Up Close 
RID’s 14 steps to reduce hospital infection risk
Although the Joint Commission on Accreditation of
Healthcare Organizations may have its "Speak Up" Safety Initiatives, one
of which is "Three Things You Can Do To Prevent Infection" (e.g., clean
your hands, cover your mouth and nose and avoid close contact), the
Committee to Reduce Infection Deaths (RID) adds a bit more depth to its
recommendations – including 11 more.
So that you’re prepared from a financial and
operational angle, and your organization’s doctors and nurses are
prepared from a clinical angle, here’s what RID urges patients to do
once they enter into a healthcare facility.
1. Ask that hospital staff clean
their hands before treating you.
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.52 Do not hesitate to say the following to your doctor or
caregiver: "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. Gloves more often protect staff than
patients. If caregivers have pulled on gloves without cleaning their
hands first, the gloves are already contaminated before they touch
you.53
2. Before your doctor uses a
stethoscope to listen to your chest, ask that the diaphragm (or flat
surface of the stethoscope) be wiped with alcohol.
Numerous studies show that stethoscopes are
often contaminated with Staphylococcus aureus and other dangerous
bacteria, because caregivers seldom take the time to clean them in
between patient use.54 The American Medical Association recommends that
stethoscopes routinely be cleaned for each patient. The same precautions
should be taken for many other commonly used pieces of equipment too.
3. Ask visitors to clean their
hands and avoid sitting on your bed.55
4. If you need surgery, choose a
surgeon with a low infection rate.
Surgeons know their rate of infection for
various procedures. Ask for it. If they won’t tell you, consider
choosing another surgeon. You should be able to compare hospital
infection rates too, but that information is almost impossible to get.
That is why RID is working hard for hospital infection report cards in
every state.
5. Beginning one week before
surgery, shower frequently with Chlorhexidine soap.
Various brands can be found at drug stores.
This will help remove any dangerous bacteria you may be carrying on your
own skin.
6. Ask your surgeon to have you
tested for Staphylococcus aureus at least one week before you
come into the hospital. The test
is simple, usually just a nasal swab. About one third of people carry
Staphylococcus aureus on their skin, and if you are one of them,
extra precautions can be taken to protect you from infection, to give
you the correct antibiotic during surgery, and to prevent you from
transmitting bacteria to others.
7. 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.56
8. Ask your doctor about keeping
you warm during surgery.
Operating rooms are often kept cold for the comfort of the staff, but
research shows that for many types of surgery, patients who are kept
warm resist infection better.57 There are many ways to keep patients
warm, including special blankets, hats and booties, and warmed IV
liquids.
9. 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.58
10. Ask that your surgeon limit
the number of personnel (including medical students) in the operating
room. Every increase in
the number of people adds to your risk of infection.59
11. 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. New
research shows that when blood glucose levels are tightly controlled to
stay between 80–110 mg/unit, heart patients resist infection better.
Continue monitoring even when you are discharged from the hospital,
because you are not fully healed yet.60
12. 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. Ask for
a diaper or bed pan instead. They’re safer.61
13. If you must have an IV, make
sure that it is inserted and removed under clean conditions and changed
every 3 to 4 days.
Intravenous catheters, or IVs, are a common source of infection and are
not always necessary. If you need one, insist that it be inserted and
removed under clean conditions, which means that your skin is cleaned at
the site of insertion, and the person treating you is wearing clean
gloves. Alert hospital staff immediately if any redness appears.
14. If you are planning to have
your baby by Cesarean section,
take the steps listed above as if you were having any other type of
surgery.
HPN
References:
52. Vincent JL, Bihari DJ, Suter PM, et al. The
prevalence of nosocomial 380 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
May 2003 infection in intensive care units in Europe: results of the
European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC
International Advisory Committee. JAMA 1995;274:639-644.
53. Cars O, Molstad S, Melander A. Variation in
antibiotic use in the European Union. Lancet 2001;357:1851-1853.
54. Frank MO, Batteiger BE, Sorensen SJ, et al.
Decrease in expenditures and selected nosocomial infections following
implementation of an antimicrobial-prescribing improvement program.
Clinical Performance and Quality Healthcare 1997;5:180-188.
55. Fukatsu K, Saito HK, Matsuda T, Ikeda S, Furukawa
S, Muto T. Influences of type and duration of antimicrobial prophylaxis
on an outbreak of methicillin-resistant Staphylococcus aureus and
on the incidence of wound infection. Arch Surg
1997;132:1320-1325.
56. Batteiger BE. Personal communication.
Indianapolis: Indiana University; 2001.
57. Back NA, Linnemann CC Jr, Staneck JL, Kotagal UR.
Control of methicillin-resistant Staphylococcus aureus in a
neonatal intensive-care unit: use of intensive microbiologic
surveillance and mupirocin. Infect Control Hosp Epidemiol
1996;17:227-231.
58. Barrett FF, McGehee RF, Finland M. Methicillin-resistant
Staphylococcus aureus at Boston City Hospital. N Engl J Med
1968;279:441-448.
59. Boyce JM. Are the epidemiology and microbiology
of methicillin-resistant Staphylococcusaureus changing? JAMA
1998;279:623-624.
60. Brumfitt W, Hamilton-Miller J. Methicillin-resistant
Staphylococcus aureus. N Engl J Med 1989;320:1188-1196.
61. Naimi TS, LeDell KH, Boxrud D, et al.
Epidemiology and clonality of community-acquired methicillin-resistant
Staphylococcus aureus in Minnesota, 1996-1998. Clin Infect Dis
2001;33:990-996.
Source: "Unnecessary Deaths: The Human and Financial
Costs of Hospital Infections," by Betsy McCaughey, Ph.D., chairman,
Committee to Reduce Infection Deaths, 2005
For more information on RID, visit the organization’s
Web site at www.hospitalinfection.org. |
