Every year 35 million Americans are admitted at least once into hospital care. Every year 1.4 million Americans catch some kind of infection while they are hospital patients, and over 75,000 die as a result. More Americans die from infections they catch in the hospital than die from airplane crashes, terrorist attacks, lung cancer, breast cancer, prostate cancer, or AIDS. As antibiotic resistance spreads around the world, many of these infections are difficult or impossible to treat. It is only in very recent years, however, that hospitals have started doing anything about these facts.
Hot Zones in the Hospital
About 25 percent of all nosocomial (hospital-acquired) infections, about 350,000 infections a year, are spread by contaminated devices. These infections are spread by urinary catheters, ventilators, and central lines, also known as central venous catheters, which are IV lines that are inserted in the neck, chest, or groin, and allowed to stay in place for days or weeks at a time.
Hospitals have been making progress in controlling infections spread by these kinds of devices for several years. Urinary tract infections spread by catheters, pneumonia spread by ventilators, and "blood poisoning" caused by central lines are less common than they were even in 2010. However, there are other kinds of infections that are still far from controlled.
- About 280,000 patients every year develop surgical-site infections. In 2012, an antibiotic-resistant strain of Klebsiella that appeared in a Centers for Disease Control facility escaped containment and killed dozens of people. (The writer of this article caught this strain in hospital and was sick for months.) Thousands more are infected with methicillin-resistant Staphylococcus aureus, also known as MRSA.
- About 280,000 patients every year contract pneumonia through the hospital ventilation system.
- About 230,000 patients every year contract gastrointestinal infections, about 2/3 of them with the bacterium Clostridium difficile.
Most hospitals don't even keep track of infections other than those caused by MRSA or Clostridium. To be fair, hospital infections are much less common in the United States than they were in the 1970's or earlier, and some estimates put the total number of infections per year at less than 1 million. However, hospitals still have a long way to go to make their wards infection-proof.
Are You Someone Who Is Likely to Catch an Infection in the Hospital?
The procedures most likely to result in a hospital-acquired infection are amputations of the toes or feet, hip replacement, colostomy (removal of the colon), and small bowel surgery. The older a patient, the more likely he or she is to contract an infection in the hospital. Patients in critical care or the ICU are more likely to catch infections, and the longer someone stays in the hospital, the more likely he or she is to catch something.
Larger hospitals are more likely to have problems with infections than smaller hospitals, and hospitals that treat patients from all over the world, that is, prestigious hospitals that are well known for certain kinds of care, seem to treat patients with more infections. Getting IV antibiotics before a procedure is no guarantee one will not get an infection, and neither is getting tested for infections (with nasal swabs or rectal swabs) when you are admitted to the hospital.
What You Can Do to Avoid Catching an Infection When You Are in the Hospital
A lot of the burden of keeping your hospital experience infection free, of course, rests with your hospital. Their procedures are critical to your health. However, there are thing patients can do to lessen the risk of hospital-acquired infection.
- When you have a choice, choose a smaller hospital over a larger hospital. This is especially the case if you are having colon or hip replacement surgery. You want a hospital that has all the equipment and medical expertise you need, but not necessarily a huge, sprawling medical complex.
- Ask that your doctors and nurses wash hands before examining you. Many healthcare professionals don't automatically do this. It's OK to ask, "Excuse me, but before you examine me, could you use the handwash?" Alcohol-based handwashes kill more germs than soap and water, and are usually available in every hospital room.
- Don't assume that the gloves healthcare workers protect you against infection. If the healthcare didn't wash hands before putting on the gloves, the glovers are infected.
- Before the doctor or nurses touches your skin with a stethoscope, ask that the diaphragm (the flat part of the stethoscope) be wiped with alcohol. Stethoscopes can transmit bacteria, including MRSA.
- If you have to have a central line, ask your doctor to use a catheter that is impregnated with antibiotics or coated with silver chlorhexidine to prevent infections. If you have an IV port in your wrist or arm, make sure it is changed every few days to prevent infections. Hospital nurses will usually replace any IV's you receive in an ambulance for this reason. It can be unpleasant to get an IV, but it is more unpleasant to get an infection.
- If you know you are having surgery ahead of time, starting bathing with chlorhexidine soap 5 to 7 days before the procedure. This will kill many of the bacteria living on your skin without causing antibiotic resistance.
- Ask about warming blankets in the operating room. Your body can resist infection better when you are warm. Especially when the surgical procedure involves high-tech imaging equipment, it is likely to be kept very cold. Blankets, booties, and caps can keep you warm (although many times what you will get is a pre-heated blanket).
- Don't shave the surgical site yourself before the procedure. This can break the skin and increase the risk of infection.
- Avoid touching your hands to your mouth, and do not set utensils or food on anything other than your food tray. This will help you avoid exposure to Clostridium dificile.
- If you are diabetic, be careful about monitoring your blood sugar levels before your procedure. Bacteria thrive on high blood sugar levels. Controlling blood sugar levels is especially important after heart surgery.
- Make sure any IV line you receive in the hospital is replaced under clean conditions every 3 or 4 days. Your skin should be cleansed at the site of the new IV line, and your nurse should be wearing gloves to do the insertion. Let your nurses know immediately if any redness occurs around an IV port.
- If you can take yourself to the bathroom, wash your own hands both before and after using the toilet. Washing your hands before you touch infection-susceptible parts of your anatomy can reduce the risk that you will transfer infections from your hospital bed or other hospital room surfaces to your body.
Hospitals don't make it easy to get information on how well they control infections. You may have to rely on your own observations. Most medical personnel, however, no matter how overworked, will be glad to cooperate to keep you well.