passengers donít review the preflight checklist with the
pilot, and restaurant customers arenít expected to check the
kitchen and the staff for cleanliness.
health care experts say itís wise for hospital patients and
their families to ask doctors and nurses to wash their hands,
remove unnecessary catheters and explain how they will prevent
an infection from developing after surgery.
advice is an acknowledgement of reality: A hospital can be a
dangerous place to spend the night.
infection control is more goal than fact at most hospitals. On
hand-washing alone, for example, healthcare workers comply
only about half the time, studies have shown. And one in 20
patients will acquire an infection while in the hospital.
speaking up for yourself in that setting is not an easy thing
one wants to be confrontational with the person you hope will
save your life," said Dr. Michael Bell, acting director
of the division of healthcare quality promotion at the U.S.
Centers for Disease Control and Prevention in Atlanta.
Bell and other experts advise patients and their families to
are too many harmful things and bad bugs that can hurt
you," said Victoria Nahum, a Cobb County, Ga., advocate
for patient safety whose family faced three hospital-acquired
infections in one 10-month period about seven years ago.
Hospitals have been on a quest to become safer since 1999,
when the Institute of Medicine stunned the medical world with
its publication of "To Err is Human." That study
found that tens of thousands of patients died every year from
infection control has proven to be a complicated undertaking.
Protecting patients requires hospitals to follow new
checklists, hand-washing requirements and cleaning regimes.
While doctors were free to practice as they saw fit in the
past, many hospitals now demand that they follow protocols
known to keep patients safe.
donít want to take away the art of medicine," Bell
said. "We want to make things as goof-proof as
possible." Hospitals are trying to learn from other
industries that have strong safety records. Many hospital
executives are focused on turning their facilities into
"high reliability organizations" in which staff take
the right steps with every patient every time. But most freely
admit that theyíre not where they want to be.
people, including myself, would say there are dangerous things
that can happen in hospitals and there are mistakes ó thatís
where we are right now in American healthcare," said Dr.
Bob Wise, an expert on healthcare quality at The Joint
Commission, which accredits and certifies more than 20,000
health care organizations and programs across the nation.
person who is going to be most concerned is obviously the
patient themselves and their families. The issue is you canít
be there scanning the environment and be afraid. You do have
to have some education about where should you be spending your
attention and your focus."
Healthcare, Dr. William Bornstein, the systemís chief
quality and medical officer, said thereís a way to invite
patients to help. "What I think is particularly effective
is when healthcare providers say, ĎHey, by the way, if you
ever see me forget to do hand hygiene, would you remind me?í"
posted in Emory hospitals say, "We encourage you to ask
your health care providers if they have cleaned their
the Cobb County advocate, and her husband, Armando, dedicated
their lives to improving patient safety in 2006 after their
brushes with hospital infections. Their son, Josh, who had
been hospitalized in Colorado after an accident, died from an
infection at the age of 27.
coupleís most recent focus has been producing posters, now
in hospitals across the country, that offer patients links and
QR codes connecting them with information on the right
questions to ask, depending on what kind of treatment the
patients is facing.
I had had any of this information when our son was in the
hospital, then he might be alive today," Nahum said,
"and so I know that itís helping people live and not
die." Dr. Robert Wachter, a professor at the University
of California, San Francisco and one of the nationís leading
experts on patient safety, said he understands why patients
try to protect themselves. Wachter said he played the role of
protector himself when he camped out on a cot in his motherís
hospital room when she underwent treatment.
fact that patients are thinking this way is an indictment of
our healthcare system," he said. "Itís not as safe
as it needs to be and itís scary and itís perfectly
logical that patients and families would want to do all they
can to keep themselves safe." But his caveat is that heís
not sure it really works. First, itís awkward. Second, even
doctors can have difficulty monitoring everything that goes on
with a patient they care about, since so much happens behind
Wachter doesnít like the message it sends.
some ways it says to patients, ĎThis is your responsibility
for us to do things safely for you, including hand hygiene,í"
he said. "Why should it be the job of the patients or
family members to make sure everybody cleans their hands? Thatís
the job of the system."
STORY CAN END HERE)
said his hospital and many others are much safer than they
used to be. But he said entering any hospital needs to feel
more like settling into a seat on a jet.
durable solution is that patients come in the hospital and
they can relax, knowing that the hospital has done everything
it can possibly do to keep them safe," Wachter said.
"Thatís the way I feel when I get in an airplane, but
itís not the way I feel when I get to a hospital." What
to say Hospital-acquired infections kill about 100,000
Americans per year. Even so, many patients are reluctant to
ask doctors and nurses to observe anti-infection protocols.
The CDC advises, however, that you get over your reticence:
your doctor or nurse what they are doing to protect you from
you donít see hospital staff clean their hands, ask them to
do so before they touch you. Also remind your family and other
visitors to wash up.
you have a central line or a urinary catheter, ask whether you
still need it. Leaving a catheter in place too long increases
the chances of getting an infection.
out for C. diff (Clostridium difficile). Tell the staff if you
develop severe diarrhea, especially if youíre taking an
antibiotic. Some hospital inflections are declining, but C.
diff is at historically high levels.