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Hand washing by hospital staff, patients and visitors is an effective way to prevent hospital acquired infections. Screening and environmental cleaning are very important but are not effective without hand washing.
After decades of less than stellar performance, an increasing number of hospitals are making significant changes to rein in hospital-acquired infections. Consumer advocates say we've had the knowledge to prevent these infections for some time but we've lacked the will to do it. Two major forces are fueling the drive to improve – a more focused approach to quality of care and a growing recognition by hospital administrators that these infections eat into earnings. Studies have shown that when hospitals invest in proven precautions, they're rewarded with as much as tenfold financial return.
Hospitals are proving that infections are preventable through rigorous hand hygiene, meticulous cleaning of equipment and rooms in between patient use, and testing incoming patients to identify those carrying dangerous bacteria. They've been achieving and spreading effective change by letting employees know infection control is an institutional priority and by taking an interdisciplinary approach, involving everyone from house staff to nurses to physicians. They've built a sense of ownership in departments by appointing teams to create standardized procedures and hands-on training programs, enforcing compliance, testing cleanliness, monitoring results, and rewarding positive behaviors and results.
Hand Hygiene
Even though hand washing is the number one defense against infection, recent studies have suggested an average of 50% of doctors and nurses do not adequately wash their hands between patient contacts. Meaningful actions that hospitals are taking include
• Educating all staff about and requiring them to comply with the recommended guidelines for hand washing
• Encouraging visitors and patients to follow the same procedures as hospital staff
• Ensuring convenient access to hand hygiene supplies:
o Adding sinks
o Providing alcohol-based hand rubs that are less irritating than antiseptic or non-antiseptic detergents
o Promoting the use of hand lotions to help protect the skin and reduce microbial shedding
• Requiring the proper use of sterile gloves:
o Removing gloves between patient encounters and prior to touching surfaces
o Removing gloves between dirty and clean body site care for the same patient
o Disposing of gloves after a single use
o Washing hands after glove removal
• Prohibiting artificial nails for all patient care providers who work with high risk patients
Cleaning, Disinfection and Sterilization
Previous contamination of a hospital care area is a strong predictor of future infection according to a study published in Clinical Infectious Diseases. Unfortunately, another study has revealed that nearly three-quarters of patients' rooms are contaminated with MRSA. Hospitals are upgrading their methods for cleaning rooms, like using new microfiber mopping systems and paying particular attention to the highest bacteria carriers – TV remote controls, toilet bowl handles, bathroom doors and call buttons. The protocols for disinfecting and sterilizing isolation hospital rooms are set at a higher standard. For instance, isolation room curtains and blinds are routinely removed for cleaning; carpets are steam cleaned; surfaces are drenched in disinfectant for several minutes, not just sprayed and wiped.
Anything that moves from patient to patient is a potential source of infection-causing microbes – people, ventilators, humidifiers, blood pressure cuffs, EKG leads, stethoscopes, wheelchairs, IV poles, commodes, glucometers, stretchers and more. Hospitals divide reusable medical equipment into three groups of risk: high, intermediate and low. High risk items are sterilized; intermediate items are disinfected; low risk items are cleaned.
Clothing can be a virtual conveyor belt for infections. Studies have shown that when doctors and nurses lean over a patient with MRSA, their coats and uniforms pick up bacteria 65 percent of the time, and carry it to other patients. One researcher found that neckties worn by clinicians are an overlooked hazard. Even when doctors washed their hands after patient examination, they also frequently adjusted their neckties. Healthcare workers use sterile gowns, gloves, masks, and barriers for intermediate and high risk situations.
Hospitals are also being more proactive in looking for and destroying pathogen reservoirs such as those in heating ventilation and air conditioning systems and installing HEPA air filtration in areas that house high-risk patients.
Use of Invasive Procedures
Some of the technological advances that save our lives can also increase the likelihood that we'll get an infection. Common procedures that increase our risk of hospital-acquired infections include:
• Urinary bladder catheterization
• Respiratory procedures such as intubation or mechanical ventilation
• Surgery and the dressing or drainage of surgical wounds
• Gastric drainage tubes into the stomach through the nose or mouth
• Intravenous (IV) procedures for delivery of medication, transfusion, or nutrition
Meaningful actions that hospitals are taking include:
• Using catheters and tubes judiciously and for as short a period of time as possible
• Pre-preparing "insertion bundles" – a series of precautionary steps and related materials packaged together
• Using sterile barrier precautions during device insertion
• Using catheters impregnated with antiseptic/antibiotics
• Changing catheters and dressings on time: i.e. peripheral IV catheters every 72 hours and central line dressings every week
• Keeping skin around dressings and intravenous catheters dry
• Before surgery:
o Having a patient shower preoperatively with an antimicrobial agent (Link to glossary and anchor to word)
o Administering antibiotics just prior to surgery
o Removing hair with clippers rather than shaving area (shaving can cause microscopic skin abrasions)
• For patients on ventilators:
o Learning proper suctioning technique
o Keeping the head of the patient's bed upright at 30-45 degrees
Screening and Isolation
Infection-causing micro-organisms may already be present in the patient's body at the time they're admitted. Some hospitals have instituted programs using new, same-day molecular testing to screen patients to determine if they're infected with methicillin-resistant staphylococcus aureus (MRSA) or are colonized with the bacteria but are not yet infected. If the test is positive for the bacteria, the patient gets nasal antibiotic ointments and is carefully washed for a few days. Some patients are put in isolation rooms. The efficacy of screening to reduce hospital-acquired infections is still being studied.
Learn more about Hospital Acquired Infection:
Key Point 1: Of all illnesses, infections are among the most common cause of death in U.S. hospitals. Hospital Acquired Infections are now recognized as a major cause of sickness and death.
Key Point 3: While the burden of decreasing the number of hospital acquired infection cases lies with the healthcare system, patients can also take steps to protect themselves.
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