Committee to Reduce Infection Deaths'
14 STEPS YOU CAN TAKE
TO REDUCE YOUR RISK OF A HOSPITAL INFECTION

Most of us will have to go into the hospital some day. Here are specific steps you can follow to protect yourself from deadly hospital infections:

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 could be at stake. All caregivers should clean their hands before treating you. Alcohol-based hand cleaners are more effective at removing most bacteria than soap and water.[1] Do not hesitate to say the following to your doctor or caregiver: “Excuse me, but there’s an alcohol dispenser right there. Would you mind using that before you touch me, so I can see it?” Don’t be falsely assured by gloves. Gloves more often protect staff than patients. If caregivers have pulled on gloves without cleaning their hands first, the gloves are already contaminated before they touch you.[2]
   
   
2. Before your doctor uses a stethoscope to listen to your chest, ask that the diaphragm (or flat surface of the stethoscope) be wiped with alcohol. Numerous studies show that stethoscopes are often contaminated with Staphylococcus aureus and other dangerous bacteria, because caregivers seldom take the time to clean them in between patient use.[3] The American Medical Association recommends that stethoscopes routinely be cleaned for each patient. The same precautions should be taken for many other commonly used pieces of equipment too.
   
   
3. Ask visitors to clean their hands and avoid sitting on your bed.[4]
   
   
4. If you need surgery, choose a surgeon with a low infection rate. Surgeons know their rate of infection for various procedures. Ask for it. If they won’t tell you, consider choosing another surgeon. You should be able to compare hospital infection rates too, but that information is almost impossible to get. That is why RID is working hard for hospital infection report cards in every state.
   
   
5. Beginning three to five days before surgery, shower daily with 4% chlorhexidine soap. Drug stores that don’t stock chlorhexidine soap are generally happy to order it for you. You don’t need a prescription. One of the easiest brands to find is Hibiclens. Using this soap will help remove any dangerous bacteria you may be carrying on your own skin that could enter your surgical incision and cause an infection.[5] Keep the soap away from your eyes and ears.
   
   
6. Ask your surgeon to have you tested for Staphylococcus aureus at least one week before you come into 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 during 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.[6]
   
   
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.[7] There are many ways to keep patients warm, including special blankets, hats and booties, and warmed IV liquids.
   
   
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 be used instead of a razor.[8]
   
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.[9]
    
    
11. Ask your doctor about monitoring your glucose (sugar) levels 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 fully healed yet.[10]
    
    
12. Avoid a 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.[11]
    
    
13. If you must have an IV, make sure that it is inserted and removed under clean conditions and changed every 3 to 4 days. Intravenous catheters, or IVs, 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 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, follow the steps listed above as if you were having any other type of surgery. Most mothers-to-be probably aren’t worried about hospital infections, but if you’re having a cesarean, you are ten times more at risk of infection than if you are giving birth vaginally.[12]

Ideally, you would choose a hospital with a low infection rate. Good luck getting that information. It's impossible. Many states collect data on infections that lead to serious injury or death, but nearly every state—with the exception of 6—has given into the hospital industry's demands to keep the information secret. The federal Centers for Disease Control and Prevention also collect infection data from hospitals across the nation, but refuse to make it public. Government is too often on our backs, instead of on our side.

What's the answer? Hospital infections report cards. Hospitals object that comparisons would be unfair because hospitals that treat sicker patients, such as AIDS, cancer, and transplant patients who have weakened immune systems, will have a higher infection rate. True, but the data can be risk adjusted to make comparisons fair. What is unfair is preventing the public from knowing which hospitals have infection epidemics. Keeping infection rates secret may help hospitals save face, but it won't save lives.

[1] “Impact of Ring Wearing on Hand Contamination and Comparison of Hand Hygiene Agents in a Hospital,” Clinical Infectious Diseases 36 (2003): 1383-1390.

[2] Nearly three quarters of patients’ rooms are contaminated with MRSA, and 69% with VRE, studies show. In one study, 42% of gloves worn by hospital personnel who had no direct patient contact but who touched contaminated surfaces became contaminated. “Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications,” Infection Control and Hospital Epidemiology 9 (1997): 622-627. A Concensus Statement by a multidisciplinary group of experts asked by the American Medical Association to provide guidelines for infection control cautions that “In some cases caregivers actually go from patient to patient without changing their gloves, apparently confusing self-protection” with patient protection. “Strategies to Prevent and Control the Emergence and Spread of Antimicrobial- Resistant Microorganism in Hospitals,” Journal of the American Medical Association 275 (1996): 234-240.

[3] Routine disinfection of stethoscopes between patients is recommended by the American Medical Association. “MRSA and VRE: Preventing Patient-to-Patient Spread,” Infections in Medicine 20 (2003):194-200; “The Stethoscope: a powerful source of nosocomial infection?” Archives of Internal Medicine,157 (1997): 786-90; “Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant Enterococci,” Infection Control and Hospital Epidemiology 9 (2001): 560-564; “Recovery of vancomycin-resistant Enterococci on fingertips and environmental surfaces,” Infection Control and Hospital Epidemiology 12 (1996): 770-772.

[4] “Eradication of methicillin-resistant Staphylococcus aureus by ‘ring fencing’ of elective orthopaedic beds,” British Medical Journal 329 (2004): 149-51. Visitors who sit on a chair or lean on a cabinet, then sit on the bed are transferring bacteria to the patient’s bedclothes. “MRSA and VRE: Preventing Patient to Patient Spread,” Infections in Medicine 20 (2003):194-200.

[5] The following three studies support this suggestion : (1) L. J. Hayek and J.M. Emerson, “Preoperative whole body disinfection – a controlled clinical study,” Journal of Hospital Infection (1988) vol.11, supplement B, 15-19 This study showed that two chlorhexidine showers reduced total infection rate by 30% and Staph aureus infections by 50%.staph. (2) D. J.Byrne, A.Napier, and A. Cuschieri, “Rationalizing whole body disinfection,” Journal of Hospital Infection (1990), vol. 15: 183-187. This study shows that a single shower does not maximizre skin disinfection. The authors conclude that three showers should be recommended. (3)Daryl S. Paulson, “Efficacy Evaluation of a 4% Chlorhexidine Gluconate as a Full-Body Shower Wash,” published by the Association for Practitioners in Infection Control (1993). This study found that showering for five days with chlorhexidine yielded maximum results for reducing bacteria on the skin, and keeping it low for 24 hours or more. “a 1 or 2 day presurgical application period is simply too short to establishthe necessary levels of residual antimicrobial properties to be of value in reducing postsurgical infection rates.”

[6] The Institute for Healthcare Improvement guidelines for improving infection prevention state that:
“Administration of prophylactic antibiotics beginning 0 to 1 hour prior to surgical incision decreases the risk of surgical infection. www.ini.org/IHI/Topics/PatientSafety/SurgicalSiteInfections/ImprovementStories accessed 10-14-02.

[7] Ibid., the Institute for Healthcare Improvement Guidelines for improving infection state that “surgical patients with core temperatures greater than 36 degrees C./ 98.6 degrees F are less likely to get an infection.”

[8] Ibid., the Institute for Healthcare Improvement states that “clipping instead of shaving results in decreased infection rates,” and recommends that patients be told “not to shave the surgical site for 72 hours prior to surgery.”

[9] “Operating Room Environment” Clinical Orthopaedics and Related Research 369 (1999): 103-109.

[10] Pittsburgh Regional Healthcare Initiative, “PHRI Executive Summary,” (June, 2005).

[11] Urinary tract infections are the most common hospital-acquired infections. Limiting their use and duration reduces risk of infection. “Catheter Associated Urinary Tract Infections in Neurology and Neurosurgical Units,” Journal of Infection 44 (2002): 171-175.

[12] Carol A. Killian, EileenGraffunder, Timothy J. Vineiguerra, Richard A. Venezia, “Risk Factors for Surgical-Site Infections Following Cesarean Section,” Infection Control and Hospital Epidemiology, (October, 2001) vol. 22, no. 10.

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