How to Avoid Deadly Hospital Infections

Every year, about two million Americans enter the hospital for treatment and develop a nosocomial infection, the name given to an infection that develops as a result of a stay in the hospital. These infections are often caused by a patient's exposure to unclean medical devices and instruments and by infections that develop after surgery at the incision site... but can also be transmitted to you by doctors, nurses or other hospital personnel who examine or treat you without washing their hands first. About 90,000 people a year, many of them older adults and individuals with weak immune systems, die from a hospital-acquired infection. Imagine the pain these families suffer, thanks to these avoidable deaths. How can you and your loved ones avoid being a statistic?

THE PROBLEM HAS GOTTEN WORSE NOT BETTER

 Although hospital administrators have long been aware of the problem, the hospital-acquired infection situation has gotten worse over the last 30 years, Charles B. Inlander, founder of the People's Medical Society, a consumer health advocacy organization, told me, "With more procedures being performed in doctors' offices and other outpatient settings, people entering the hospital often have more serious conditions and more compromised immune systems, making them more vulnerable to infection. And with more invasive equipment being used today, such as open-ended catheters, intubation tubes and colostomy bags, there are more routes for these pathogens to enter. Unfortunately, there has been no real improvement beyond the use of preventive and very basic techniques, such as hand washing, removing scrubs when leaving high-risk areas and changing or removing gloves."

What's more, some patients move to multiple locations within a hospital -- say, from the emergency department to the intensive care unit and then to one or more hospital rooms -- increasing their exposure to a number of other patients and staff members and their associated germs, upping their risk for infection. Add to that the problem of antibiotic-resistant germs and you have a serious health danger that puts millions of Americans at risk each year.

LOOKING FOR SOLUTIONS

In a recent paper, The Impact of the Environment on Infections in Healthcare Facilities, Anjali Joseph, PhD, the director of research at The Center for Health Design, a nonprofit research and advocacy organization, identified ways hospitals can reduce infections caused by pathogens transmitted via air, water and surfaces. "Surface contact is the most common way an infection is transmitted, although one way may be no more dangerous than another. It depends on the pathogens you're exposed to and your health status," Dr. Joseph told me. Her investigation uncovered ways that hospitals can minimize infection transmission through measures such as proper cleaning and maintenance of water systems and proper ventilation systems with proper maintenance, as well as by providing conveniently located washing sinks and alcohol-rub dispensers.

Think your doctor can tell you a hospital's infection rate so you can simply select the "safest" hospital in your area? Most physicians have no idea how many infections occur in hospitals, Inlander said. And, except in a few states (such as Pennsylvania, where Inlander campaigned vigorously for legislation to protect patients), hospitals aren't required to publicly disclose the numbers of infections that occur. The Centers for Disease Control and Prevention (CDC) has a voluntary surveillance program, but approximately 300 out of 5,756 hospitals in the country report infection data to the CDC -- anonymously, Inlander added.

Selecting a hospital designated as one of "America's 100 Best Hospitals" won't help you avoid infection either, since the designation doesn't reflect infection rates. In fact, Inlander pointed out that the highest infection rates probably occur in what people consider the "best" hospitals -- the bigger hospitals and the teaching hospitals -- because they offer more complicated and invasive surgeries and procedures and have sicker patients. But even rural hospitals aren't infection-free.

Your hospital's infection control manager may be vigilant and well-trained, Inlander said, but he/she may be less than effective at getting hospital personnel to perform duties appropriately, such as applying disinfectants to surfaces for the appropriate length of time required to kill bacteria. That may be due to a simple lack of time required for staff training in disinfection methods and insufficient ongoing monitoring. Hospital infection control managers are further thwarted by non-hospital personnel, including doctors who aren't hospital employees and a high nurse turnover, which causes hospitals to rely more on temporary nurses and traveling nurses.

Inlander, who has spent three decades fighting to make hospitals safer for patients, told me that taking steps to prevent infection isn't costly, but requires intense effort on the part of hospital staff. "It's the human stuff that accounts for most infections. For example, a food service worker might lay a food tray down on a bedside table, fluff up a patient's pillow, then pick up the tray and go to another patient with it."

WHAT CAN YOU DO?

If you have a choice, get a private room, Dr. Joseph recommended. "You'll reduce the number of people you come in contact with. Also, take a careful look around. See if the bathrooms are clean and well-maintained... if there are spills on the floor. See if sinks with soap dispensers are nearby." And don't be fooled by medical personnel wearing latex gloves. Bacteria on a glove can travel from one patient to another if the gloves aren't removed. So, make sure the personnel put on new gloves before they treat you.

Inlander suggests these strategies for consumers who want to protect themselves against nosocomial infections...

Don't let anyone touch you unless they've washed their hands in front of you and/or put on new gloves. Dr. Joseph agrees. "These days, most physicians won't take offense if you ask them to wash their hands before examining you," echoed Dr. Joseph.

Make sure that any invasive equipment brought into your room is sterile. If it does not come in a sterilized pack, question that. Be cognizant and ask about anything that's going to be done invasively. Simply asking, "Is that sterile?" puts you on the list as someone who's concerned. "Put a copy of my book, Take This Book to the Hospital with You (St. Martin's), on your bed stand. Staff will take note. Hospitals don't want lawsuits."

If you're going into the hospital for a planned procedure, always ask your doctor if you should take antibiotics before entering the hospital as a precaution. In spite of the issues of antibiotic resistant bacteria, this is one measure being used more and more often to prevent hospital infections. Theoretically, the doctors will know what bacteria are common in their specific hospital and the appropriate antibiotic to counter them.

Ask your doctor about getting a pneumonia vaccine prior to a planned hospitalization. It can drastically cut your infection risk. Studies show that hospital patients have a higher risk of being rehospitalized for pneumonia within three to five years from discharge -- particularly older adults and anyone with a health condition that renders them more vulnerable.

Question anything that doesn't look as clean as you'd want it to be at home -- even lint on the floor. Request to have the cleaning staff come and reclean if the room or bathroom do not look cleaned.

IMMUNE BOOSTING

Of course, there's always the proactive part of preventing infection -- boosting your immune system to make you better able to resist germs that you might be exposed to in the hospital. For immune boosting suggestions, I asked Daily Health News contributing editor Andrew L. Rubman, ND, for suggestions. Well before your hospitalization, Dr. Rubman recommends that you bring a naturopathic physician into your treatment team. He/she can coordinate with your primary care provider and specialists that will be attending to you in the hospital and help you establish a healthy diet, eating habits and lifestyle to maximize your strength prior to your hospital stay.

Naturopathic physicians are specially trained to prescribe antioxidants, immune support and nutrient supplementation that will help you minimize your vulnerability to infection in the hospital and can also help support the underlying problems that have led to the hospitalization in the first place. Again, it is best for the ND to work in conjunction with your primary care MD and specialists. Dr. Rubman emphasizes that you should under no circumstances try to do this on your own or withhold information relating to naturopathic treatments from your physicians. To do so may be not only counterproductive, but deadly.

All experts agree that becoming paranoid about infection won't help you avoid sickness related to it. But being a proactive patient can.

Carole Jackson,  Bottom Line's Daily Health News

Sources:

How to Avoid Deadly Hospital Infections

Charles B. Inlander, founder, People's Medical Society, a consumer health advocacy organization, and coauthor, Your Medical Rights (Little Brown) and Medicine on Trial (Pantheon Books).

Anjali Joseph, PhD, director of research, The Center for Health Design, and author of The Impact of the Environment on Infections in Healthcare Facilities.