No one wants to go to the hospital, and certainly no one wants to get sicker while they are there. However, germs lurk throughout hospitals, giving you a pretty good chance you could acquire a serious hospital infection. Unfortunately, healthcare-associated infections (HAIs) are common enough that any patient is at risk. Furthermore, these infections can be very serious, and can even be fatal. Although any patient can develop an HAI, some patient characteristics, and some conditions and treatments, increase the risk. Therefore, it’s important that you learn how to protect yourself from hospital infections – before you go to the hospital.
Before I dive into this topic, I want to clarify a few things. When I refer to “hospital infections”, I’m actually referring to the broader category of “healthcare-associated infections” which can develop at a range of healthcare facilities. The medical and scientific community often use the term “healthcare-associated infections” because it covers the full range of patient facilities, but for reading ease, I also use the term “hospital infections”.
What is a healthcare-associated infection?
HAIs are infections that people catch when receiving care in any type of healthcare facility, including hospitals, surgical centers, doctors’ offices and clinics, and long-term care facilities such as nursing homes and rehabilitation facilities. However, an infection is also considered an HAI if it develops within 30 days of receiving health care.
How do patients develop hospital infections?
Exposure to germs can lead to infections.
Unfortunately, in healthcare settings, germs can easily spread to and between patients. How? Germs can get into your body through contact with your eyes, nose, mouth, genitals, and/or open wounds.
These germs can come through the air, or from your own hands if you touch contaminated surfaces.
Additionally, others can transmit germs to you if they touch you without properly cleaning their hands after touching contaminated surfaces or sick patients. Lastly, you can also get infected from contact with contaminated medical instruments.
Importantly, dangerous germs like C diff. and MRSA can live on surfaces for days and can transfer back and forth between people, equipment, and other surfaces.
What types of infections can patients develop?
Although there are many possible infections, common healthcare-associated infections include:
- Urinary tract infections.
- Surgical site infections.
- Bloodstream infections.
Importantly, two of the worst superbugs, C diff. and MRSA, are common and deadly.
How serious are hospital infections?
Hospital infections can be quite serious, even life-threatening. In fact, the US Centers for Disease Control and Prevention (CDC) estimates that healthcare-associated infections lead to 99,000 deaths every year in US hospitals. If an infection doesn’t kill you, it can cause a variety of unpleasant, sometimes difficult, symptoms, including fevers, shortness of breath, and headaches.
And, infections can increase your time in the hospital, lead to a return trip to the hospital, and impede your recovery.
For example, patients who develop infections related to surgery spend an average of 6.5 additional days in the hospital as compared to patients without infections. Moreover, infected patients are 5 times more likely to be readmitted after discharge, and twice as likely to die.
Importantly, surgical patients who develop infections are 60% more likely to be readmitted to an intensive care unit.
How common are these infections?
The CDC report that on any given day, about 1 in 31 hospital patients has at least one healthcare-associated infection (HAI). Additionally, according to the CDC, HAIs account for an estimated 1.7 million infections every year in US hospitals.
The COVID-19 impact on hospital infection rates.
In September, 2021, a CDC report showed the incidence of healthcare-associated infections (HAIs) rose as much as 47% from 2019 to 2020.
The most common HAIs were bloodstream infections associated with central lines — catheters inserted directly into large blood vessels and kept in place over long periods of time. Additionally, infections from the use of ventilators increased significantly, as did catheter-associated urinary tract infections, and antibiotic-resistant Staphylococcus aureus infections.
Interestingly, the analysis of ventilator-associated infections found a large increase in the rate of infections, not just the number of infections. This indicates that the higher infection rates were not just the result in the increased use of ventilators.
Why the increase in infection rates?
Certainly, the use of central lines, ventilators and urinary catheters increased significantly to care for COVID-19 patients. Additionally, hospitals faced shortages of staffing and supplies. Plus, it’s not hard to imagine how infection control measures could be pushed aside as very stressed, exhausted, overworked staff struggled to care for so many extremely sick patients. On top of all this, government oversight of hospital infection programs was lacking throughout COVID-19.
What increases your risk for hospital infections?
Any patient in any healthcare facility can develop an HAI. But, some patients are more at risk than others. Patients with a greater risk include:
- Young children.
- People with compromised immune systems.
Additionally, other factors that increase the risk of developing an HAI include:
- Long hospital stays.
- Failure of healthcare workers to wash their hands.
- Overuse of antibiotics.
- The use of:
- Catheters inserted into patients’ bladders.
- Central lines inserted into patients’ veins.
- Implants and prostheses.
What do hospitals do to prevent infections?
Generally, hospitals have infection prevention programs to reduce the risk of hospital infections, although some do a better job than others.
Interestingly, several studies suggest that even simple infection-control procedures such as cleaning hands with an alcohol-based hand sanitizer can help prevent HAIs, save lives, and minimize health care costs.
The CDC provides a list of Standard Precautions that are the minimum infection prevention practices that apply to all patient care, in all patient settings. Their guidelines include direction on:
- Hand hygiene.
- Use of personal protective equipment (e.g., gloves, masks, eyewear).
- Respiratory hygiene / cough etiquette.
- Sharps (needles, etc.) safety.
- Safe injection practices.
- Sterile instruments and devices.
- Clean and disinfected environmental surfaces.
Interestingly, some new infection-control programs show very promising results. Below are a few examples of hospital efforts that have reduced infection rates.
Bathing and nasal cleansing reduced bloodstream infections.
A study published in 2013 reported that bathing and nasal cleansing (with antimicrobial soap and ointment) of all ICU patients led to a significant reduction of infections.
For instance, these efforts decreased MRSA-positive infections by 37% and bloodstream infections from any type of pathogen by 44%. Interestingly, the research took place in hospitals that had previously implemented national guidelines for preventing healthcare-acquired MRSA infections.
Following on the success of the ICU study, researchers embarked on another study to evaluate similar strategies in non-ICU patients. This research, published in 2019, found that nasal cleansing and patient bathing with antimicrobial solutions significantly improved the infection rate for patients with medical devices such as catheters and drains.
For these patients, there was a 30% decrease in bloodstream infections, and an almost 40% reduction for antibiotic-resistant bacteria, including MRSA. There was no significant difference in infection rates among the general hospital population.
However, patients with devices have a high risk for bacterial infections: 37% of all MRSA cases and over 50% of bloodstream infections are in patients with devices. Therefore, reducing the risk for these vulnerable patients is a huge step forward.
Pre-surgical bathing instructions may reduce infections.
Since surgical-site infections can occur when there are bacteria on the patients’ skin before operations, surgeons instruct patients to diligently wash the impacted body part with antimicrobial soap for a specific amount of time before they arrive at the hospital for their surgery.
But patients do not always use the right soap or wash for as long as required, putting themselves at risk. A program at Dignity Health in California provides a kit with soap, a timer and a shower card with instructions. Preliminary results indicate the program helps reduce surgical-site infection rates.
Regular toothbrushing reduced pneumonia rates.
Researchers found that when patients brushed their teeth twice/day, there was a 92% reduction in hospital-acquired pneumonia cases (for patients who were not on ventilators).
The researchers note that although this seems like a very simple mandate to implement, there are some barriers in hospitals, including:
- Hospital staff often feel that toothbrushing and other oral care is not an essential task but is an optional daily care activity for a patient’s comfort.
- The quality of toothbrushes and other oral care supplies at hospitals is often poorly designed or in limited supply.
Why do infections persist?
With government mandates and hospital programs, why do infections persist? According to a Consumer Reports article, there are two prime factors:
- Patients with very serious infections are treated close to other patients, by the same employees using the same equipment.
- There is widespread use of antibiotics, often inappropriately, which encourages growth of these superbugs that are immune to antibiotics and that kill off a patient’s protective bacteria.
How can you protect yourself if you have to go to the hospital?
Fortunately, there are many steps you can take to protect yourself from hospital infections, including issues to consider before, during and after a stay. Although the suggestions below focus on hospital infections, many of the tips apply to nursing home stays as well.
Handwashing is key to protect yourself from hospital infections!
One of the most important things you can do as a patient or family caregiver is to make sure all medical personnel wash their hands before touching the patient, or any medical instrument.
According to the CDC, in healthcare settings, “handwashing can prevent potentially fatal infections from spreading from patient to patient and from patient to healthcare worker and vice-versa”.
Furthermore, a 2009 study stated that hand hygiene is the single most important factor to prevent healthcare-associated infections. Unfortunately, researchers found that health professionals are only washing their hands 50% of the time.
Don’t be shy about asking your doctor, or other staff member, to wash their hands and/or put on new gloves. Your health, and even your life, could depend on it!
And don’t forget about everyone else! Patients, family members and guests should frequently wash their own hands as well.
For more information, read Handwashing in Healthcare Could Save Your Life!
Before you go to the hospital.
You can, and should, evaluate hospitals in your area to determine how well they control infections and other safety hazards. Your hospital might not do as good a job as you would expect.
Interestingly, Consumer Reports found that hospitals with strong infection-reduction programs take the following steps:
- Use antibiotics wisely by making sure patients get the right drug, at the right time, and at the right dose.
- Monitor the use of broad-spectrum antibiotics.
- Keep surfaces clean or replace items between patients.
- Encourage hand hygiene through hospital wide programs.
Ask your doctor how his/her hospital reduces the risk of hospital infections, including how they address the 4 items above.
Additionally, you can find information on many websites that provide information on safety measures in Zaggo’s Resource Center, including Medicare’s Care Compare site and The Leapfrog Group’s website. Although take the information provided with a grain of salt – it’s unclear how accurate some of the ratings systems are.
While at the hospital.
- Ask about MRSA testing, which staff can easily test with a nasal swab.
- Insist on room cleanliness – if your room looks dirty, ask for a cleaning.
- Bring your own bleach-based wipes. Regularly clean the bed rails, TV remote, doorknobs, tray table and anything else you touch.
- Make sure ALL visitors and staff should all wash their hands upon entering the room and before touching the patient. Patients should wash their hands frequently as well.
- When/if a doctor prescribes antibiotics, ask your doctor if they are needed and appropriate.
- If heartburn drugs are prescribed, ask your doctor if they are needed since they reduce stomach acid and increase the risk of C diff. If you must take them, ask for the lowest dose possible.
- Every day, ask staff if they can remove catheters, ventilators, and any other tubes. The longer these devices are in place, the higher the risk of infection.
- If the doctor needs a part of your body shaved, ask the staff to use an electric hair remover. Razors can nick the skin, providing an opening for an infection.
Additionally, based on the recent research successes outlined above, it’s a good idea to:
- Ask if you could benefit from nasal cleaning and bathing with antimicrobial solutions.
- Brush your teeth twice a day. Ask a loved one to help you if necessary.
And, before you leave the hospital, ask the doctor how to protect yourself from hospital infections. Additionally, ask what signs of infection to watch out for, and what to do if you see signs. For more information, read Tips for Hospital Discharges.
After a hospital stay.
When you, or your loved one, returns home after a hospital stay, consider these suggestions to reduce your risk of infection:
- Assume there is a chance the patient was exposed and therefore may develop an infection.
- Watch for warning signs, including “fever, diarrhea, worsening pain, or an incision site that becomes warm, red, and swollen”.
- Take extra precautions by practicing good hygiene:
- Clean frequently touched surfaces with a solution you can make with 1 part bleach to 10 parts water.
- If possible, reserve a bathroom specifically for the use of the patient.
- Don’t share toiletries or towels. If necessary, use paper towels instead of cloth hand towels.
What else can you do to protect yourself from hospital infections?
There are many steps that patients you can take, along with your family members, to protect yourself from hospital infections. Read these posts for more information:
- Germs in Hospitals and Doctor Offices – Watch Out!
- Why is Sepsis so Dangerous?
- How do you Get C. Diff Infections?
- What you Need to Know about C. Auris.
- What You Need to Know About Pressure Sores.
- What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
- Is Your Hospital Safe? Are Programs in Place to Avoid Dangerous “Never Events”?
NOTE: I updated this post on 9-28-21.