Hospital Survival Guide – Notes to my daughter

German philosopher Arthur Schopenhauer:  “All truth goes through three stages.  First, it is ridiculed. Then it is violently opposed. Finally, it is accepted as self-evident.”

You will need to search the entire blog for additional suggestions for protection from antibiotic resistant bacteria.  This endeavor began as a single page and has grown into about 50 posts — and is still growing.  There are many suggestions for protection on this blog and directives regarding antibiotics in clinical trials.  However, there are new strains of antibiotic resistant bacteria popping up and the new antibiotics may not be effective.  These include MSSA and acinetobacter.  There has been a suggestion that the rising Community Acquired MRSA may be different in its strain from the hospital acquired MRSA.  Chose the suggestions that seem appropriate and fitting to you.  Better to know than not.

Bloodstream infections cause at least 30 percent of the estimated 99,000 annual hospital-infection-related deaths in the U.S. and add on average $42,000 to the hospital bills of each ICU patient who gets a central-line infection. According to the new study released by the Archives of Internal Medicine (February 22, 2010), 48,000 deaths were caused by hospital acquired infections.

See the United States Department of Human Services National Healthcare Quality Report noting 100,000 deaths annually and insignificant progress in hospital acquired infections noting this is an URGENT ISSUE – published April 14, 2010.  The Report indicates that 2 million people are infected in hospitals annually.

Poorly performing hospitals include several major teaching institutions in major metropolitan areas. Some examples include New York University Langone Medical Center in New York City, the University of Virginia Medical Center in Charlottesville, the Cleveland Clinic in Ohio, Strong Memorial in Rochester, New York, Hackensack University Medical Center in New Jersey, Robert Wood Johnson University Hospital in Hamilton, New Jersey, and the Santa Monica UCLA Medical Center in California.

IF YOU ARE ABOUT TO CHECK INTO THE HOSPITAL — OR SOMEONE YOU LOVE IS — READ THIS BLOG.  DO NOT END  UP BEING ONE OF THE 100,000 ANNUAL DEATHS FROM HOSPITAL ACQUIRED INFECTIONS IN THIS COUNTRY.

In the United States Hospital Acquired Infections kill three times as many people as AIDs.  More people die from Hospital Acquired Infections than from car crashes and homicides together.

A full list of 105 U.S. hospitals that have tallied zero central-line infections in their most recent reports can be found at  StopHospitalInfections.org .  Some states have databases of Hospital Acquired Infection rates.  For example, South Carolina’s HAI home page is found at at http://www.scdhec.gov/hai. Click the Hospital-Acquired Infections Report for comparison reports by type of infection and by the individual hospital reports, which are grouped by general bed size and listed alphabetically.  Check to see if your state has a Hospital Infections Disclosure Act Annual Report.

• Before you are admitted to the hospital, call and ask about their infection rates.
• Ask if the hospital pre-screens all patients for MRSA.
• Ask your primary care physician if it would be appropriate for you to be given antibiotics to prevent infections.
• Ask everyone who comes in contact with you to use an effective hand anitizer (Safe4Hours) and put on a fresh pair of disposable gloves.
• Ask your physician to wipe his or her stethoscope with an antimicrobial coating called AgIon or cover it with a latex glove.
• Request a private room if this is feasible. This cuts in half your exposure to infection spread by a roommate’s physicians, nurses and visitors.
• Ask if your hospital uses antimicrobial plastics in areas such as air vents to prevent the transfer of communicable diseases.  Application areas include heating, ventilation, air conditioning (HVAC) .
• Ask your hospital whether they use the Pronovost checklist when inserting central line catheters.    The hospital’s rate of bloodstream infections should be at or below one infection per 1,000 catheter days.
• Ask if the clinicians wash their hands each time they enter your room.
• Remember now it has been found that computer keyboards harbor MRSA.  Touching a keyboard and then coming to your room can carry MRSA.
• Avoid touching meal tray tables and bedrails unless they have been  freshly cleaned.

Aspirin Prior to Surgery

300mg daily for three days prior to surgery can cut the risk of developing a deadly infection in half, according to research from Dartmouth College in the U.S.  Aspirin protects from Staphylococcus infections (which can include MRSA) by stopping the bacteria multiplying.

Note aspirin should not be taken with anticoagulant drugs — as aspirin also thins the blood — or if you have a stomach ulcer as it can further irritate the stomach lining. In high doses it can prevent blood clotting, so don’t take any on operation day, without your surgeon’s consent. It should not be given to anyone under sixteen because of Reye’s syndrome, a rare brain and liver condition, or to asthmatics as it can trigger attacks.

Visitors Should Not Touch Patient Bed

In a study published in the British Medical Journal, researchers found that a combination of infection control strategies that included eliminating visitor contact with a patient’s bed was able to stop the spread of MRSA and reduce the number of infections by 70 per cent.

Clothes can carry potentially dangerous bacteria and viruses.  Chairs can harbor millions of bacteria, which can be picked up by the hands when sitting down or getting up, so you then transfer those bacteria to sheets when you sit — avoiding contact with a patient’s bed has to be at the top of anyone’s list.

Timing of Operation

Patients whose procedures started near 9am were four times less likely to have anesthesia complications — nausea, post-operation pain, fluctuating blood pressure — than those wheeled in around 4pm, according to an analysis of 90,000 operations by U.S. researchers.

Washing Hands

Wash your hands with antibacterial soap and hot water for a full minute. ‘It won’t kill bugs, but it will help dislodge them, so there’s less chance of them entering your system.’

Dry your hands completely after washing, as any lingering moisture can harbor harmful viruses and bacteria.

While washing every hour is a sensible plan of action, be especially wary every time you’ve touched door handles or are about to eat.  Bacteria and skin cells from patients are easily transferred to objects like toys, magazines and books, which, unlike medical equipment, aren’t cleaned frequently.

Bleach is Great!

Take a small bottle of bleach.  Hospitals are full of white wash clothes.  Take a fifty percent solution of bleach and fifty percent water for your wash cloth and wipe EVERY THING down.  Do this daily for your loved one’s hospital room.  Door knobs, bed rails, everything.

Water for Hydration

Two liters of fluids a day in the two weeks before your hospital visit  will help you keep hydrated.  In order for the body to heal, the cells must have sufficient amounts of water.  Dehydration creates a risk for infection, pressure sores, electrolyte imbalances in your blood that can leave you feeling nauseous and weaken your immune system, heart irregularities and other complications, especially if you’re older. Dry airways also give harmful bacteria open access.

Ask Your Doctor to Sanitize the Stethoscope

A physician can place a disposable latex glove over the stethoscope.  An antimicrobial coating called AgIon can be used as well.  Take you own.  Order and take your own AgIon.

Eat More

Increase your calorie intake with nutrient and energy-rich foods to avoid malnutrition.  Your body needs more energy than usual to repair and fight off bugs, so opt for full-fat milk, butter, fill up on carbohydrate-rich foods such as pasta.  Men should aim for at least 2,500 calories a day, and women at least 2,000 calories, including three main meals, snacks and plenty of fluids.

Britain Precautions — Good Ideas to Prevent MRSA and C.diff.

In some British hospitals doctors and nurses are being banned from sitting on patients’ hospital beds in a bid to limit the spread of superbugs.

Visitors are prohiited from taking in flowers to stop people getting MRSA and C.diff.

Antiseptic Bath – Chlorhexidine Gluconate Cloths – Take Your Own

Researchers had previously shown that bathing medical intensive care unit (ICU) patients with cloths containing the antiseptic chlorhexidine gluconate reduced infections with two types of drug-resistant bacteria, Evans and her team note in their report in the Archives of Surgery.  See the Duke Medical Center Video .

To investigate whether the cloths would be helpful for trauma ICU patients as well, the researchers used antiseptic-free disposable cloths to bathe these patients daily for six months, and then used the antiseptic cloths for another six months.

Antiseptic bathing cut the likelihood that patients would develop catheter-related bloodstream infections, as well as the risk of ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA, popularly known as a “superbug”). Such superbugs kill about 25,000 people a year in Europe and 19,000 in the United States.

Patients who had the antiseptic baths were also significantly less likely to have MRSA or another tough-to-treat bug, Acinetobacter, growing on their bodies, known medically as “colonization.”

Patients in the non-antiseptic group were at nearly triple the risk of having MRSA colonization compared to those who got the antiseptic baths. The only adverse effects that occurred were rashes in two patients.

Evans noted that all ICU patients at Harborview are now being bathed with the chlorhexidine-containing cloths. In 2007, she added, there were 20 cases of MRSA infection per every 1,000 patients admitted; now there are 7.6 for every 1,000 admissions. “That’s pretty impressive,” she said.

Still, the design of the study did not prove the new cloths were responsible for the change, and there is an expense involved: Chlorhexidine cloths cost $5.52 per bath, according to the study, while the regular bath product costs $1.23 per bath. Whether that expense is worth it for thousands of patients per year will require further study, the authors note.

Another potential concern at Cedars-Sinai Medical Center, Los Angeles, is that using the chlorhexidine cloths could actually lead to other drug-resistant bacteria. However, Towfigh writes in an accompanying editorial, the study demonstrates important benefits.

Clip Nails

Clip your nails short to minimize the chances of bacteria hiding.

Fifteen Minute Shower

A 15-minute piping-hot shower with an antibacterial soap to scrub every nook and cranny of your body.

Probiotics

Probiotics – or ‘good’ bacteria – have been found in trials to reduce patients’ risk of c.diff infections. Antibiotics can kill your good as well as the harmful bacteria, leaving your immune system depleted. Choose a probiotic drink containing live bacteria like Healthy Dairy, which also has a probiotic — this makes good bacteria healthier — in it.

Ask about your catheter. The risk of catheter-associated urinary-tract infections increases the longer the catheter remains in place. So if you’re still using a catheter 48 hours after surgery, find out whether your nurse or your doctor has forgotten to remove it.

Cinnamon Oil – Thieves Oil – Cinnamon Bark, Lemon Oil and Eucalyptus

Antibacterial soaps and sanitizers  contribute to the growing problem of antibiotic-resistant bacteria.  Sanitizers made with cinnamon oil have been shown in many studies to have powerful antimicrobial properties.

A recent study by a team of surgeons, for example, found that a solution made with cinnamon oil killed a number of common and hospital-acquired infections, like streptococcus and methicillin-resistant Staphylococcus aureus, or MRSA. The study found it was just as effective as several antiseptics widely used in hospitals. Another study by French researchers in 2008 had similar results, showing that at concentrations of 10 percent or less, cinnamon oil was effective against Staphylococcus, E. coli and several antibiotic-resistant strains of bacteria.

Dr. Lawrence D. Rosen, a pediatrician in New Jersey who dispenses natural health advice on his blog, wholechildcenter.org, recommends a tried-and-true recipe for hand sanitizer called thieves oil. “I add cinnamon bark, lemon oil and eucalyptus,” he said, adding, “The recipe goes back to the Middle Ages, where it was used by these thieves who would go around stealing jewelry from dead bodies, and they never got sick.”

Single Room

Each person who shares your hospital room raises your chance of catching a life-threatening infection by at least 10 per cent, research shows.

A review of the records of 17,200 patients admitted to Kingston General Hospital over six months indicated the risk of infection with one of those three superbugs went up 10 per cent per roommate for each of the three infections.

Two simple techniques could help hospitals reduce costly hospital-acquired infections, which affect more than 300,000 surgery patients every year, according to a pair of studies published on in the New England Journal of Medicine, the New York Times reports. The studies examined how a common bacteria — staphylococcus aureus, which about one-third of people carry in their noses or on their skin — could cause infection after surgery. In the first study, surgery patients were tested for bacteria using nasal swabs prior to their procedures. About 500 of those patients who tested positive were treated for five days prior to their operations by showering with soap containing the antiseptic chlorhexidine and receiving an antibiotic ointment on their noses. Patients receiving the extra treatment were 60% less likely to develop infections after surgery than those who received a placebo ointment and placebo soap (Belluck, New York Times, 1/7).

The treatment also reduced patients’ average hospital stay by two days (Hutchison, ABC News, 1/6). The second study found that patients who underwent surgery and were pre-treated with the disinfectant povidone-iodine, which is used about 75% of the time, were more likely to develop infections than those who received the less common disinfectant chlorhexidine-alcohol. Patients who used chlorhexidine-alcohol had 40% fewer infections and half as many Staph aureus infections as those who received povidone-iodine.

Chlorhexidine-alcohol over povidone-iodine

The anti-infection treatments used in both studies also are more costly, but experts say they are worth the price. Chlorhexidine-alcohol costs about $12 per patient, compared with $3.50 for povidone-iodine. The screenings that tested for bacteria in the first study cost about $20. However, it can cost tens of thousands of dollars to treat a patient who develops an infection following surgery (New York Times, 1/7). About 250 patients would need to be screened and treated using the soap and ointment to prevent a single infection, according to the researchers. However, study co-author Henry Verbrugh said, “Preventing one infection will pay for thousands of these screenings” (Reuters, 1/6).In an editorial accompanying the studies, infectious disease specialist Richard Wenzel of Virginia Commonwealth University wrote that the ointment and soap treatment should be used by patients with serious operations, such as heart surgery or joint replacement, as well as those with immune system problems. Wenzel added that the chlorhexidine-alcohol treatment should be used in all surgeries (New York Times, 1/7). See New England Journal Medicine Article.

Chose Your Hand Sanitizer Wisely

Alcohol based hand sanitizers have been exposed as ineffective.  In Britain an independent scientific investigation, reported in the Sunday Express, that the Health Service’s “gold standard” hand-wash, used to stop germs spreading inside wards, is far less effective than widely available alternatives.

Safe4Hours by Skinvisible is effective against MRSA.  Load Up!

“We believe that alcohol is a product of the past; Nurses complain of dry and damaged skin caused by alcohol hand-gel and it isn’t even very effective when you consider that it stops working as soon as it evaporates – which is almost immediately. In contrast, our product is water-based and its strength comes from its structure. It represents the future of anti-viral and anti-infection products.

“Frankly, which would you prefer your doctors used? A hand-wash that kills germs then leaves hands vulnerable again, or one that kills germs and then protects hands for hour after hour?”

Alongside regular cleaning of hospital wards with antibacterial agents, hand-wash use by NHS staff, patients and visitors is regarded as critical in halting superbug infections such as C difficile and MRSA, which claim more than 7,000 lives a year and infect many more patients.

The research, carried out by the Agri-Food and Biosciences Institute (AFBI), on behalf of anti-infection firm Byotrol, measured Byotrol hand-foam, NHS hand-gel (Spirigel), Vick’s First Defence and Dettol hand-foam on their performance in killing dangerous viruses 24 hours after application.

The tests looked at which products prevent viruses returning for up to 24 hours after application. Worryingly, the NHS “gold standard” hand-gel offered no residual effect whatsoever.

After 24 hours, First Defence continued to be effective against 90 per cent of the sample, a surrogate for Norovirus (Feline Calicivirus), with Dettol hand-foam remaining 50 per cent effective and the NHS standard hand-gel offering no ongoing protection at all.

Byotrol hand-foam, the only product not based on alcohol, remained effective with a 99.9 per cent kill rate, 24 hours after application.

The results are in line with last year’s study at Manchester Royal Infirmary, which showed Byotrol performed much better than the NHS gold standard cleaner in reducing levels of the hospital superbug on wards.

Byotrol was over 30 per cent more effective than NHS “gold standard” bleach in reducing MRSA on the wards.

Similar tests at Monroe Hospital in Indiana, America, have resulted in there being no cases of hospital-acquired infections for over 3 years since Byotrol became their standard cleaning product. Dr James Ballard, Monroe Hospital’s Infection Preventionist, said “the evidence clearly demonstrates that micro-organisms simply cannot remain present on surfaces days after being cleaned with the Byotrol technology.”

Byotrol’s strength comes from its unique micro-structure, which forms an invisible protective barrier on any surface, be it human hands or a hospital floor. Previous independent laboratory tests have demonstrated Byotrol’s effectiveness as it keeps on working after it has dried unlike conventional disinfectants which stop working when dry. This means that it remains effective for hours on skin and days on hard surfaces, whilst remaining completely harmless to people and the environment.

Microbiological results from the study

- There was a significant 33 per cent reduction in environmental MRSA in the wards cleaned with Byotrol compared to the NHS gold standard bleach.

- The effect was very quick and within five weeks of introducing Byotrol to the wards there was a significant reduction in environmental bacteria.

- Throughout the trial, significant reductions in total environmental microbial load existed between the Byotrol-treated wards and those treated with bleach.

- Following the crossover in the cleaning regimes , once again Byotrol proved superior to Chlorclean in reducing environmental bacterial loads.

And it is also important to note that this trial showed that it outperformed the very best remedy in current use by a wide margin. Hence, when Byotrol is adopted as a replacement for soap and water the benefits can be expected to be even greater.

Commentary on the MRI results from Professor Curtis Gemmell:

”It is clear that the microbiological cleanliness attained with Byotrol was superior to Chlorclean (hypochlorite) and the results obtained in this study warrant its adoption in hospitals. Byotrol is a safe alternative to Chlorclean and hitherto has not been shown to engender resistance or tolerance amongst hospital bacteria, nor does it damage inanimate surfaces. One benefit which is worth serious consideration as part of any hospital hygiene programme is the recognition that Byotrol displays residual anti-bacterial activity for at least 24 hours (and probably longer) after its application to inanimate surfaces unlike Chlorclean.

The study shows that Byotrol Technology is a viable alternative to the current “gold standard” in hospital infection control and superior to neutral detergents. ”

The image below demonstrate that with no sanitising treatment (post inoculation) the E. coli bacteria survive well on the hands during the test period. The use of 70 per cent alcohol hand rub removed a high proportion of the inoculated E. coli, while the use of a water based hand sanitiser (Assure mousse containing Byotrol technology as the active biocide) removed a much greater proportion of the inoculated E. coli.

Use of the 70 per cent alcohol hand rub resulted in bacterial colonies, distinct from the seeded organism, appearing on test plates. These are thought to be resident skin flora organisms released by the action of alcohol on the epidermis. No such colonies were seen with the water based sanitiser treatment.

Pajamas with Silver

PJs with small threads of silver running through them have been shown in initial tests to kill 99.9 per cent of harmful bacteria in under an hour.   A UK clothing store, Marks & Spencer (M&S) sells pajamas containing silver thread to protect against hospital superbugs like MRSA.

It is silver’s bivalency which makes the metal highly reactive to the extent that, among other things, it is a natural biocide which means growing medical usage – and it is being used in clothing too for people in arduous occupations – like the military. It has uses in combating many viruses like legionella.  Mark Enright, a microbiologist at Imperial College London, said the pyjamas would reduce the risk of a patient getting a skin infection that could infect a wound.

C difficile Those Most Vulnerable – Over 65 -or- Post Surgery

People most vulnerable to a C difficile are those who:

Have been treated with broad-spectrum antibiotics. Have had to stay for a long time in a hospital or nursing home. Are over 65 years old. Have a serious underlying illness or condition. Have a weakened immune system. Have had numerous enemas or gut surgery.

Whenever possible, people who are infected with C difficile will have their own room and own toilet facilities to avoid passing the infection on to others.

Staff, patients and visitors should be encouraged to wash their hands regularly and thoroughly. Thorough cleaning using water and soap is an effective way of removing any spores that have transferred onto a person’s skin or clothes.

Lee Ann Torrans
ltorrans@gmail.com