The hospital is supposed to be the place where people go to get better. However, that same place may be doing more harm to trusting patients than good. The Centers for Disease Control and Prevention estimate 90,000 people die annually in the United States from infections they acquire in the hospital and 2 million people get infections every year during hospital stays. Other statistics show more than 100,000 people die from hospital infections each year. Some health practitioners believe the problem is getting worse while others believe that more awareness in the profession is leading to infection decline. The difference of opinion yields a variety of approaches to keeping hospital infections down.
Some health officials cite the lack of infection control staff. The CDC recommends one specialist for every 250 beds. Others attribute infections to the nursing shortage. A University of Pennsylvania study published in The Journal of the American Medical Association in 2003 shows in surgery units, every additional patient added to a nurse’s workload increases a patient’s chances of dying by 7 percent. Research also shows overuse of antibiotics leads to infection. As seen in different studies, one quarter to one half of all hospital patients are on antibiotics. The most common types of hospital-acquired infections are antibiotic-resistant.
Types of Infections
One of the most common hospital-acquired infections is called methicillin resistant staphylococcus aureus (MRSA), a staph bacteria resistant to the antibiotic methicillin. The CDC says there are about 120,000 cases of MRSA each year. Staph is found in the nose or skin of about one-third of healthy adults. Though it is usually harmless, a break in the skin allows the bacteria to enter the body and poison the blood and organs.
Another common infection is vancomycin-resistant enterococci. VRE is an intestinal bacteria immune to the most powerful antibiotic on the market. Enterococci live in the lower intestine and cause urinary tract, blood stream, and surgical wound infections.
Hospitals are also reporting increases in septicemia cases. The life-threatening blood condition known as sepsis can destroy the body’s organs. A 20-year study released by the CDC and Emory University showed the rate of sepsis infections rose an average of 16 percent each year from 1979 to 1999.
Andrew Streifel, M.P.H., hospital environment specialist at the University of Minnesota in Minneapolis, says it is hard to pin down the origins of air quality problems in hospitals. He says, “We really don’t know where the multitude of sources could be.” One source is when sheetrock walls get wet, they grow fungus at room temperature or warmer. For example, a soda machine that has been leaking can cause mold or fungus. One problem that arises is airborne fungal spores. Though they are common microbes, the spores can grow inside patients and cause allergic reactions, especially in the most immune-compromised patients such as those who received transplants or high-dose chemotherapy. Another problem is aspergillus infections, which, Streifel says, affect a fair number of patients. The first risk factor is neutropenia, and the second is building construction. Once it becomes invasive, aspergillus infections have an 80-percent mortality rate. Not all, but most aspergillus infections are hospital-acquired. Streifel stresses the importance of building maintenance and adequate training for professionals to control the air system and identify potential sources of infection. At the University of Minnesota, ventilation is the biggest problem. Streifel says: “There’s not enough fresh air. That’s the number one complaint.”
Hospitals may cause Sick Building Syndrome. Because of modern architecture, sealed, energy-conserving buildings continually recycle contaminated air. In the Indoor Air Quality News Report, “Hospital Air is Sick,” author Kenneth Brownson, Ed.D., R.N., writes, “Sealed hospital buildings have a higher humidity level, which helps bacteria, viruses and molds multiply.” Symptoms of SBS include eye irritation, dry throat, runny nose, sinus congestion, nose irritation, shortness of breath, sneezing, chest tightness, headache, fatigue, mental confusion, dizziness, skin irritation, rashes, and nausea. Symptoms vary between people and hospitals. Usually, symptoms increase in severity the longer a person is in a contaminated building and gradually disappear after a person leaves the building. Poor indoor air quality can also cause or contribute to chronic diseases that do not go away such as asthma, chemical sensitivity and hypersensitivity pneumonitis.
Suggestions on how to fix the problem:
- Hospitals need to pro-actively investigate all buildings to determine if the air quality is healthy.
- Identify all pollution sources and remove them.
- Laboratories, pharmacies, central sterilization or any area where fumes are emitted should have a separate exhaust system so these fumes do not enter and remain in the general ventilation system.
- Places where chemicals and cleaning supplies are stored should also be vented.
- Increase the flow of outside air. Most buildings only have five cubic feet per meter (cfm). The American Society of Heating, Refrigeration & Air Conditioning recommends a minimum of 15 cfm to 60 cfm.
- All surgical and examination gloves should be unpowdered. A cost-effective alternative to latex gloves should be used if available. Particles from cornstarch on gloves used to help separate them can get into the air and cause allergic reactions.
- Wearing cosmetics and perfumes should be discouraged. Chemicals in cosmetics and other products introduce volatile organic compounds into the air such as acetone, alpha-pinene, benzaldehyde, benzyl-acetate and limonene.
What can medical practitioners can do?
Contaminated hands still remain one of the major ways infections are transmitted. Studies show doctors and nurses wash their hands about half as often as they should. One CDC study found nurses and doctors in an intensive care unit should wash their hands an average of 45 times an hour. Study shows the average level of compliance has varied among hospitals from 16 percent to 81 percent.
Alcohol-based hand rubs address obstacles health professionals may face when complying with hand hygiene guidelines, such as lack of time, access to a sink and the harshness of soap and water which may cause dry hands. In fact, some studies show gels may be even better than soap and water. However, the CDC insists soap and water is best.
Health practitioners at LDS Hospital in Salt Lake City use computer-based triggers to identify surgical patients that need antibiotic prophylaxis. When a doctor or nurse reviews the computerized list of surgery patients, dozens of signals drawn from electronic medical records flag the desired patients. The timing and appropriate dose of antibiotics has improved from less than 50 percent to more than 99 percent using this method and can be directly linked to keeping infection control down. In regards to timing, if an antibiotic is given too soon or after the operation, a patient has a four- to six-fold greater risk of infection.
What patients can do?
There is relatively little patients can do to protect themselves from the spread of antibiotic-resistant infections. However, for patients who need surgery — which puts them at a higher risk for infections — Dorctor has some suggestions to reduce their risk of acquiring an infection.
- Stop smoking at least 30 days before surgery. Quitting is even better.
- Keep pre-operative hospital stays short. The longer you are there, the more likely antibiotic resistant germs are going to be moved from patient to patient.
- Request an antiseptic (chlorhexidine) shower or bath and more than one (whether in the hospital or at home preparing for surgery) before going to the operating room.
- Ask for a preventive dose of antibiotics before surgery. A dose administered within an hour before surgery will yield optimal levels in the tissue when the operation starts.
- Diplomatically remind healthcare workers to cleanse their hands before examining you if they aren’t doing this.
Each hospital and state have guidelines and recommendations for infection control. It appears more awareness and a focused effort by both doctors and patients is the best start for keeping hospital-acquired infections at bay.