Thursday, August 28, 2008

Hospital Infections - Take Charge

Hospital acquired infections are a serious problem that the quality improvement movement is shining a light on. Each year 2 million Americans acquire an infection while hospitalized. We used to accept these rates as just unfortunate events.

From methacillin resistant staph (MRSA) to Clostridium difficile (C. diff), we now know that these infections can be prevented through rigorous precautions and awareness. Here are 12 steps you can take to reduce your risk of hospital infections.

1. Ask hospital staff and visitors (very important!) to wash their hands before treating you.
Alcohol based hand cleaners should be at every bedside. Make sure it is used.

2. Make sure the Doctor or nurse wipes the stethoscope with alcohol before examining you.

3. Ask your surgeon about his/her infection rate. He should know the answer for the
procedure being performed.

4. Beginning 3-5 days before surgery, shower or bathe daily with chlorhexidine soap. You can
buy it over the counter.

5. Ask your surgeon to have you tested for MRSA one week before your surgery. It is a
simple test with a nasal swab.

6. Stop smoking well in advance of surgery. Smokers are 3X as likely to develop surgical site infections.

7. Remind your doctor that you may need an antibiotic one hour before the first incision. (this depends upon the type of surgery but is a critical time period)

8. Do not shave the surgical site. Razors can cause small nicks in the skin and allow infection.

9. Avoid putting food or utensils on furniture or hospital bed sheets.

10. Ask your doctor about monitoring your glucose levels continuously during and after
surgery, especially cardiac surgery. Tight glucose control helps patients resist infection.

11. If possible avoid a urinary tract catheter. (This is not always possible but be aware)

12. Make sure your IV is inserted under clean conditions and changed every 3-4 days.

Infection control is every one's responsibility. I know it is hard to question a caregiver when you are the patient, but these infections are absolutely preventable and we can't afford to make excuses for not doing the right thing. The evidence is clear. Now we need to make sure everyone adheres to them.


Anonymous said...

Thanks for your valuable excellent suggestions!!

Different then infections, but also very important is to make sure allergies to madications or other things are told and written on your chart in the hopital as well as to your doctor. I recently saw a case where it was told to the ER at the hospital but omitted from the list on their report.

Anonymous said...

This is a random statement, but is a response to the poll on your website (the author's). I think the only time doctors should be required to care for all patients is if the government subsides medical school costs. It doesn't seem fair for students to graduate with $100,000 in debt and then have to care for all patients regardless of if they will be compensated or not. In the ideal world, all doctors would like to help everyone. But in the ideal world, people wouldn't have so much debt it influences their career choices either.

Toni Brayer MD said...

Anon #2: The poll you are referring to related to the California Supreme Court decision that does not allow doctors who provide a certain service (in this case in-vitro fertilization) to discriminate on the basis of race, gender or sexual preference. In this case they refused to perform in-vitro pregnancy services for gay women. The Supreme Court ruled against the doctors on the basis of discrimination.

There is no requirement that physicians treat all patients and this case did not relate to compensation at all.

I agree with you about the debt burden and freedom of choice for everyone...including physicians.

CountryMidwife said...

Hi Doc, can we pass on this good info, giving you and the blog credit of course? Thank you!

Toni Brayer MD said...

Countrymidwife: Thanks and of course. Good info should be shared freely for the benefit of all.

Quiact said...

Sometimes, death is a good thing- for a vicious multicellular organism.
There are a variety of different types of bacterial infections one can get from many different sources, yet some are more common than others. If bacteria are not beneficial for your health, as many bacteria are, the rest should die in order to restore your health.
Bacteria are a simple life form, yet are incredibly productive and efficient. As with other life forms, they exist to reproduce, and does so about every hour. Bacteria mutate, evolve, and adapt according to the enviornment in which they exist. To do this, it fully utilizes all available resources and energy to develop the protein that is essential for its survival in their enviornment. Bacteria need exactly 7 genes to produce the essential ribosomes for their existence. Any more or less genes than 7, the bacteria is not maximizing its efficiency to survive and reproduce. Amazing.
Strept infections are caused by what are called gram positive bacteria, and they are the most common bacteria that infect other humans. . Group A strep infections can cause diseases such as strep throat and pneumonia. Also, staph bacterial infections are gram positive as well that potentially infect humans, and do so often.
Of all pathogenic, or disease-causing bacteria that exist, it is the MRSA, the methicillin resistant staff aureus bacteria, that are most concerning to health care providers in particular. This is because MRSA bacterial infections are the most difficult to cure when a patient suffers from their damage from being infected by these bacteria. Another difficult situation is when a patient is infected by VRE, Vancomycin Resistant Enterococci, which is another type of gram positive bacteria that exist.
These MRSA and VRE bacteria are difficult to eradicate due to the fact that most antibiotics that are available to rid the patient of other bacterial infections, MRSA and VRE are resistant to the effectiveness of these antibiotics. MRSA and VRE infected patients are quite challenging for the health care provider who is attempting to cure patients infected with these particular bacterial infections.
In many situations, pathogenic bacteria infect a patient already within a medical institution for another disease. When this occurs, it is called a nosocomial infection.
Greater than 5 percent of nosocomial infections are determined to be MRSA infections, it has been reported. As a result, there are about 100,000 serious hospital infections, as well as about 20,000 deaths from MRSA infections annually.
Since there are several types of pathogenic bacteria that exist, a diagnostic test called a culture and sensitivity is usually performed at a clinical laboratory to assure the correct antibiotic is selected for treatment, as the bacteria are identified with this diagnostic method.
Typically, fluid from the area suspected of being infected is obtained from the patient suspected to have an infection and smeared on what is called a petrie dish. And then these dishes are incubated for 2 to 3 days. Gram positive bacteria stain during this process a dark violet or blue. Gram negative bacteria would be pink in color, and are capable of harm as well to a human being.
When the culture is complete, technology that is available offers recommendations on the appropriate class or brand of antibiotic to treat the pathogenic bacteria present in another person- presuming the bacteria will not be resistant to the antibiotic recommended, as this happens on occasion.
Usually, classes of antibiotics that are used to treat gram positive strep infections that are not VRE or MRSA bacteria are cephalosporins, macrolides, or general penicillins. If the microbe that is causing the infection is resistant to the antibiotic from such classes that are administered to the infected patient, other options should be considered for anti-microbal therapy.
With two very powerful antibiotics in particular, which are methicillin and vancomycin, their frequent use in infected patients has resulted in VRE and MRSA bacteria that are now resistant to these antibiotics. When a patient is infected with VRE or MRSA bacteria, other selections for antimicrobial therapy that provide more efficacy should be selected for a patient infected with these types of infections. Such brands and types of antibiotics for MRSA and VRE bacteria include Zyvox, which has both IV and oral dosage options, and an antibiotic called Cubicin.
However these antibiotics for antibiotic resistant bacteria are given usually due to infections that have progressed to a more serious nature within a patient infected in such a way, so a cure is not immediate when these antibiotics are selected for such patients.
Progressive medical conditions with such infected patients include sepsis, or blood infection, osteomyelitis, or bone infection, as well as peumonia, which is a serious lung infection. A hospital stay is normally required with such patients infected with MRSA and VRE infections that cause such diseases. This is because when the antibiotics that potentially cure the patient of these microbes are selected, they are usually given via IV administration, and are administered normally for several days, if not several weeks.
There are numerous classes and types of antibiotics available, yet bacterial resistance to most of these antibiotics, with the exception of the two mentioned earlier, constantly remain a serious concern for the health care provider, and the MRSA and VRE infected patient. With MRSA at the top of the list of concerns for the health care providers, this infection continue to occur progressively, which amplifies the concerns of others.
Medical institutions should possibly consider quarantine for those patients at their locations that have been determined to be infected with the MRSA and VRE bacteria more often then they do at this time.
Dan Abshear

generic viagra said...

This very interesting subject!

Indian Surgical Industries said...

delhi/india based manufacturer and supplier of hospital/medical furniture and provide laboratory furniture, lab furniture, hydraulic tables, Semi- Fowler Bed, Baby Cots, hospital beds (electric hospital bed),Dressing Trolley, Instrument Trolley etc

Max said...

Leading supplier of best quality and cost effectiveinstrument trolley and ward bed. Examination light suppliers in Delhi India.

Max said...

Leading supplier of best quality and cost effectiveinstrument trolley and ward bed. Examination light suppliers in Delhi India.

Max said...

Leading supplier of best quality and cost effectiveinstrument trolley and ward bed. Examination light suppliers in Delhi India.

Indian Surgical Industries said...

Hospital Furniture manufacturer and supplier in delhi, India- Hydraulic Tables, Semi- Fowler Bed, Baby Cot furniture, Hospital/Medical Beds(electric hospital bed, hydraulic bed), Dressing Trolley, Instrument Trolley. wholesale supply in all delhi NCR (Noida, Ghaziabad, Faridabad and Gurgaon).

Max said...

Max Star Medical offers quality hospital furniture, examination table, operation table, and fowler bed.

Invertir en oro said...

I think it's important that we all know a little about this subject so interesting, I think it's part of human culture tell us about such things.
Invertir en petroleo