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Healthcare-associated infections (HAI) are a major public health problem world wide. HAI are the most common complication affecting hospitalized patients, with between 5 and 10 percent of inpatients acquiring one or more infections during their hospitalization. It is estimated that in the United States there are 2 million hospital-acquired HAI each year. They account for an estimated 99,000 deaths each year. HAIs add $4.5 to $5.7 billion in healthcare costs. Experts generally believe that at least 20-30% of these infections are preventable. This is increasing more and more every year. Anyone who is a patient in any type of healthcare facility, whether hospital, nursing home, or clinic, is at risk of developing an HAI. You, as a healthcare consumer, need to know some basics in order to protect yourself and your loved ones from ending up with an HAI.

The most common HAI’s are urinary tract infections (32 percent), surgical site infections (22 percent), pneumonias (15 percent), and bloodstream infections (14 percent).

Most states have passed legislation mandating the reporting of HAI data or have similar legislation pending, with varying reporting requirements. This sounds great, except there is, as yet, no consistent way developed to report the data and make it understandable to the public. It is like comparing apples to oranges to grapes to juice to wine to bees to etc… You get the idea.

What should you watch for when you are a patient in a facility?

The number 1 defense is hand washing. All staff should be washing their hands before and after caring for you or touching anything in your environment. Hand washing can prevent potentially fatal infections from spreading from patient to patient, and from patient to healthcare worker and vice-versa. Be proactive – watch what the staff are doing in your room. Ask politely, but insist they wash their hands before they touch you. Even if they say they did it before they came in, I personally would ask then to do it again. You can’t be too safe! If they balk – tough. I’m the patient and I’m the one who is most likely to get an HAI. As a nurse and as a surveyor I have seen way too many bad outcomes from a patient getting an HAI which can be one that is resistant to most antibiotics. People die from HAIs that have gone past the point of treatment.

Most hospitals today will have those alcohol-based gel cleansers, and they are fine for some things. The alcohol-based gel cleansers, though, are not a substitute for good old fashioned hand washing. According to an article published by the CDC in March of 2006, the alcohol content in the sanitizer should be of sufficient strength to be effective. Tests have shown that those with a 60% alcohol content?are more effective. The alcohol-based gels are also not effective in situations such as when there is visible material on the hands, such as dirt, body fluids, etc. Anoher important thing to realize is the alcohol-based gels are not effective in the case of Clostridium Difficile.

Clostridium Difficile is an infection of the intestines. It occurs for several reasons, one of which is the overuse or inappropriate use of antibiotics. Alcohol is not effective against the Clostridium Difficile spores, which can live for many months on animate and inanimate objects, and therefore can be passed easily onto others who are in an environment in which the spores are present.

Watch the staff; make sure they wash their hands. Don’t be afraid to ask the physicians and residents and everyone who enters your room to wash their hands. Also, remember, the use of gloves does not replace hand washing.

Ask questions about what you are getting and why. Why and what antibiotics are being received? How often are those dressings supposed to be changed? What process is there to be for changing the dressing. What about that Intravenous line, what is in it? How long is it supposed to be in? How long is a “bag” good for? Watch the staff as they work with any line that goes into your body; are they taking clean, sterile precautions to ensure you don’t get an infection from that line? Is your loved one on?a ventilator (a machine that breaths for them)? How are the staff taking care of it? How often is the tubing changed? Someone on a ventilator should ideally not be in a flat position. It leads to a risk of what is called Ventilator Associated Pneumonia (VAP). Ask questions, and know what is supposed to happen so you can make sure it does happen.

Also remember that a clean environment is important. Watch when your room is being cleaned, how often is it being cleaned? What are they doing to clean the room? Are the housekeepers cleaning every area or just wiping off a few things. Do they use a clean cloth and mop in your room or are they using the same cloth and mop from room to room. HINT: That is not a “good thing”. The cloths and mops should be changed between rooms.

Be proactive and protect yourself and your loved ones. You have a right to be safe!

JL

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