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multidisciplinary group sponsored by the Chlorine Chemistry Council. Its mission is to promote science based practices and policies to enhance water quality and health by advising industry, health professionals, policy makers and the public.
 

Hospital-Acquired Infections a Menacing Trend in Health Care Settings
Guidance for Hospital Personnel and Patients Offered

Hospital-acquired infections - infections acquired in health care settings by patients admitted for reasons unrelated to the infection or not previously infected when admitted to the facility - continue to be a major concern for the public health community.

The Chicago Tribune recently dedicated a series of investigative articles to hospital-acquired infections. The articles delve into the unimaginable - multiple newborns in the same nursery dying of the same virus - psueudomonas aeruginos. Another patient contracts an infection during bypass surgery that penetrates deep within her sternum, keeping her hospitalized for a year before her eventual death.

While these examples are the extreme, just how prevalent are these infections? And what should healthcare professionals and patients know to help prevent their spread?

According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 36 million people are admitted to U.S. hospitals every year, and nearly two million patients annually acquire an infection while being treated; over 80,000 patients die from complications resulting from the infection. The CDC estimates that up to one-third of infections acquired in health care settings are preventable.

From relatively minor urinary tract infections to life-threatening infections of the bloodstream and pneumonia, hospital-acquired infections vary in gravity. The CDC reports that hospital infections cost the American public nearly $5 billion in healthcare costs each year. The extra costs are the result of the additional days - or weeks - patients are required to stay in the hospital to treat the new infection.

While the precise causes are difficult to pinpoint, some hospital-acquired infections can be attributed to human error - such as failure to properly sterilize or disinfect objects coming into contact with a patient or properly isolate a susceptible patient from potential carriers.

Information for Hospital Personnel

The risk of contracting contagious illnesses is greater among hospital patients by virtue of their already-weakened immune systems and their surroundings. However, hospital personnel can take certain measures to help protect patients from contracting preventable infections.

Among the best precautions medical personnel can take at the hospital is fundamental disinfection and sterilization practices - particularly of hands and surfaces. Proper surface disinfection practices can eliminate all pathogenic microorganisms with the exception of bacterial spores, often by directly applying specific chemicals to a surface. Sterilization requires destroying all forms of microbial organisms, and can be achieved through a variety of means, including heat, steam under pressure, liquid chemicals and hydrogen peroxide gas plasma.

The CDC recently released specific guidelines for hand-hygiene in healthcare settings. Among the recommendations is the use of alcohol-based lotions in lieu of traditional soap and water, as well as other specific cautioning against long or artificial nails among those coming into contact with infected patients. As part of the guidelines, the CDC asks that healthcare facilities develop monitoring policies to implement the hand-hygiene procedures. The CDC also offers the following recommendations:

  • To prevent cross-contamination, medical staff should always wash hands after touching contaminated items and bodily secretions, between patient contacts and, in certain instances, when working on different areas of the same patient. Strict adherence to hand washing protocol among hospital staff is often overlooked because of the skin irritation caused by frequent soaping. But new sinkless alcohol-based rubs that provide ample disinfection may remedy the problem, improving skin condition and saving precious time between patients.
  • Clean gloves help protect both doctor and patient against infection and disease. However, wearing gloves should never replace hand washing because microscopic tears may be present in the gloves, which can harbor germs.
  • Hospital personnel should always wear appropriate eye and face protection, masks and gowns.
  • When caring for a patient suspected of having an airborne infection, personnel should place the patient in an isolated room with proper ventilation and should wear proper masks when entering the room. When moving the patient about the hospital, personnel should, whenever possible, place a surgical mask on the patient.

In addition to its hand-hygiene guidelines, the CDC also is finalizing its "Guidelines for Disinfection and Sterilization in Healthcare Facilities." The report emphasizes the need for strict adherence to disinfection and sterilization procedures in order to reduce the risk of hospital-acquired infections, with a focus on equipment used on patients.

A variety of infection control training courses are available to medical personnel through organizations, universities and public health agencies. Links to organizations offering such courses can be found on the CDC's web site http://www.cdc.gov/ncidod/hip/training/infctctl.htm).

Information for Patients

A report issued in 1999 by the Institute of Medicine offers a startling statistic: medical errors claim the lives of between 44,000 and 98,000 hospital patients every year. Recognizing that hospital infections can stem from medical errors, it falls on the shoulders of hospital administration and personnel to remain conscientious, meeting strict safety standards, during each patient procedure.

Last year, the Joint Commission on Accreditation of Healthcare Organization (JCAHO) issued new patient safety standards, requiring hospitals to take specific measures to prevent medical errors and to inform patients if harmed during treatment. The organization's president, Dennis O'Leary, M.D., strongly supports the new measures, emphasizing, "Health care executive, physician, and nursing leaders must radically change their thinking about medical mistakes."

To help prevent against infection, patients should be aware of their rights in the healthcare setting and remain alert during their treatment, whenever possible. JCAHO offers some helpful tips for patients at the hospital:

  • Speak up if you have questions or concerns. If you don't understand, ask again.
  • Pay attention to the care you are receiving. Make sure you are receiving the right medications and the appropriate treatment.
  • Educate yourself about your own diagnosis, the medical tests you are undergoing and your treatment. Ask a friend or family member to accompany you and advocate on your behalf.
  • Know what medications you take and why you are on them.
  • Choose a healthcare setting that has undergone an on-site evaluation against strict safety standards.
  • Participate in all decisions regarding your health care. Keep medical records, talk to others and even seek a second opinion if it will help you make certain decisions.

The National Patient Safety Foundation (NPSF) also teamed up with the American Hospital Association (AHA) and the American Medical Association (AMA) to provide patients with helpful tips. Among the guidelines are communicating with the hospital staff if you have questions about whether they have cleaned their hands or if you have catheters or dressings on wounds that need to be tended so that they are not exposed to infection (http://www.npsf.org/html/prevent_infections.html).

For additional information about patient safety and preventing hospital-acquired infections, please visit these organizations' web sites:

U.S. Centers for Disease Control and Prevention:
http://www.cdc.gov/ncidod/hip/training/infctctl.htm
http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm

Joint Commission on Accreditation of Healthcare Organizations:
http://www.jcaho.org/

National Consumers League:
http://www.nclnet.org/health/cdcguidelinepr.htm

American Hospital Association:
http://www.hospitalconnect.com/DesktopServlet

National Patient Safety Foundation:
http://www.npsf.org/html/prevent_infections.html

The World Health Organization:
http://www.who.int/emc-documents/antimicrobial_resistance/whocdscsreph200212.html

Institute of Medicine:
http://www.iom.edu/

   
 

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