A hospital is the worst place to be when you’re sick…
Staph Infections Are Too Common
Is your hospital staff carrying a deadly weapon? Despite disposal of needles and diligent sanitation of most hospital surfaces, at least two people I know contracted pneumonia in a hospital while receiving care for another illness. (Patients on breathing machines are more likely to contract it.)
A friend who was admitted to the hospital with a diabetic foot developed a staph infection resulting in a leg amputation that brought about more health problems. Each of these people either died in the hospital or within a short time after being discharged due to unforeseen complications occurring while being treated for a primary illness.
Staph infection is caused by members of the Staphylococcus genus of bacteria. Commonly inhabiting the skin and nose where they are innocuous, they may also enter the body through minor cuts or abrasions. The staph can spread to a number of body systems and organs, including the heart, where the toxins produced by the bacterium may cause cardiac arrest.
Who Goes To The Hospital To Get Sicker?
Such situations led a hospitalist caring for my father-in-law to make the paradoxical statement: “A hospital is the worst place to be when you’re sick. The only worst place to be when you’re sick is not in a hospital.”
More than 8,000 people a year die from surgical site infections (SSIs) picked up in hospitals. The Centers for Disease Control and Prevention (CDC) estimates roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.
Primary defensive measures continue to be thoroughly scrubbing both sides of hands and fingernails, sterilizing the skin before puncturing or cutting it, and using sterilized equipment. But infection continues to pervade medical centers.
The only worst place to be when you’re sick is not in a hospital.
Candida auris has been around since 2016. Unlike other species of Candida, C. auris spreads more easily from person to person, according to the CDC. It survives on surfaces even after routine cleaning, making health care settings like hospitals and nursing homes a breeding ground. A study says 22 percent of privacy curtains may harbor multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA).
Despite defensive measures, the grim statistics seem to favor outpatient care versus prolonged hospital stays. But why does what arguably should be one of the most sanitary environments lead to so many life-threatening infections?
If you start playing the blame game, there could be any number of third-parties at fault: Harmful bacteria is sometimes introduced through the food chain. (Do not sneak food from outside into hospitals.)
Germs may be transported from visitor contact. Doctors, nurses, or staff who interact with multiple patients run the risk of transferring illness. A routine medical examination can be the genesis of a bacterial infection if proper hygiene is not practiced by anyone having contact with a patient.
Beware of Stethoscopes
Watching a doctor care for you can seem like an attempt to discover the secret behind a sleight-of-hand trick. The physician enters the examination room, immediately squirts his hands with sanitizer or scrubs them in the nearby sink before touching your body.
He or she then listens to your heartbeat or asks you to breathe deeply while applying a stethoscope to your chest or back. Did you miss something? Is that the same stethoscope used on the prior who-knows-how-many ill patients?
The stethoscope may become the conduit of infection passed from one patient to another.
If such a legerdemain was exposed in a casino, the doctor might be ejected from a gambling table. By washing his hands and then applying a contaminated medical instrument to patients’ skin, there is only an illusion of cleanliness. Germs can be transferred to the doctor’s washed hands from the stethoscope. The instrument may become the conduit of infection passed from one patient to another.
You could theoretically leave the exam room to pick up a prescription for one ailment, develop a rash, and assume it is a side effect of the medication. In some cases, what is transferred may be more serious than the original illness.
Identifying and Minimizing Infection Sites
A research study of 71 patients by three doctors at a Swiss hospital over a period of five months has suggested that stethoscopes may spread bacteria, including MRSA, inside hospitals. After a patient examination with sterile hands and stethoscope, the part of a doctor’s hands most highly contaminated with bacteria was the fingertips, followed by the diaphragm of the stethoscope.
This study serves as an important reminder for doctors and other health professionals about the potential risks of cross-contamination if hospital equipment (not limited to stethoscopes) and hands are not disinfected between one patient and the next.
Bare Below the Elbows (BBE), with variation among facilities, is a physician dress code defined as wearing short sleeves, no fabric, and in some cases no wristwatch or jewelry (wedding band sometimes exempted), below the elbows during clinical practice.
In 2007, the United Kingdom began requiring physicians to practice BBE, effectively banning the wearing of long sleeves (including scrub jackets and white coats) and watches, wristbands, bracelets, and rings on the hand, wrist, or lower arms.
The aim of the European BBE mandate is to enable better hand and wrist hygiene, and to minimize the transfer of bacteria that might be contaminating the cuffs or sleeves of healthcare practitioners’ attire.
Furthermore, coat hooks should be readily available to encourage wearers to remove and hang up their lab coats or long-sleeved jackets before entering a patient’s immediate environment. In its place, a disposable protective gown or apron may be used with each patient, much as one would wear when performing surgery. Neckties, if worn, should be secured so as not to drape over contaminated patients and surfaces.
A research study at a United States children’s hospital sought to determine if easily-accessible visual reminders to sanitize stethoscopes improved compliance. By having a basket of individually packaged 70% isopropyl alcohol prep pads with an encouraging sticker outside each patient room, disinfection compliance increased significantly from a baseline of 34% to 59% post intervention. The study did not record patient outcomes.
So what can you do as a patient to minimize infection? Request visual confirmation of sanitation compliance among medical personal and visitors. (Politely ask those caring for you to wash their hands.) Take note of whether a new needle is used and properly disposed of.
Ask that instruments like stethoscopes, blood pressure cuffs or other communal equipment be wiped down with an alcohol pad before coming in contact with you. Avoid embraces and handshakes. Do not stay longer than necessary.
When going to the hospital to encourage patients, adhere to rules regarding a limited number of visitors in hospital rooms, wash thoroughly before and after visiting. Refrain from going if you have a known infection, even if minor, so everyone can remain A Bit More Healthy.
- Hospital-acquired pneumonia. medlineplus.gov/ency/article/000146.htm (Jun 12 2019)
- Staphylococcal infection. en.wikipedia.org/wiki/Staphylococcal_infection (Jun 12 2019)
- Why Are Hospitals the Worst Place to Be When You Are Sick? huffingtonpost.com/judith-johnson/health-care-reform_b_817892.html (Jun 12 2019)
- 5 Infectious Diseases You Might Get in the ER. howstuffworks.com/medicine/5-infectious-diseases-you-might-get-in-er.htm#page=1 (Jun 12 2019)
- Superbug fungus a 'serious global health threat' as over 600 in US are infected: CDC. abcnews.go.com/health/superbug-fungus-global-health-threat-600-us-infected/story?id=62297532 (Jun 12 2019)
- C. auris: CDC’s Response to a Global Emerging Threat. cdc.gov/drugresistance/solutions-initiative/stories/cdc-response-to-global-threat.html (Jun 12 2019)
- Hospital Privacy Curtains Attract Some Scary Germs. webmd.com/a-to-z-guides/news/20190412/hospital-privacy-curtains-attract-some-scary-germs (Jun 12 2019)
- Stethoscopes could spread hospital infections. nursingtimes.net/news/behind-the-headlines/stethoscopes-could-spread-hospital-infections-11-03-2014/ (Jun 12 2019)
- Zúniga A, Mañalich J, Cortés R. Stethoscope or staphyloscope?: Potential vector in nosocomial infections. Rev Chilena Infectol. 2016 Feb;33(1):19-25. Spanish. doi:10.4067/S0716-10182016000100003. PMID: 26965873.
- Bare Below the Elbows: Myth or Matter? appliedsilver.com/bare-below-the-elbows-myth-or-matter/ (Jun 12 2019)
- Bare below the elbow and implications for infection control. infectiousdiseaseadvisor.com/home/decision-support-in-medicine/hospital-infection-control/bare-below-the-elbow-and-implications-for-infection-control/ (Jun 12 2019)
- Department of Health: Uniforms and Workwear (PDF). webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_078435.pdf (Jun 12 2019)
- Improving Stethoscope Disinfection at a Children's Hospital. medscape.com/viewarticle/813432?src=wnl_edit_specol&uac=153268ER (Jun 12 2019)
- Photo by Dirima licensed from iStockPhoto.