By Michelle Gardner
According to Richard Sim, RN, MBA, nosocomial (hospital-acquired) infections result in substantial morbidity, prolonged hospital stays, increases in direct patient-care costs and mortality.1 The incidence of nosocomial infections continues to affect about 5 percent of hospitalized patients. There is evidence that active hospital infection control programs lead to reduced infections and safer patient care.
The Centers for Disease Control and Prevention (CDC) reports nearly 2 million patients annually get infections while being treated for other illness or injury, and nearly 88,000 die as a cause of these infections. The CDC says nearly $5 billion is added to U.S. health costs every year as a result of infections patients get while hospitalized for other health problems. The costs result largely from extended hospital stays and the use of medical and therapeutic resources, including antibiotics to treat these infections.
"We are working at the terrible disadvantage that people can't see germs," says Leona Ayers, MD, professor of pathology at Ohio State University in Columbus. "People think hands that heal can't hurt, but they can. People are in a hurry and think an immediate task is more important than washing their hands. Wearing personal protective equipment (PPE) and washing your hands between patients should not require thought, it should be an automatic part of practice; otherwise, you will forever fail at infection control. It should be that well-trained professionals will feel uncomfortable if they have not washed their hands or put on gloves."
And it is Diane Major's job to make sure this happens. Major, RN, MSN, is the director of the learning resource center at Fairfield University's School of Nursing in Fairfield, Conn. The nursing simulation lab teaches skills modules encompassing infection control and asepsis, vital signs, body mechanics and patient hygiene.
"We talk about nosocomial infections, the chain of infection, nonsterile and sterile gloving and handwashing in the asepsis unit," shares Major. "We address it again in the urinary and wound care units. We impress upon the students that gloving is not enough; you have to wash your hands before and after because bacteria and microorganisms are always present. For a patient to become infected, you have to have a susceptible host, a mode of transmission and the organisms. If any of those are disrupted with handwashing or if the patient is healthy and young, chances are they will break the chain and infection will not occur."
Major admits that, at first, students are careful about washing their hands and using gloves, but as they get more confident, they aren't as cautious. "It is a lot of responsibility at once," she says. "They get wrapped up in the task at hand and don't think about what they don't see ... the bugs. Initially, students don't know about a sterile field -- what can you touch, what can't you touch? When I am teaching, I have them pretend everything is coated in black ink. If you touch anything outside that sterile field, you have black ink on your hands."
Cheryl Phillips, MD, of Sutter Medical Group in Sacramento, Calif., educates nursing home staff and family members by first telling them about infectious organisms. "When methicillin-resistant Staphylococcus aureus (MRSA) was first an issue in clinical settings, there was this panic that it was a supervirulent bug that was going to attack healthy people. There were bizarre impressions about these killer organisms that had no sensitivity to any antibiotics," she says. "Staphylococcus is in our noses, mouths and on our skin; it is widely present. MRSA is no more aggressive, but if you get infected, it is resistant to antibiotics commonly use to treat Staph infections. These are not bugs that jump out at you, but they are carried on things like bed rails, linens, on your hands and in fluids."
It's a Team Effort
As stated by the American Association for World Health (AAWH),2 health professionals have a fundamental responsibility to prevent infectious diseases by following hygienic practices in their work (e.g., washing their hands after touching a patient) and they should be immunized against vaccine-preventable diseases, according to public health recommendations.
Physicians must recognize infectious diseases, report notifiable diseases to the public health authorities and be alert to detect abnormal situations or syndromes that may indicate the presence of an infectious disease or an outbreak. Physicians can help reduce the development of antimicrobial resistance by prescribing antibiotics only when they are necessary, by prescribing correctly, and by insisting their patients understand the need to take the complete course of therapy.
Nurses must strictly follow procedures to prevent nosocomial infections and they should educate patients on how to minimize the risk of disease transmission.
In the end, each of us must take charge of our own health and learn how disease threats can endanger our families and our communities: knowing how infectious diseases spread, how they can be prevented, when they can turn dangerous and what to do if a family member is exposed.
Ten Things to Do to Prevent Infectious Diseases
1. Keep immunizations up to date. Follow recommended immunizations for children, adults and pets.
2. Wash your hands often, especially during cold and flu season. Be sure to wash hands after using the bathroom, before preparing or eating food, after changing a diaper, after blowing your nose or sneezing or coughing, after caring for a sick person and after playing with a pet.
3. Be aware of what you eat and how you prepare it. Keep hot foods hot and cold foods cold until eaten or cooked. Wash counters, cutting boards and utensils frequently with soap and hot water, especially after preparing poultry or other meats.
4. Use antibiotics exactly as prescribed. Take them for the full course prescribed by your doctor, but not for colds or other nonbacterial illnesses. Never self-medicate with antibiotics or share them with family or friends.
5. Report to your doctor any quickly worsening infection or any infection that does not get better after you take a prescribed antibiotic.
6. Be cautious around all wild animals and unfamiliar domestic animals. After any animal bite, clean the skin with soap and water and seek medical care immediately.
7. Avoid areas of insect infestation. Use insect repellants on skin and clothing when in areas where ticks or mosquitoes are common. If you have visited wooded or wilderness areas and are now sick, your doctor needs all the details to diagnose both rare and common illnesses quickly.
8. Avoid unsafe, unprotected sex and injecting drug use.
9. Stay alert to disease threats when you travel or visit undeveloped areas. Get all recommended immunizations, and use protective medications for travel, especially to areas with malaria. If you become ill when you return home, tell your doctor where you've been.