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. All caregivers should clean their
hands before treating you. About two-thirds of medical staff were
unaware they should clean their hands with soap and water, because
alcohol sanitizers don't kill this superbug.
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.
These "15 Steps" are available in a color brochure.
For purchase information or to place your order, please contact:
jon@hospitalinfection.org
[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 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.
