patient safety | Nancy B. Finn

Empowered patients not only have to be good communicators, who know how to use the Internet for research and networking, you have to be aware of what is going on around you and savvy enough to take appropriate action in situations where there are no specific rules. That is what keeps you empowered and in charge of your health. One example of that is to understand the dangers you face as a patient in the hospital, and what you can do to address those dangers.

Hospital-acquired infections (HAIs) are among the top five leading causes of death in the United States, striking 4.5 of every 100 patients admitted to a hospital. As an e-patient you do not want to be one of those statistics. A recent study released by the American Journal of Infection Control, www.ajicjournal.org (Sept., 2011, Vol. 39, Issue 7, p. 555-559) reports that many of these acquired infections could be caused by bacteria and pathogens that linger on hospital staff uniforms .and other clothing worn by doctors, nurses and hospital workers.

A team of researchers, led by Yonit Wiener-Weil, MD from the Shaare Zedek Medical Center in Jerusalem, Israel, collected swabs samples from the uniforms of nurses and doctors and found that fifty percent carried pathogens on their pockets, sleeves and waists of their clothing, particularly the scrubs and lab coats that they wore when they were in direct contact with patients. Other studies have found that hospital bed handsets, TV remote controls, cell phones of hospital staff were also found to contain biologic material that could be contaminated with disease-causing microbes.

It would seem obvious that hospitals need to go back to the practice of several years ago when they laundered the scrubs and lab coats used by doctors and other workers. They also need to make sure that hospital issued clothing does not leave the hospital and come back in the next day, and that street clothing worn by individuals who have direct patient contact need somehow to be sanitized each day. Additionally hospitals need to adopt programs to sanitize equipment such as bedside remotes, cell phones, and other electronic devices that patients and workers use, so they will not carry these pathogens around the hospital and spread the incidence of HIAs.

There is also the issue of hand hygiene. Following the H1N1 scare, hospitals, doctor’s offices and other institutions, instituted stricter hand washing policies and installed hand sanitizer dispensers in key locations. They launched a major campaign encouraging people to be more diligent about hand washing, especially healthcare professionals who were in contact with patients or with lab equipment.

There are steps that e-patients can take to avoid exposure, including:

1. In your bag that you take to the hospital pack a large bottle of hand sanitizer and a disinfectant or wipes that you can use to clean the equipment around your bed. If you are too ill to do this, ask your advocate (family members or friends) to oversee this task.

2. Be diligent about cleansing your hands and ask your doctors and nurses directly if they washed their hands before examining you

3. Check out the hospital where you are planning to stay. There are websites for that purpose such as: www.hospitalcompare.hnhs.gov or www.qualitycheck.org

4. Take direct action. Send messages to you hospital officials to advocate for safer hospital practices; Volunteer to work with hospital officials on initiatives that address this problem. Solicit other patients to get behind this effort.

It is a known fact that more people die annually from medical error, in both in-patient and out-patient healthcare settings, than die from motor vehicles accidents, breast cancer or HIV. Nearly 100,000 reported medical errors occur each year. As an e- patient, there are actions that you can take to insure the safety of your care. They include:
•Do not assume anything! Make sure that all health professionals involved in your care have all the important health information about you. Talk with them about what additional data they might need.

•Ask questions. If you have a test, insist on getting the results. If you are given medication be sure to ask what it is; what it is for; is it the right dosage. If there are pills you do not recognize, do not take them until you talk with your doctor. This is your right.

•Learn about your conditions and treatments. Discuss your healthcare with your doctor, nurse practitioner, physician assistant and/or pharmacist. Check the Internet to see what information you can find. A few of the helpful, unbiased web sites include:

1. Google or Bing search for the most general compilation of available data.

2. http://www.healthfinder.gov/, or institutions sites such as http://www.mayoclinic.org/ or http://www.clevelandclinic.org/. for general information on a variety of health conditions.

3. http://www.noahhealth.org/, and http://www.medlineplus.gov/, for the most comprehensive health information in one place.
4. http://www.qualitycheck.org/ , a website of the Joint Commission on Accreditation of Healthcare Organizations that provides extensive information on hospitals, sorted by geographic location and including accreditation criteria, special citations and programs.

I have been away from this blog for a while because I spent some real time as a patient, having hip replacement surgery. Although I had complete confidence in my surgeon, I made sure that I fully understood the parameters of my problem, the solution, and the recovery by asking the right questions and conducting my own research to find answers to all of my concerns. Much to my surprise, my hospital experience completely changed from previous in-patient encounters. Everyone diligently washed their hands at one of the antiseptic soap dispensers located in patient rooms and on every floor. That alleviated my biggest fear of staph and mersa infection so prevalent in the hospital environment.

Another concern was the potential for a fall as I knew that the hip replacement would incapacitate my movement for a while. However I was told to absolutely call for help when I wanted to get out of bed, and the nurses and aides were most pleasant about assisting me. The last time I was in the hospital after surgery the nurse told me I had better learn to get out of bed myself and not bother them. What a turnaround in patient safety!

Because I am familiar with the dangers of medication error, both in the hospital and at the rehab, I also questioned every IV and oral medication that I was given to be sure that the right medication in the right dosage for me was what I received. No one took offense. They appreciated my caution and understanding.

Patient Safety is not an easy goal to accomplish in the stressful healthcare setting. Mistakes are still made. However when an e-patient opts to become an integral part of the healthcare team many unpleasant medical errors can be averted.

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