The notion that hospital is the place to run to when you don’t feel well is worth exploring. We might get a wake-up call when we consider the statistics on global outbreaks of hospital-acquired infections and their associated deaths. These show the following:
- One in 10 adults and one in 12 children will contract an infection while in a Canadian hospital.
- Canada’s healthcare-associated infection rate is nearly 12 per cent, one of the worst among developed countries (the figure is approximately 10 per cent in the US and UK, and 6.7 per cent in France).
- In 2003, there were 220,000 hospital-acquired infections in Canadian hospitals, resulting in 8,000 deaths.
My message is this: stay away from hospitals unless absolutely necessary—especially if you’re an older adult.
An alert for the frail elderly
The risk of acquiring an infection is higher in frail elderly people, who often present with a weakened or compromised immune system. They may enter hospital for treatment or observation of a condition that we consider untreatable in a physician’s office and succumb to a hospital-acquired infection. The introduction of an infection not only increases the length of their hospital stay, but also decreases the possibility of recovery from the original disease.
The offending bacteria
At the moment, four major hospital-acquired bacteria are currently in circulation:
- Clostridium difficile, an intestinal bacterium.
- FRI, a respiratory-based illness.
- Methicillin-resistant Staphylococcus aureus (MRSA), a skin and lower intestinal bacteria.
- VRE, a lower intestine, blood, urine and skin-based bacteria.
These bacteria are resistant to standard antibiotics, and are most often transmitted by simple and often avoidable contact.
Main routes of transmission
Infections are spread by poor housekeeping and direct physical contact from hospital staff as they perform procedures on a patient and neglect to use accepted hygiene practices, the most effective of which is proper handwashing. Medical and hospital staff who travel between patients are a means of spreading pathogens. Essentially, the staff act as carriers.
The main problem is that once an infection has spread through the body, antibiotic treatments that can work in an otherwise healthy person may not be effective in a frail patient with an impaired immune system.
It is my observation (and I spend hours in hospitals ensuring that events happen and medical staff are available for questions) that hospital personnel travel too frequently between patients, units and other hospitals and easily become vectors for the transmission of germs. And then there’s “musical beds.” Patients are frequently transferred between different areas of the hospital while they wait for procedures, treatments or to be admitted. The most offending areas are hubs such as the emergency department, operating rooms, intensive care and step-down units. Most recently, a client was transferred seven times during her hospital stay. To the horror of her family, she succumbed to C. difficile following successful surgery and died in the same hospital within weeks.
How can infection be prevented?
All hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing and other preventative measures. Thorough handwashing (or use of alcohol rubs) by medical personnel before and after each patient contact is one of the most successful preventative measures in combating hospital-acquired infections. Equipment sterilization, patient isolation and appropriate cleaning with bleach are additional effective tactics. Simply put, prevention is achieved by scrupulous infection-control procedures—which, unfortunately, are often not followed in the rush to provide care.
More careful use of antibiotics is also considered vital to reducing the presence of resistant bacteria, along with the possible consideration of probiotics to replace healthy bacteria in the bowel.
Best practice should probably dictate that all patients are in single rooms, thus providing a physical barrier to infections and a constant reminder to staff of isolation practices. Let’s hope that all new hospitals are designed with this in mind!
Too little, too late
An often overlooked issue is the nutritional status of patients and how this influences resistance to infection. Many patients who stop eating because of sickness are often left far too long before the situation is rectified. The intervention of a dietician, use of calorie counts and prompt addition of additional calories through dietary supplements cannot be overemphasized. If necessary, the option of a nasogastric or gastric feeding tube may need to be explored sooner rather than later.
Managing hospital stays
The lessons to be learned are as follows. First, stay out of hospital if at all possible. Second, if you must check in, keep your wits about you as you interact with both the environment and the staff. And third, don’t be afraid to speak up if you feel that stringent infection-control procedures are not being followed.
About Carol Edwards
Carol Edwards, RN, GCM, is President of Careable, Inc. She can be reached at carol@careable.com or http://www.careable.com.
