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by Senator Richard T. Moore

January 3, 2006 - Famed nurse Florence Nightingale's dictum that the first requirement of a hospital was “that it should do the sick no harm,” is just as important today as it was when she said it more than 150 years ago. The sad truth is that medical errors occur even in our best hospitals. One of the leading causes of death in hospitals is infection. An estimated 103,000 people in America die each year from infections acquired in a hospital – that’s as many deaths as from AIDS, breast cancer and auto accidents combined. What’s more, hospital infections add over $30 billion to what the nation spends on health care.

These infections are almost all preventable! A few hospitals in the U. S. are proving it, reducing some of the deadliest infections by 90%. These hospitals are proof that we have the knowledge to solve the problem. Recently, the Massachusetts Senate proposed spending a million dollars to start a statewide infection control system to combat this problem in Massachusetts. If the House agrees, our state could be in the forefront of saving lives and money through our health system.

There are some steps that each of us can take to minimize infection when any of us, or a family member or friend, enter the hospital for needed care. The national Committee to Reduce Infection Deaths (www.hospitalinfection.org) has provided fourteen common sense steps that we ought to follow when our health needs place us in a hospital, even when it’s for day surgery.

1. Ask that hospital staff clean their hands before treating you. This is the single most important way to protect yourself in the hospital. If you’re worried about being too aggressive, just remember YOUR life is at stake. All caregivers are supposed to wash their hands, preferably with alcohol based cleaners that remove bacteria better than soap. Don’t be falsely reassured by gloves since those are more to protect the caregiver than the patient. If gloves were pulled on without cleaning their hands, the gloves are already contaminated before they touch you.

2. Before your doctor uses a stethoscope to listen to your chest, ask that the flat surface of the stethoscope be wiped with alcohol. Numerous studies show that stethoscopes are often contaminated with bacteria because caregivers seldom take the time to clean them between patient use.

3. Ask visitors to clean their hands and avoid sitting on your bed.

4. If you need surgery, choose a surgeon with a low infection rate. Surgeons know their rate of infections for various procedures. Ask for it, and if they won’t tell you consider choosing another surgeon.

5. Beginning one week before surgery, shower frequently with Chlorhexidine soap. Various brands can be found in drugstores. This will help remove any dangerous bacteria that you may be carrying.

6. Ask your surgeon to have you tested for Staphylococcus aureus at least one week before you come to the hospital. The test is simple, usually just a nasal swab. About one third of people carry Staphylococcus aureus on their skin, and if you are one of them, extra precautions can be taken to protect you from infection, to give you the correct antibiotic after surgery, and to prevent you from transmitting bacteria to others.

7. On the day of your operation, remind your doctor that you may need an antibiotic one hour before the first incision. For many types of surgery, a pre-surgical antibiotic is the standard of care, but it is often overlooked by busy hospital staff.

8. Ask your doctor about keeping you warm during surgery. Operating rooms are often kept cold for the comfort of the staff, but research shows that for many types of surgery, patients who are kept warm resist infection better. There are many ways to keep the patient warm, including blankets, hats and booties and warmed IV fluids.

9. Do not shave the surgical site. Razors can create small nicks in the skin, through which bacteria can enter. If hair must be removed before surgery, ask that clippers by used instead of a razor.

10. Ask that your surgeon limit the number of personnel (including medical students) in the operating room. Every increase in the number of people adds to your risk of infection.

11. Ask you doctor about monitoring your glucose (sugar) continuously during and after surgery, especially if you are having cardiac surgery. The stress of surgery often makes glucose levels spike erratically. New research shows that when blood glucose levels are tightly controlled to stay between 80 – 110 mg/unit, heart patients resist infection better. Continue monitoring even when you are discharged from the hospital, because you are not likely fully healed yet.

12. Avoid urinary tract catheter if possible. It is a common cause of infection. The tube allows urine to flow from your bladder out of your body. Sometimes catheters are used when busy hospital staff don’t have time to walk patients to the bathroom. Ask for a diaper or bed pan instead. They’re safer.

13. If you must have an IV, make sure that it is inserted and removed under clean conditions and changes every 3 to 4 days. Intravenous catheters, or IV’s, are a common source of infection and are not always necessary. If you need one, insist that it be inserted and removed under clean conditions, which means that your skin is cleaned at the site of the insertion, and the person treating you is wearing clean gloves. Alert hospital staff immediately if any redness appears.

14. If you are planning to have your baby by Cesarean section, take the steps listed above as if you were having any other type of surgery.

The federal Centers for Disease Control and Prevention report that compliance with simple hand-washing by health care providers – doctors, nurses, clinic staff, etc. – is generally below fifty percent! Even the best hospitals have not sufficiently addressed this problem. Help your doctors and nurses do a better job of caring for you by making sure that they follow standard infection control practices – it really is a matter of life or death – yours!

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