Approximately three quarters of a million people in the U.S. get infections as a result of their in-patient care in a hospital. Each year 75,000 of those infections prove fatal; meaning 205 people die every day due to infections acquired while in healthcare institutions.
Many infections are obvious and patients are aware of the danger they face when actively participating with their doctors on their course of treatment. However, a large number of patients don’t realize that they can become infected while at the hospital. Many older or chronically sick patients interpret hospital-acquired infections (HAI) as part of the recovery process. HAIs can cause serious health complications requiring additional treatment, increased healthcare costs, prolonged hospitalization, otherwise unnecessary surgeries, and even death.
There are 4 types of HAIs that are the most common types of infections patients are likely to acquire while in the hospital.
Central-Line-Associated Blood Stream Infections (CLABSI)
A CLABSI is a common type of infection that patients face during prolonged hospital visits. CLABSIs result from contaminated catheter tubes. The catheter tubes are inserted in large neck, chest, or groin veins to give medications and fluids and collect blood for tests.
This differs from IVs because accessing a major vein means that the insertion is closer to the heart. Unlike most IVs, catheter tubes can remain in place for weeks, even months. The prolonged exposure of a sensitive area of the body, such as the heart, greatly increases the likelihood of infection. Intensive Care Units (ICU) typically uses this method for the introduction of medications and fluids to the body, as well as for chronically ill patients requiring prolonged hospitalization.
How Should the Hospital Minimize the Risk of CLABSI?
Hospitals must have strict sterilization protocols when inserting the catheter. Stringent infection control should be implemented each time the line is checked or the dressing is changed.
- Red skin and soreness around the central line
What can patients do to help prevent CLABSI?
- Do your research. Check and see if CLABSI rates for the hospital are available for you to review. Infection rates can tell you a lot about a hospital’s cleanliness and adherence to sterilization procedures.
- Speak up. If you witness any healthcare personnel not following the best infection prevention practice.
- Is it necessary? Ask your healthcare provider if a central line is unavoidable. Have them explain the need for it and how long it will be in place.
- Be vigilant. If the bandage or area around the central line becomes wet, or dirty, let your provider know right away.
- Know the symptoms. If the area around the central line becomes sore or red or if you develop a fever or chills tell your provider.
- Don’t touch. The patient should avoid having any visitors touch the tube. The patient should avoid touching the tubing as much as possible.
- Wash your hands. Everyone visiting the patient should wash his or her hands both before and after the visit.
Surgical Site Infections After-Surgery (SSI)
How do you know if you have this type of infection?
Surgical site infections are caused by pathogens (usually a virus or bacteria) entering the surgery site during or after surgery. Patients most often notice infections only when they develop long after surgery and after they have been released from the hospital. However, many infections that are developed as the result of surgical operations occur immediately following the surgery. These infections can prolong recovery, increase hospital stays, and require additional treatment and surgeries. In many cases, patients who develop SSIs are unaware of the cause of their infections since they are also treated for general infections post-surgery.
How Should the Hospital Minimize the Risk of SSIs?
Doctors, nurses, and other healthcare providers should institute stringent sterilization protocols in order to prevent SSIs. Doctors should clean their hands and arms with an antiseptic agent up to the elbows before and after any patient contact. Many surgeries require removing hair around the surgery site. Ideally, electric hair clippers should be used to remove the hair, rather than a traditional razor. Wearing masks, gloves, and other barrier devices are important to preventing infection. Patients should ask healthcare provider if the use forced airflow anti-hypothermic devices is absolutely necessary or if alternative methods are available. Antibiotics should be administered 60 minutes prior to surgery and stopped 24 hours after surgery. Lastly, cleaning the surgery site with special germ killing soap will help prevent SSIs.
- Redness and pain at the surgery site
- Fever or chills
What can I do to help prevent SSIs?
Before your surgery:
- Talk to your Doctor. Let your doctor know if you have any medical conditions, allergies or are taking any medications.
- Understand each step. Find out what type of surgery will be performed and about any specialized medical equipment that might be used during the procedure. Conduct a cursory search, on your own, about the risks associated with the procedure and the equipment.
- Quit smoking. Smoking contributes to an increased risk for infection. Your doctor may be able to help you quit smoking before your surgery.
- Do not use a razor. Using a razor to shave around the surgery site can lead to skin irritation and eventually an infection.
At the time of your surgery:
- Speak up. If someone tries to use a razor to shave you before surgery ask a doctor if it is medically necessary.
- Ask if you will get antibiotics before surgery.
- Bair Hugger. Ask if the Bair Hugger forced air warming blanket will be used during your surgery. The system is used in 80% of hospitals so it is likely your doctor plans to use this system. The system has been reported to increase the likelihood of infection by increasing the level of airborne pathogens during surgery.
After your surgery:
- Hand Wash. Make sure any healthcare worker that examines you washes their hands with an alcohol based rub or soap and water. If you don’t see a healthcare worker or a visitor washing their hands, ask them to do so.
- Don’t touch. Non-medical professionals should not touch your surgical wounds or dressings.
What do I need to do when I go home from the hospital?
- Understand your condition. Make sure your doctor explains how to properly care for your wound while at home.
- Contact Information. Make sure you know who to contact if you have any problems once you are home.
- Call your doctor immediately if you have any symptoms of infections.
Catheter-Associated Urinary Tract Infection (CAUTI)
CAUTIs are the most commonly reported hospital-acquired condition. More than 560,000 patients develop CAUTI each year and the rates continue to rise. CAUTIs lead to extended hospital stays, increased healthcare costs, patient morbidity, and mortality.
CAUTIs are caused by catheter tubes, inserted into bladder though the urethra to drain urine, becoming infected. Between 10-25% of all hospital patients get catheters. The most important factor for developing a CAUTI is the prolonged use of a catheter.
How Should the Hospital Minimize the Risk of CAUTI?
Hospitals must have strict sterilization protocols when inserting the catheter. In addition to hand washing, using proper aseptic techniques for placement, manipulation, and maintenance of catheters is an important preventive measure. Hospitals staff should be properly trained on the proper use of gloves, drape, sponges, antiseptic solution, and single-use sterile lubricant packets.
- Cloudy urine
- Blood in the urine
- Strong urine odor
- Urine leakage around your catheter
- Pressure, pain, or discomfort in your lower back or stomach
- Fever or chills
- Unexplained fatigue
What can patients do to help prevent CLABSI?
- Do your research. Check and see if CLABSI rates for the hospital are available for you to review.
- Ask your doctor. Every day, ask for a review of the necessity of your catheter, and advocate for the removal if it’s no longer absolutely necessary (Unless there are indications that it is medically necessary to continue use, the CDC recommends removal within 24 hours.)
- Speak up. Don’t assume your physician or nurse is aware of your catheter status. It is your job to advocate for yourself when under another’s care.
Clostridium Difficile Infections
Colon infections are caused by bacteria called Clostridium Difficile. Patients at the greatest risk of illness are elderly people and people with naturally week immune systems due to an underlying chronic condition. The primary cause of infection is long-term antibiotic treatment. Antibiotics kill many of the bacteria naturally present in the gastrointestinal tract. These naturally occurring bacteria usually keep Clostridium Difficile in check. When they are removed, Clostridium Difficile overgrows and releases toxins into the body causing the infection. Most people contract the infection by touching a surface that is contaminated by the bacteria and then touching orifices on their face.
How Should the Hospital Minimize the Risk of Clostridium Difficile Infection?
- Hand Washing. Healthcare workers should be washing their hands with soap and water before they treat a patient. Healthcare workers should not rely solely on alcohol-based hand sanitizers especially when a patient is particularly at risk.
- Sterile Environments. Healthcare facilities should clean surfaces in bathrooms and kitchens regularly with bleach-based products.
- Clothing and Bedding. Soiled clothing and bedding should be cleaned with both detergent and chlorine bleach for all patients.
- All visitors should wash their hands before they visit with a patient and if they use the bathroom at any time during their visit.
- Don’t use antibiotics unless your doctor recommends them.
- Watery diarrhea, (up to 15 times each day in severe cases)
- Severe abdominalpain
- Loss of appetite
- Bloodor pus in the stool
- Weight loss
What can patients do to help prevent Clostridium Difficile Infection?
- Hand Washing. Washing your hands with soap and water as much as possible is key. Do not rely just on alcohol-based hand sanitizers.
- Make sure your home is cleaned regularly and that bathroom and kitchen facilities are cleaned with bleach.
- Try to minimize touching your face without first washing your hands with soap and water. Even dry surfaces can have the bacteria on it.
- Make sure to speak with your doctor regularly if you are on a prolonged antibiotic regiment. Ask if it is necessary for you to remain on the medication. Always continue the regiment if your doctor tells you that it is necessary.