The Center for Disease Control and Prevention estimates that two million people a year contract nosocomial (hospital-acquired) infections. In 1993, I was one of those patients after I found myself in the hospital with an intestinal blockage and the need for emergency surgery. As a seasoned surgery veteran and a licensed nurse, which included a mandatory rotation through the O.R., I thought it odd that the operating room was extremely warm in temperature.
A warm O.R. coupled with my weakened immune system from the immuosuppressant medication I was taking for my Crohn’s Disease made me a prime candidate for contracting an infection. Within hours after the surgery, my temperature spiked. Luckily, they caught the infection early and promptly started me on an intravenous course of antibiotics, while my six-inch long, three-inch deep incision was re-opened and packed three times a day with antibiotic soaked gauze. What should have been a five to seven day hospital stay lasted a month. When I’d regained a bit more of my mental faculties, one of the nurses and my husband both informed me of how close to death I’d come.
It’s estimated that 90,000 out of the 2 million die each year from their infections. That’s more deaths than from homicides and auto accidents combined. 1.9 million contract nosocomial infections that do not result in death, but the infections extend hospital stays one to thirty days longer. All in all, around 5-10% of hospital patients will contract hospital-acquired infections each year.
The most common nosocomial infections are septicemia, respiratory tract infections and staph infections. These infections usually begin at, but are not limited to, urinary catheters, intravenous cannulas, and surgical incisions.
The healthcare community is taught to practice Universal Precautions. These precautions state, in general, that every bodily fluid be handled as if it were contaminated. That means nurses, nurse’s aids, orderlies, and technicians should wear gloves when accepting, transporting, or cleaning blood, urine, mucous, emesis (vomit), and feces. One of the most important and easiest aspects of Universal Precautions is vigilant hand washing. Hospitals can decrease infection rates by up to 70% using this simple technique, yet a recent study shows that good hand washing practices happened less than 50% of the time.
Along with infected patients and those with weakened immune systems, hospitals often, unwittingly, play into the spread of infection. Many hospitals are understaffed, especially at night, and on weekends and holidays. This could mean that a nurse is forced to work even if she herself is sick. Also, understaffing places a strain on nurses who must then manage more patients and may be less likely, due to time constraints, to consciously follow strict hand washing guidelines.
With a basic knowledge of how hospital-acquired infections manifest and are spread, patients can decrease their chances of contracting an infection.
First and foremost, insist on clean hands. In each room there is a sink and antiseptic soap available for staff to wash when entering and before leaving. Before any staff member touches a patient, she should wash her hands.
Make sure the nurse handles bodily fluids (including bedpan and emesis dish), starts an I.V. or gives an injection wearing gloves.
She should promptly deposit used needles and cannulas in the box provided in each room. Under no circumstances, should they be carried out of the room.
If the patient has a urinary catheter, the staff emptying the bag at the end of each shift should use a receptacle assigned to that patient. One of the most common ways to spread infection is when staff carries one receptacle from catheter to catheter. The receptacle should never be left on the floor, as that’s where bacteria and germs are most prevalent.
Urinary catheters are inserted into the bladder. The tubing closest to the body can slide in and out of the bladder with movement, causing irritation and moving external bacteria in. That part of the catheter should be cleaned once a day and kept dry. Ideally, catheters should be removed about 48 hours after surgery. If the catheter remains longer, ask the nurse or doctor if there is a specific reason for doing so. Also, if there is urinary discomfort, inform the nurse, as it may be a sign the catheter is blocked.
Many newer hospitals have single patient rooms only, but if not and if possible, patients should opt for a private room. Sharing a room with another patient increases the risk of infection.
If the patient detects redness coupled with pain around an I.V. or incision site, he should notify the nurse immediately. A red line running the length of a vein means the I.V. should promptly be removed. These sites should be inspected once a day, if not once a shift.
If for some reason, the patient does catch a staphylococcal septicemia from an infected I.V. or incision wound, guidelines suggest a ten to fourteen day intravenous course of anti-microbial agents. Additionally, patients should also discuss with their doctors the need for an electrocardiogram so that possible damage to the heart can be assessed.
Smoking and diabetes can suppress immune systems. Smokers should quit several days before entering the hospital, and diabetics should make sure their blood sugar stays at a stable and consistent level. This is especially important if being admitted for surgery.
Overuse of antibiotics causes resistant strains of bacteria, however, if a patient’s immune system is suppressed, he should discuss with the doctor whether a preventative antibiotic course is needed before or after surgery.
While operating rooms should be chilly, surgical patients should not. A cold and shivering body can impair the immune system and inhibit blood flow. Operating room staff should place heated blankets over the patient to warm the body before surgery begins.
The best defense is an offense. Studies have shown that the sooner a patient gets mobile after surgery the more he decreases post-operative complications and the sooner he recovers. Walking after surgery decreases the chance of dangerous blood clots in the legs and lungs (thrombosis). If a staff member is not available, a family member or friend can assist the patient out of bed and as he walks. Post-operative falls are common, so patients should never attempt getting out of bed or walking without assistance. If for some reason, the patient is unable to get mobile, he may request “pneumatic” stockings or thrombosis cuffs to help prevent blood clots in the legs.
Patients should also adjust their position in bed at least every two hours. This prevents the formation of bedsores which increases chances of infection.
Likewise, patients should perform coughing and deep breathing exercises as soon as possible post-op. Initially, the exercises are painful, but they are crucial to the patient’s speedy recovery. To decrease soreness during these exercises, a pillow may be pressed against the incision site for support. Coughing and deep breathing exercises keeps fluids from resting in the lungs, a common side effect from anesthesia and immobility and they should be performed at least once, if not twice day. Not doing these exercises will increase the probability of pneumonia in the patient.
Along with either a sponge bath, or if mobile enough, a shower, a patient’s bed linens and gown should be changed once a day. Not doing so, will increase risk of infections.
Patients should not complain too often or too aggressively. This will only alienate staff. However, every patient should expect timely answers to reasonable inquiries or concerns. If the patient feels he’s not getting the feedback he needs, he can ask to speak to the hospital’s patient advocate.
Patients should have a trusted family member or friend available to ask questions or voice concerns should the patient not be able to due to illness or medication.
A patient should always feel comfortable enough to ask what medicines are being given and why. Communicating with the doctor on a patient’s course of treatment will help eliminate medication errors and unnecessary tests.
Insurance companies often set target release dates for specific illnesses, surgeries, and treatments. If a patient still does not feel well at the end of that time, let the doctor know and insist on staying until feeling better. Keep in mind, any illness or surgery will deplete a person’s energy, but the patient should notice some improvement each day.
When released home after a hospital stay, the patient should pay close attention to their temperature and/or incision site for the next week. If either changes, notify the doctor immediately, and/or return to the E.R. if necessary.
Keeping this information in mind when entering the hospital will help decrease the chance of medical errors and hospital-acquired infections. No longer can we count on under-staffed and under-paid hospital professionals to micro-manage every aspect of our daily care. With knowledge comes reassurance and every patient is his own best advocate for a safe and complication-free hospital stay.