAKE TO REDUCE

YOUR RISK OF A HOSPITAL INFECTION

http://hospitalinfection.org/protectyourself.shtml

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Disclaimer

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 aureus and 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, " ls 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.

son, " 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 Diseases 33, 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.