How to Avoid Hospital-Acquired Infections

1
Steps for Prevention

Nurses station
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Hospitals are dangerous places to be for several reasons. First, the only patients hospitalized are those who are very sick, those who need surgery that can't be performed in an outpatient facility, or those who have severe injuries. In all cases, these patients are at grave risk for acquiring infections, called "nosocomial" infections, because their immunity is compromised, or because they have open wounds. The only way to protect oneself or a loved one from being infected is to know how to prevent hospital infections.

According to the CDC, about 1.7 million Americans are infected in hospitals every year. Most are immunocompromised. Almost 100,000 of them die. Most of these infections are preventable. Your goal as a hospital patient will be to avoid being a hospital infection statistic.

While it is impossible to prevent every nosocomial infection, here are some steps you can take to attempt to keep yourself or your loved one from acquiring an infection while in the hospital:

  1. Know how hospital infections spread.
  2. Choose the cleanest hospital for your care or treatment.
  3. Choose a doctor with a lower infection rate.
  4. Prepare ahead of time for your hospital stay.
  5. Insist on hand washing.
  6. Prevent the spread of germs from unsafe surfaces.
  7. Insist catheters be removed or replaced as soon as possible.
  8. Plan for times you can't advocate for yourself.

2
Know How Hospital Infections Spread

Infections spread both by touch and through the air. Healthy people can usually fend them off, or may get only mildly sick from them. But someone with a compromised immune system or an open wound will be at risk for getting very sick or even dying from an infection. It's wise for us to understand how these infections spread:

Touch: Every surface in a hospital is suspect for carrying infection germs. From the telephone, to the TV remote, to the doctors' stethoscope, to the catheters used in patients, to bed linens, bed rails, bathrooms, and door handles—to people—everything.

Included in the touch category would be infections that are introduced through tools and devices like surgical instruments or catheters.

Airborne: Some infection germs may be airborne through coughing or sneezing. A roommate with pneumonia can transfer pathogens to the other roommate. A patient with an upper-respiratory infection may be pacing the halls, walking off anesthesia, and cough or sneeze germs to another patient.

Many of the infections that spread in hospitals are old and familiar. You've heard terms like "staph infection" or pneumonia. They are just two of an entire host of hospital acquired infections. Others you may, or may not have heard of. All these infections can be deadly:

  • MRSA
  • C.Diff.
  • VRE
  • CRKP
  • Necrotizing fasciitis (pronouncing fas-she-eye-tis), also known as flesh-eating bacteria
  • Central line infections are not a specific germ, but a method of transfer
  • You may also have heard the terms "sepsis" or "septicemia"—blood transfer of infections​

3
Choose the Cleanest Hospital for Your Care or Treatment

Granted, we don't always have the luxury of choosing a hospital. In an emergency, you may not be able to speak for yourself. If you get sick while you are out of town, you probably won't know anything about the hospitals in that location. But if possible, and certainly if you are at home and know you may need to be hospitalized at some point, it's wise to intentionally choose which hospital is the cleanest.

Do some research to choose the best hospital for you. Learn what you can about a hospital's infection track record and choose the one that has the lowest infection rate. You may want to discuss this with your doctor, too.​

However, keep in mind that your doctor may or may not have admission rights at the hospital you think is best. If he or she cannot admit you to your choice of hospital, you'll have to decide if you want to change doctors.

If your insurance allows it, or if you can afford it, ask for a private room. Having a room to yourself will reduce the chance you will be infected by another patient.

One other caveat: There are certain times of the year that are more dangerous than others, increasing the opportunities for patients to acquire infections. Learn when those times are, and how to avoid them.

4
Choose a Doctor With a Lower Infection Rate

Once you know which hospital is the cleanest, then ask which doctors of the specialty you need, have admitting privileges at that hospital. Do some background research to choose the right doctor for you.

Prior to your hospital admission, work with your doctor to set the stage for reducing your risk of infection. She may recommend a special soap, called chlorhexidine soap, be used each time you shower for a week before admission. She may give you a prescription to begin taking antibiotics a day or two prior to your surgery. She may tell you to stop smoking, too, because studies have shown a correlation between smoking and higher infection rates.

5
Prepare Ahead of Time for Your Hospital Stay

Understanding how infections spread, you can prepare ahead of time by packing some items that will help you fend off those germs.

Must-have items include:

  1. Antiseptic wipes and sprays will help you kill germs on surfaces. Don't be afraid to wipe down everything you or your patient-loved-one will touch, or be touched by. Telephones, TV remotes, bedside tables, bed rails, bathroom surfaces, bathroom door handles, chairs and others. Spray pillows and bed linens. The most effective wipes and sprays contain bleach which is necessary to kill some of the most dangerous germs.
     
  2. Make yourself a sign using neon posterboard and a permanent marker that says "PLEASE WASH YOUR HANDS before touching me." Then hang it in a prominent place in your hospital room, preferably just above your head so every caregiver will see it.
     
  3. A germ-filtering mask might come in handy if your roommate begins coughing. Find masks at your local pharmacy. Be sure they are the germ-filtering kind and don't let someone else open the package if they haven't already washed their hands.

6
Insist on Hand Washing

Insist that anyone who will touch you, or will touch something you will touch, washes his or her hands for at least 30-seconds using soap and water.

All providers know they are supposed to wash their hands, but they don't always do it. They have excuses galore! If you call them out, they may be momentarily embarrassed, but let them be. They know better.

If you don't see them wash their hands, then politely, but assertively, ask them to do so. Do not accept the excuse that they washed their hands before coming into the room. Don't accept their simple use of hand sanitizer, or even worse, gloves. Sanitizer isn't enough. And gloves protect them, but not you, the patient.

Yes, it's sometimes difficult to ask, because we think it's not polite, or we're fearful of retribution. (I call this "the waiter will spit in my soup" syndrome, where we are afraid that the doctor or nurse will do something bad or gross or dangerous, and we won't know about it.)

Here are some ways to politely ask doctors to wash their hands with a minimum of embarrassment or discomfort for you both.

7
Prevent the Spread of Germs From Unsafe Surfaces

Ask providers to wipe anything that will touch you with antiseptic wipes before it touches you. There are dozens of surfaces intended to be part of your care, that germs can reside on, making them unsafe. The doctor's or nurse's stethoscope can carry germs, as can a new IV bag or catheters that need to be inserted.

Other hospital personnel may come in to your room and carry germs with them, too, despite their best intentions. The cleaning staff, the food delivery people, maintenance staff - just be on alert so anytime something in your room is touched by someone else, it needs to be wiped or sprayed with your sanitizer when they are finished.

8
Make Sure Visitors Don't Infect You

Visitors can be a great help when it comes to showing you how much they care for you. The last thing a visitor would ever intend to do would be to give you an infection.

Be sure that anyone who visits you, including your advocate, keeps his or her hands washed before touching you. Ask them to wash their hands, ask them not to kiss you (the best intentions can be dangerous to a patient!), even ask them not to sit on your bed or touch your bed rails.

Here is a good list of guidelines to give to your visitors before they come to see you. Providing these instructions to visitors ahead of time will help them understand how serious these infections can be.

9
Insist Catheters Be Removed or Replaced ASAP

Catheters are like an engraved invitation to a germ! Inserted into a nice, warm, human body, a catheter too easily introduces germs like staph (MRSA) which then spread quickly throughout the body.

Stringent sanitary steps must be taken when catheters are first inserted. Then, the areas around where the catheter is inserted should be kept clean to keep infectious germs from using the catheter as the fast track into a patient's body.

Catheters are often a necessary part of effective care, but they must regularly be removed or replaced to reduce the chance of spreading germs.

10
Plan for Times You Can't Advocate for Yourself

If you are the patient, then you know there are times you will be asleep, or knocked out with anesthesia or painkillers. You need someone to sit by your side in the hospital for those times you can't advocate for yourself.

Arrange ahead of time for someone to sit by your side 24/7, not just during visiting hours. Choose someone who will be assertive enough to insist on safety. Provide them with instruction (this article is a good start) on how to go to bat for you. Be sure they understand, too, the other hospital safety problems that exist like drug errors or patient misidentification since infections are not the only safety problems in hospitals.

If you don't have a loved one or neighbor who can assertively perform these protective duties for you, then consider hiring a professional patient advocate.

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