Hospital Germs: How you can reduce the risk

Visitors coming to visit patients - touching, caring for and feeding them - are doing so without washing their hands even though they have just pushed elevator buttons, opened doors, used a public phone, or touched other surfaces touched by many others some of whom may have carried one of the germs.

The slowness of laboratory testing for any of the infectious agents and lack of methodical testing which might discover such infection.

The posting of humorous warnings in areas containing infected patients which are not recognized by first time visitors as warnings.

Nurses wearing the same pair of gloves to treat and handle different non-infected patients some of whom are later found to be infected.

A nurse wearing gloves while treating a contagious patient needed something in the intensive care unit and without removing the gloves opened the door to the ICU which visitors, doctors, other nursing personal open on a regular basis for treating or visiting patients who are not infected.

A nurse called out to ask if there was another blood pressure monitoring machine and was told there was only one because someone had taken a second one home to test their mother, and the only other one was broken. She then went from contagious room to non-contagious room taking blood pressure and using the same cuff against open skin when one of the germs prevalent in the ward was the one which infects by touch..

A patient was released to home care before fully recovered from an infection by one of the germs without her or her family being warned of all of the dangers still facing a patient who may have completed a first round of treatment for one of the contagions. There was no arrangement for follow-up, no arrangement for retesting at the end of a prescribed series of antibiotics, no indication of what symptoms meant a relapse, or the necessary procedures to be taken and the time period within which to accomplish procedures, re-admittance, etc.

There was a failure to indicate on the release forms the fact that a patient had been infected by one of the germs and the treatment given so that family doctor and care givers were not aware that the person has been infected and may still be in an unstable condition thus alerting them to possible signs of relapse or continued infection.

When there was a relapse and the person was re-admitted to emergency, the surgical team which was to do an emergency operative procedure was shocked after the sudden collapse of the individuals system and death to be told by the family that the person had contracted the germ two weeks earlier and had been treated for it before being released. This combined with the fact that lab test for the germ was conducted before the surgery only because a family member insisted on it being taken. The results showed that the germ was still active.

The lackadaisical manner in which visitors are allowed to wear or not wear protective garments and gloves when visiting contagious patients.

Keeping food by families for their loved ones in a refrigerator which is opened and handled by everyone regardless of the infectious condition of the patient they are visiting.

The lack of chairs for visitors who then go into the next room which might contain an infected patient to borrow a chair.

The process of keeping doors shut to the ward during visiting hours which means the constant handling of door knobs and door surfaces which might carry infection.

Toilets constantly left for days without toilet paper, paper to wipe hands, soap which means that individuals from different parts of the department traveled around looking for a bathroom where these were provided thus increasing the risk of spread of infection.

Trays and dishes not picked up on time from patient's rooms are washed by hand including trays and utensils from infected patients. When nurses were asked what should be done with dishes and utensils used by someone infected with one of the germs, the answer was "just put them in the kitchen with the others". No precautions were taken in their cleaning nor were any sanitation measures used.

It is said that 75% of the deaths could have been prevented.

What you can do

1. Get everyone you know visiting a hospital to read the article Steps..., or watch the video on this page.

2. Send page to a friend

3. Support or become members of organizations actively doing something about the problem.

4. Contact legislators in your country about passing laws forcing hospitals to report such deaths and make public disclosure (rating system). See Suggestions for model legislation If you are in U.S., go to Consumers Union and they will send a letter for you to your U.S. Representative.

5. Contact your health care plan and ask them to follow the model of Medicare which has announced refusal to pay for the care and treatment of persons contracting these diseases in the hospitals.

6. Ask hospitals to provide entry testing of patients for presence of these germs (in particular those transferring from other hospitals or other care facilities).

7. Ask your hospital to become more active in applying standards, overseeing compliance, and training of personnel by providing the necessary materials, equipment, training time and facilities to significantly reduce the danger. See What are the costs

8. Contact the editor of your newspaper and radio stations and ask them to mention this page. See Proposed Letter on Hospital Law

9. See draft bill and urge your country to pass a similar law.

10. Write to the editors of this page suggesting additions, deletions, etc.

As a healthy person, the germs may not effect you, but to someone with a compromised immune system, they can be deadly. Weakened immunity can be caused by any number of factors including another illness, simply the length of time in hospital, or a general antibiotic treatment which destroys some of the immune system defenses (Talk to your doctor about reduction of non-specific antibiotics. For more details on this, see below General Medical Procedures).

What are the rules?

Washing of Hands By Everyone
Perhaps the most basic protection is simply the proper washing of hands. You may think you know how to do it and when. Think again. Take a look at Steps to proper hand washing or view the CDC video.

   To protect yourself and others

Before kissing, touching, feeding of loved ones, wash your hand and if you leave the room or bedside and then return, re-wash. Visitors coming to patients - touching, caring for and feeding them - are doing so without washing their hands even though they have just pushed elevator buttons, parking machines, opened doors, used a public phone (or even their own cell phone), or touched other surfaces touched by many others some of whom may have carried one of the germs.

If the patient you are visiting is contagious, also wash your hands before leaving the room.

Repeatedly emphasized by health authorities as the most effective preventive measure against a number of the hospital germs and yet visitors and staff continue to ignore it.

   Video:
Things You Should Know Before Entering the Hospital-Excerpt

Measures you can take before and during your stay in the hospital

15 Steps You Can Take To Reduce Your Risk of a Hospital Infection - published by RID

Other ways you can reduce the risk include:

Do not insist on antibiotics if attending doctor advises otherwise. Antibiotics which are not specifically targeting the infection you have may reduce your immunity. For more information, see below under General Medical Procedures.

Do not borrow the utensils, apparatus, combs, brushes, books, etc. of another patient

Contagion signs - Understand the meaning of contagious signs on certain rooms or sections of the hospital.

In rooms marked as contagious do not borrow chairs, tables which are in rooms marked as contagious.

Wash hands when leaving room if visiting an infected person, for any reason what-so-ever even if it is only to get a chair, a cup of water – any thing which might entail the touching of surfaces which others will touch, and of course re-wash hands when returning so as not to add another infection.

Use soap provided by the hospital for the purpose and wash hands as prescribed.

Protective garments - If patient is contagious, adhere to the rules for protective garments and when finished visiting or on going out of the room, throw away garments.

Rental equipment - TVs and other equipment on loan or for rent. The controls put previous patient's germs into the hand of the new subscriber. Be sure that parts handled are wiped clean with an antiseptic.

Food kept in communal refrigerator – Do not keep food for your loved one in the refrigerator. The food of patients who are contagious is also kept there. If you do, be sure that hands touching the refrigerator door, kitchen door, the food parcels of others, as well as your own parcel which may have been handled by as many as 10-20 others in the course of a day (moved aside, looked at to find if theirs, etc) , are washed before feeding patients. If you think about it, the task is almost impossible.

Other measures to reduce risk taken by hospital staff and management include

Nursing Staff

Wear a new set of gloves for each patient treated. Nurses often do not put on fresh gloves after each patient and carry the germs of one patient to the next. Use gloves or antiseptic gel between each patient even in non-contagious wards because the lab tests are not always up-to-date or take too long to often effectively serve as a warning.

Wash hands before putting on gloves. See article: Gloves - the unwashed hand that puts them on touches the surfaces

Make sure that visitors are strictly following the rules for protective garments and the washing of hands upon leaving the room.

Make sure that bathrooms used by patients and visitors are adequately stocked and that anti-bacterial soap is available in all bathrooms.

Make sure that patients who are infectious know what to do and not do to reduce the likely spread of contagion.

When rounding up chairs to put them back into circulation, do not take chairs from contagious rooms unless they are sterilized.

Use disposable cuffs on blood pressure machines.

Keep doors open during visiting hours to provide unimpeded access by staff, patients and visitors

Possible dangers of acrylic fingernails to premature babies CDC link to full text Oct 25, 2002

Toys passed around from child to child or held in a communal setting should be cleaned between patient handling.

Hospital badges may be a source of contagion says a study Germs Coat Hospital Badges, Says Study Discovery News March 19, 2007

Admittance and Release

Prescreening swabs on admission to screen out and alert staff to contagion brought into hospitals by new patients.

Give all first time visitors a verbal and a written list of precautionary measures and the possible dangers.

If patient is released to home care with continuation of the antibiotic treatment before full recovery from an infection by one of the germs, patient and family should be warned of the dangers still facing the patient and make active arrangement for follow-up, retesting at the end of a prescribed series of antibiotics, what symptoms meant a relapse, and the necessary procedures to be taken with in indication of the time period within which to accomplish procedures, re-admittance, etc.

If infected by one of the hospital germs, the release forms should state clearly the fact that the patient has been infected, the seriousness of the disease, and the treatment given so that the family doctor and care givers are fully aware that the person may still be in an unstable condition thus alerting them to possible signs of relapse or continued infection.

General Medical Procedures   return top  ways reduce risk
Non-use of broad spectrum antibiotics where not absolutely necessary. See studies related to use of Narrow spectrum antibiotics in combating Clostridium difficile to reduce destruction of anaerobic flora in intestinal tract.

Surgery

Use of antibiotic one hour before surgery and stopped within the 24 hour period afterwards.

Administration

Do follow-up to make sure that staff, nursing, technical, and doctors know the rules and follow them regarding reducing the spread of infection.

Supply the necessary supplies, machines, etc which will provide for the safe and separate handling of infected and non-infected patients

Make sure that the general public and visitors know what they must do to reduce the spread of contagion to their loved ones.

Wheelchairs or beds used for transport - all parts of wheelchairs and beds in contact with patients should be cleaned between transports. All handlers should wash hands after each transport, and wear a new pair of gloves between patients.

Provide the necessary supplies of basic materials, make them available and instruct nursing staff to distribute as needed if depleted outside of cleaning staff hours.

Make sure that hospital personnel do not carry infected material, instruments, etc. from one patient to another.

Provide full and open documentation of all infections contracted by individuals while in the care of the hospital.

Provide instructions to all patients released as to what to do if any of the symptoms occur or reoccur within a 2-4 week period after release.

Provide detailed instructions to those who have undergone treatment for one of the infectious diseases as to what procedures they must go through in the course of treatment continuation, periodic lab checks, and the signs and symptoms involved in detection of reoccurrence or continuation of the infection.

Provide active follow-up by the hospital and not just "let the family doctor take care of the patient once the hospital doors close behind them".

Make sure that family doctor or those caring for the patient know of the risks, the signs of continuance, reoccurrence, necessity for follow-up checks, etc. (to the depth needed by each level of caregiver ).

Print out instructions and be sure that they are disseminated to applicable individuals as well as to the patient.

Make sure that all dishes, trays, utensils are sanitized, and provision and instructions made for this procedure along with follow-up to be sure that this is accomplished.

Related Articles
Guidelines for Environmental Infection Control in Health-Care Facilities Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) Look for Recommendations near bottom of page
Guidelines for Infection Control in Dental Health-Care Settings 2003 Look for recommendations near bottom of page
Guidelines for the Prevention of Intravascular Catheter-Related Infections (includes recommendations on pressure monitoring equipment) Look for recommendations near bottom of page Aug 9, 2002
Secret Handwashing Observation is Part of One Hospital’s War on Germs ICT (Infection Control Today)

What Can Be Done By the Insurance Groups

Medicare ends coverage for hospital errors New incentive for better care, August 12, 2007 Carol Ann Campbell, Star-Ledger Staff "Beginning next year, Medicare will stop paying for hospital mistakes." Under rules issued last week, the government insurance program will no longer pay extra to treat certain infections that patients pick up in the hospital."

What Can Be Done Through Legislation

Hospital Infection Disclosure Laws Listing of states which have passed state hospital infection disclosure laws or are considering such legislation that will give their residents important information about hospital infections. New law aims to wipe out deadly staph infection Hospitals must screen and isolate patients to fight antibiotic-resistant bacteria By Carol Ann Campbell Star-Ledger Staff "Gov. Jon Corzine yesterday signed a law requiring all New Jersey hospitals to create similar "screen and isolate" programs to fight this antibiotic-resistant bacteria, which is on the rise in hospitals around the nation."

Hospital Infection Reporting Bill Approved by Washington Senate Thursday, April 12, 2007 ConsumersUnion.org Bill Would Require Washington Hospitals to Report Patient Infections to the Public "The Washington Senate approved a bill that requires hospitals in the state to disclose the rate at which patients acquire certain infections during treatment. HB 1106, sponsored by Representative Tom Campbell, is designed to spur hospitals to improve care and reduce infections. Hospital infections kill 90,000 Americans every year according to the Centers for Disease Control and Prevention… The Department of Health would be required to publish a report on its web site that compares the health care associated infection rates at individual hospitals in the state using the date reported in the previous calendar year."

Committee to Reduce Infection Deaths Wealth of information on the problem and what can be done to reduce it.

Stop Hospital Infections.org updated references to what is being done and current status in the U.S.

ICT (Infection Control Today)

CDC (U.S. Center for Disease Control) Guideline for Hand Hygiene in Health-Care Settings

A league of superbugs 25/10/2006

The cost of doing it well is minimal against the cost of caring for patients who contract these diseases while in the hospital. In many cases, hospitals are being partially reimbursed for the extra time and cost in a number of ways so that the hospitals are not really being forced to do what is necessary to reduce the number being infected and even dying as a result.

Time spent in hospital and costs Thursday, April 12, 2007 ConsumersUnion.org An example in one state of the U.S.: "Pennsylvania has produced the most extensive reports to date based on data submitted by its hospitals. In November 2006, the state revealed that hospitals identified 19,154 patient infections during 2005 and detailed infection rates for each of the state’s 168 hospitals. The mortality rate for patients with a hospital acquired infection was 12.9 percent compared to 2.3 percent for patients without infections. Patients with infections stayed in the hospital 16 more days, on average, than patients without infections. On average, insurers paid nearly $46,000 more for patients with infections than for patients without infections."

Also see Unnecessary Deaths: The Human and Financial Costs of Hospital Infections
Table of Contents:
Third World Hygiene in Our First Class Medical System
The Major Problem: Poor Hygiene
MRSA Screening Is Essential
Preventing Infections Makes Hospitals More Profitable
Hospital Infection Is the Next Asbestos
Shouldn’t Medical Students Be Taught Hygiene?
Success Stories: Infections Can Be Eradicated
15 Steps You Can Take to Reduce Your Risk of a Hospital Infection
The Importance of Hospital Infection Report Cards

Screening patients for MRSA makes hospitals more profitable "Preventing MRSA infections costs far less than treating them. For example, in a medical intensive care unit at the University of Pittsburgh, screening tests, gowns, and other precautions cost $35,000 a year and yielded over $800,000 a year in avoided infection costs. No capital outlay was required. "Virtually all published analyses" reach similar conclusions, according to the medical journal, Lancet, in its September 2006 issue. Screening patients for MRSA makes hospitals more profitable. Most importantly, it saves lives."

First, it specifies the method of risk-adjustment for surgical site infections used by the CDC, rather than leaving the risk-adjustment method to be determined by committee

Secondly, the bill imposes civil penalties on hospitals that fail to report or flagrantly underreport their infections

Thirdly, the model bill ensures that hospital infection reporting will benefit the public, not enrich trial lawyers

Pediatric Patient Safety: Keeping Children Safe in the Hospital

CDC Recommendations For Handwashing in a Clinical Setting

Intensive Insulin Reduces ICU Morbidity and Mortality PulmonaryReviews.com, Jan 2002
LEUVEN, BELGIUM—A study of 1,548 mechanically ventilated adults in an ICU (intensive care unit) given intensive insulin treatment to keep blood glucose levels in normal range (80 to 110 mg/dL) significantly reduced morbidity and mortality. The alternative may predispose patients to "complications, such as severe infection, polyneuropathy, multiple organ failure, and death".