A couple of weeks ago, I was working in the ICU and I had a patient who was in isolation for MRSA of the blood. I was in the room with the patient, in my isolation gown with gloves on, etc, and the doctor came to evaluate the patient that particular night. He walked in the room, without gloves, without an isolation gown, was leaning against the patients bed and talking with the patient for about 10 minutes. I watched as he left the room, amazed, because as he walked out, he did NOT wash his hands or use the sterile hand sanitizer that is at the outside of every door. When I tried to speak to him about it, he became very defensive, and left the unit. Appalling, yes, but folks, it happens ALL THE TIME! This article is about Hospital Acquired Infections, and what you can do to help prevent them!
A Hospital Acquired Infection (HIA for the purpose of this article) is defined by the World Health Organization (WHO) as:
- an infection acquired in the hospital by a patient who was admitted for a reason other than that infection.
- an infection occurring in a patient in a hospital or other health care facility that was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge and also occupational infections among staff of the facility.
HAI's occur throughout the world and impact both developed and resource-poor countries.
HIA's are one of the major causes of death and increased morbidity among patients admitted to the hospital. Additionally, they increase disability and emotional distress of patients and may lead to even more disabling conditions, which can impact quality of life. They increase the overall length of stay for patients, causing health care costs as a whole to rise exponentially. This is due to an increase in the use of drugs and the increased necessity for isolation equipment and further laboratory tests or other diagnostic studies.
Contributing factors to Hospital Acquired infections are the advanced age of patients admitted to the hospital, the greater prevalence of chronic disease among them and the ever-increasing use of invasive procedures that weaken the defenses of the patient.
It is also important to bear in mind that organisms acquired in the hospital can be transmitted throughout the community through discharged patients, visitors and staff. When these organisms are multi resistant, this can cause significant disease in the community, as well.
Prevention
According to the Center for Disease Control (CDC), the 4 most common HAI are
- Urinary Tract Infections (UTI) 32%
- Surgical Wound Infections 22%
- Pneumonia 15%
- Bloodstream 14%
Each of these are associated with some sort of invasive procedure.
UTI's are associated with the use of foley catheters. This is a device that is put into the patients urethra to drain the bladder of urine. Many times, this is necessary, but hospitals tend to leave them in too long and do not change them often enough if the patient is admitted long-term. Recommended length of time before changing a foley catheter is about 3 weeks in most facilities. Sterile technique should always be used when inserting. If the catheter does not go in right the first time, a new catheter should be inserted, never inserting a device that has been contaminated by placing it in the wrong spot, and believe me, this does happen.
Surgical Wound Infections can occur in the operating room from improper surgical technique or at the bedside from not using aseptic technique during dressing changes or wound care. Surgical wound infections can also be related to extended pre-operative stay and improper skin preparation. It is always recommended that a patient shower preoperatively with an antimicrobial skin prep such as Hibbaclens to reduce the amount of bacteria on the skin during surgery.
Pneumonia is often associated with the use of ventilators that assist the patient with breathing. Improper suctioning technique can be a contributing factor to HAI as is the length of time the patient spends on the ventilator. Keeping the patients head of bed upright at 30-45 degrees has also been shown to reduce infections.
Bloodstream infections can be caused by asterile techniques of IV catheters or central lines at the time of insertion. Peripheral IV catheters should be removed and sites changed according to the hospital policy, usually every 72 hours. Central Lines stay in much longer, but the dressing needs to be changed every week, and sterile technique should be used when changing the dressing, including wearing a mask. If it appears that an IV site or Central Line site is infected, it should immediately be removed and evaluated.
What Can You Do?
Obviously, you cannot be at the bedside of your loved one 24 hours a day. But there are some things while you are visiting the patient that you can do to prevent the spread of HAI.
- WASH YOUR HANDS BEFORE AND AFTER YOU TOUCH THE PATIENT. WASH YOUR HANDS BEFORE AND AFTER YOU PUT GLOVES ON. I put this in capitol letters because HAND WASHING IS THE NUMBER ONE DEFENSE AGAINST INFECTION! Not only should you wash your own hands, but make sure all visitors and staff do so as well. This includes doctors and nurses. If you see a doctor or nurse not washing their hands, it is not improper to advise them to do so. If they refuse, tell the hospital manager. This is your loved one we are talking about and you must be their advocate.
- Make sure you wear isolation equipment provided by the hospital. Make sure all visitors wear it as well as staff. If you see staff entering the room without it, kindly advise them to put it on. If they continue, then notify hospital management. When you remove the isolation equipment, WASH YOUR HANDS AGAIN!
- Become an advocate for shorter hospital stays for yourself and your loved ones. This means you may have to look into home health upon discharge, but longer hospital stays increase the chance of developing HAI therefore it is better that the patient recover at home.
- Become an advocate of minimal use and early removal of invasive devices, ie. Foley Catheters, ventilators, central lines, etc.
- Become an advocate for prudent use of antibiotics and antimicrobials. Make sure if the patient does go home on antibiotics that the ENTIRE dose is taken as directed, even if they feel better. Resistance to medication can occur if the course of antibiotics are not complete.
It is hopeful that these tips can help you shorten the stay of you or your loved one in the hospital and ultimately reduce the incidence of HAIs in the long run for your family and your community. For more information on HAI, please visit the WHO or the CDC.
