Patient Safety--Infections 2

“Jaded Julie, back in my professorial days I was advised never to teach everything I know about a topic.”

“But you’ve been violating that rule almost weekly for the past year-and-a-half, Curmudge. And now you are going to teach health care professionals how to minimize nosocomial infections? Isn’t that rather presumptuous for someone whose current intellectual occupation is lawn mowing and snow blowing?”

“Wrong, Julie. As I’ve said before, a blog doesn’t teach. A blog inspires, reminds, refreshes, and sometimes incites; but it’s too short to teach.”

“Okay, have at it. But be sure to cite references so our readers will realize that the info we are passing along is from people who know what they are talking about.”

“To begin, I think health care workers should read last week’s blog to get a ‘heads up’ on what patients are expecting. Then you won’t be surprised when a patient asks you to swab your stethoscope with alcohol (1). And a male physician should be careful not to drag his never-cleaned necktie across a patient’s tummy during an examination (2). In addition, they should jog their memory by skimming Wikipedia’s overview on nosocomial infection (3); there are topics there that we won’t have space to cover.”

“Golly, Curmudge, after reading some of the papers you found I’ve become convinced that many surfaces in patient rooms are coated with invisible creepy-crawly drug-resistant bugs like MRSA and Clostridium difficile (4, 5). Control of C. diff. requires cleaning surfaces with bleach, and hands must be washed with soap and water; alcohol-based hand sanitizers are not sufficient (5). When using soap and water, you know you’ve scrubbed long enough when you have sung ‘Happy Birthday’ twice.”

“Hospital patients are usually in poor health and have impaired resistance to bacterial infections. Because that is likely with patients with central lines or on respirators, IHI has published ‘bundles’ of evidence-based practices to minimize central line blood stream infections and ventilator-associated pneumonia (6). We talked about these back on October 23, 2008.”

“Okay, Curmudge, suppose your are a bacterium living in a hospital and want to impress your friends by infecting someone. How would you do it?”

“I’d head for the OR. It’s a really big score for a bug if he can cause a surgical site infection. Hopefully, I would get a ride into the OR on equipment, clothing, or the patient himself. Once there, I would try to find a way into the sterile field, possibly by someone’s lapse in gowning, gloving, or aseptic technique (7). The likelihood of my succeeding is increased if there are several trainees in the OR (in a teaching hospital), if the operation is of long duration, and if the patient requires a blood transfusion or is not kept warm (8, 9).”

“But what would happen if the patient received a prophylactic antibiotic within one hour prior to surgery?”

“If it were not an antibiotic to which I am resistant, my career would go south in a hurry. The life of a bacterium is not without risk, y’know.”

“Well, Curmudge, since your microbial existence just got zapped, please return to your human curmudgeon role and tell me what you see as the bottom line.”

“I’d be delighted, Julie. Everyone from surgeon to housekeeper must learn, believe in, and practice a culture of protecting our patients from infections. It’s got to become ‘the way we do things around here.’ LEARN IT, BELIEVE IN IT, and DO IT.”

“(Hmm…sounds a lot like a religion.) I presume, Curmudge, that typing in all capitals means that you are shouting. If you continue to behave that way, we’ll have to find you a private office.”

Affinity’s Kaizen Curmudgeon

(1) http://www.hospitalinfection.org/protectyourself.shtml
(2) Garavaglia, Jan How Not to Die: Surprising Lessons on Living Longer, Safer, and Healthier. (Crown Pub., 2008)
(3) http://en.wikipedia.org/wiki/Nosocomial_infection
(4) http://articles.latimes.com/2007/feb/03/opinion/oe-mccaughey3
(5) http://www.hospitalinfection.org/cdiff.shtml
(6) http://ihi.org/IHI/Topics/CriticalCare/IntensiveCare/ImprovementStories/WhatIsaBundle.htm
(7) Affinity Policies 01689 and 01704
(8) http://www.medscape.com/viewarticle/585849_print
(9) Karl, R.C., Staying Safe: Simple tools for safe surgery. Bulletin of the American College of Surgeons 92 (4):16-22 (April, 2007).