Preventing/avoid infections in hospital

[catwoman]

Infection during a medical procedure or hospitalization, whether surgery is involved or not, is a big risk. We've had quite a few vr.com members who have suffered such.

Today the Fort Worth Star-Telegram (my employer) had a good article by Jan Jarvis about such infections. There's a great sidebar on how to help avoid infections (see below). If you are facing surgery, you may want to talk to the surgeon about how to avoid hospital-acquired infections.

Texas' legislature is in session right now, and a state rep from San Antonio has introduced a bill to require reporting of MRSA (methicilliin-resistant staph), which is a real danger and can be deadly.
The article states at that least 39 states in the U.S. have introduced legislation pushing hospitals to diclose infections.

Tomorrow I'll see about either putting a link to the article or pasting the article on another post here. I'm sure I can get permission, since I work there.


How to reduce your risk of getting an infection in a hospital

Ask hospital staff to clean their hands before treating you.

Ask that the diaphragm of the stethoscope be wiped with alcohol before use.

If you need a central line catheter, ask your doctor about one that is antibiotic-impregnated or silver-chlorhexidine coated to reduce infections.

If you need surgery, choose a surgeon with a low infection rate. Surgeons know their rate of infection for various procedures. If a surgeon refuses to tell you, consider choosing someone else.

Three to five days before surgery, shower daily with 4 percent chlorhexidine soap, available through pharmacies.

Ask your surgeon to have you tested for staphylococcus aureus at least a week before you are hospitalized.

Stop smoking well in advance of your surgery. Patients who smoke are three times as likely to develop a surgical site infection as nonsmokers.

On the day of surgery, remind your doctor that you may need an antibiotic one hour before the first incision.

Ask that you be kept warm during surgery. Patients who are kept warm resist infection better. Special blankets, hats, booties and warmed IV liquids can help.

Do not shave the surgical site. If hair must be removed, ask that clippers be used.

Ask that your surgeon limit the number of people in the operating room.

Ask your doctor about monitoring your glucose levels continuously during and after surgery, especially if you are having cardiac surgery. The stress of surgery often makes glucose levels spike erratically. When blood glucose levels are controlled to stay at 80-110 mg/unit, heart patients resist infection better.

Avoid a urinary tract catheter if possible. Ask for a diaper or bedpan instead.

If you must have an IV, make sure that it is inserted and removed under clean conditions and changed every three to four days. Alert hospital staff if any redness appears.

If you are planning to have a cesarean section take the same precautions as you would for any surgery. Women who have cesarean sections are 10 times more at risk for infection that those who give birth vaginally.

SOURCE: Committee to Reduce Infection Deaths

 

[Lynlw]

thanks great article. it is scarey stuff. In another thread we were talking about how important it is to have a person w/ you 24/7 at the hospital, this is another reason to have that person to make sure every person who comes near you washes their hands, when they walk in the room. I've made lost of people wash infront of me, even if they just did before they left the last patient, I want to see it.

ok now a commercial, when Justin is in the hospital my hands get raw from cleaning w/ the nasty antibacterial soap they have. I finally found the antibacterial products at bath and body work and beside killing things, they smell great ( I stock up on the scents that relax me, warm vanlla sugar is my fav right now,lol i'll take any help in that) and moisturize. they have liquid& foam soap, gel and even hand lotion in the antibacterial line and they have sales on them all the time, like 3 for 10 dollars, I have my stash in the toiletry bag, we take to the hospital.

 

[Guest]

Wow, Marsha ... excellent post.

Reading through it, though, made me a bit nervous ... since I know some of those things weren't done for my last few procedures/surgeries.....



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[tobagotwo]

Can't resist: my two cents' worth...

If you need a central line catheter, ask your doctor about one that is antibiotic-impregnated or silver-chlorhexidine coated to reduce infections.

Just as important or more: Don't let the nurse do anything with your central line (or any IV) right after they handle the IV hanger, particulary one with wheels. Those things are all over the hospital, and I've never seen one being washed. I have seen a nurse put on fresh latex golves, handle the filthy IV hanger, then immediately manipulate the central line - which became infected. Watch people with gloves - they begin to think the gloves are to protect their hands, instead of the patient.

Three to five days before surgery, shower daily with 4 percent chlorhexidine soap, available through pharmacies.

Probably not necessary. You're usually given a nasty, orange-red soap to wash with the night before (very tough to do with an IV in your hand - wonder which genius thought that up). It leaves you well-stained and antiseptic.

Ask that you be kept warm during surgery. Patients who are kept warm resist infection better. Special blankets, hats, booties and warmed IV liquids can help.

Nope. This isn't going to happen. Usually you are deliberately cooled to a very low body temperature for open heart surgery, to help avoid brain damage from any interupted blood or oxygen flow. Note: you should mention to your surgeon that you're concerned that they will warm you up slowly enough. When you are warmed too rapidly, your brain gets a sudden need for oxygen that your body can't provide fast enough. Result? Pumphead.

Do not shave the surgical site. If hair must be removed, ask that clippers be used.

Nope. This isn't going to happen, either. At least for most guys. You will either shave or be shaved. However, you do have that nasty orange soap...

Ask that your surgeon limit the number of people in the operating room.

Oops. StretchL should have had the film crew stay home. What I want to know is whether the surgeon's nephew got to be Best Boy...

Ask your doctor about monitoring your glucose levels continuously during and after surgery, especially if you are having cardiac surgery. The stress of surgery often makes glucose levels spike erratically. When blood glucose levels are controlled to stay at 80-110 mg/unit, heart patients resist infection better.

Perhaps, but be wary of causing doctors to dose the spikes, and then having to redose you oppositely in the troughs. I'd like to see the research for this one - in nondiabetics. I'm betting it's a logical stretch, based mostly on the higher rate of infections in diabetics.

Avoid a urinary tract catheter if possible. Ask for a diaper or bedpan instead.

Nope. This isn't going to happen, either. You're almost certainly going to have a urinary catheter. This is a protracted surgery.

Best wishes,

 

[catwoman]

Bob:

I wasn't told anything about using a special soap pre-op; I was admitted to Baylor upon having a heart cath the day before my surgery. I don't recall being washed the morning of my surgery in my room. I **do** remember such procedures the morning of my foot surgery in 1980.

I mentioned the article yesterday to a friend who works at a small hospital about 45 miles west of Fort Worth TX. She works with patients as they arrive for surgery. Said they clip, rather than shave with blade razors.

Clippers have a variety of sizes of blades. I use a #30 blade in my Oster clippers on my 2 Persians. I also have a #30, which gets a closer shave. A #40 is used by veterinarians for surgery. I'm sure there's something similar for human use.

My friend commented about the advice to limit the # of people in the OR. She said that's a great idea -- also reduces unnecessary movement in & out of the OR.

She said that there is almost no way to prevent infections at hospitals, despite the best intentions.

I wore booties at Baylor during surgery; they were put on my feet when I got into the OR.
When I have given fluids (lactated Ringer's solution) to my cats, I have run the downward loop of the ad line through a container of warm water. That warms the solution just slightly so it's not as much of a shock to the cat's body and is closer to normal body temp (about 100-101 F in a cat). My vet told me to do this, said it reduces stress to the cat's immune system. She has also zapped a bag just a tad before giving it.

 

[Mary]

And I'll throw my one cent in.
My husband is responsible for monitoring and reporting all ventilator acquired pneumonia stats (VAP) for the 400 bed hospital where he works. The data is recorded everytime a confirmed case occurs, and then the #'s are compiled and analyzed every three months. They have benchmarks that they use for comparison with other hospitals in a given geographic area.

The number of ventilator acquired pneumonia cases are generally very low, but they had a sudden spike this past July. There was general consternation and a good deal of discussion concerning the sudden rise, and after examing the variables, the cause was much simpler than what this article suggests. That month there were too few nurses, therapists, etc. for the amount of patients served in the ICU and CCU, and in addition, there was a temporary shortage of beds and space. There were simply too many patients and not enough staff/facilities to go around. The quality of nursing care went down as a result, and the VAP #'s went up. In August, the number dropped back down to what it had previously been, and a strong case was made for hiring more nursing staff so there was no reoccurence.

These #'s include cases other than OHS; head traumas and accident victims frequently end up on ventilators, and depending upon the type of accident, they are brought to the ER in a condition much less pristine than what a patient going into OHS would be.

If you want to have the best outcome you can, I would suggest looking at the day you have surgery scheduled (Monday's aren't good) and the season. I would not want to have surgery around Thanksgiving or Christmas, and certainly not the first few weeks in July when hospital personnel, like a fair number of the U.S. population, are gone on vacation.