Hospital infections? Washing hands helps!

Doctors and nurses are the main causes of infections. Working hygienically turns out to be very difficult for them. Below a number of questions about the causes of these infections and infections

1. Why do you have an increased risk of an infection in a hospital?
Although a hospital is meant to cure people, the chance of contracting an infection there is higher than in a busy shop or football stadium. Bacteria, viruses and fungi thrive there because many sick people have a weakened immune system. Because of the many vulnerable patients, pathogens can also spread more easily there.

2. Which infections can you get and with which conditions?
Most hospital infections occur in the respiratory tract, intestines, urinary tract, surgical wounds and on the skin. Patients in intensive care are most at risk. They usually have a bad condition and are attached to all kinds of tubes for infusion fluid, liquid nutrition, medicines and artificial respiration. These hoses provide bacteria and viruses easy access to the body. Wound infections mainly occur during vascular, heart, hip and intestinal operations.

3. What are the consequences?
A patient with a hospital infection stays in the hospital longer. The extra length of stay depends on the type of infection. For example, someone with a urinary tract infection spends an average of one day longer in hospital, but for an operated patient with a wound infection, this can take up to several weeks. If such an infection is complicated, the additional costs can be up to €50,000 due to the longer stay, possible re-operations, extra diagnostics and medicines.

4. What is the chance of such an infection?
In Dutch hospitals, an average of 7 percent of patients gets an infection. That is actually less than in most other countries in Western Europe. Elderly people in particular have a high risk of such an infection, because they undergo major operations more often. Annually, this concerns a total of approximately one hundred thousand patients, of whom about a thousand die.

5. How do these bacteria and viruses get to the patients?
The professional hands at the bedside are the main causes of infections. As early as 1847, the Viennese gynecologist Ignaz Semmelweis concluded that doctors were not washing their hands sufficiently, and were therefore responsible for transmitting puerperal fever. Many women died of this infection at the time because antibiotics were not yet available. Semmelweis advised all doctors and nurses on his unit to scrub their hands with a nail brush and bleach after each patient. Maternity mortality fell from 20 percent to 1 percent.

6. But now doctors wash their hands properly, right?
No, that remains a persistent problem. It appears to be difficult for doctors and nurses to work as hygienically as they should. According to the guidelines, they should wash their hands with soap or disinfect with alcohol after every patient contact. But this happens in only 40 percent of cases. The argument ‘lack of time’ is nonsense, because disinfecting with alcohol can be done without a tap and towel. The alcohol evaporates and the liquid contains an oily substance, which prevents the hands from drying out.

7. Then why don’t they do it?
Simply because they forget and usually don’t realize what the consequences could be. In addition, there are people who doubt the usefulness of hand washing.

8. Isn’t hand hygiene stimulated?
Certainly. Every effort is being made to better inform doctors and nurses. The Delft company NewCompliance has come up with the idea of ​​pointing out to them how important washing is by means of texts on toilet paper. These rolls were hung in the toilets of the healthcare workers in four departments of the Erasmus Medical Center in Rotterdam. Within four months, hand hygiene behavior improved by 35 percent. The hope is now that all hospitals will follow this example
follow.

9. Suppose everyone washes their hands, will we be rid of the infections?
No, it’s not that simple. The floors, beds, bedding, doorknobs and taps must also be regularly disinfected. Patients also carry bacteria and viruses themselves. Normally these keep quiet, but when the resistance has weakened they eagerly strike.
Another risk is that these own micro-organisms are moved by the patient himself or by medical action to a place where they can cause an infection. For example, a urinary tract infection can arise when using a bladder catheter, due to bacteria from the intestine. These bacteria are indispensable in the gut, but in another location they can easily cause major problems.

10. What about the dreaded hospital bacterium MRSA?
One third of the world’s population is a carrier of Staphylococcus aureus. This bacterium is found on the skin, in the throat and/or in the nose. The bacteria can become resistant to antibiotics and then there is a Methicillin Resistant Staphylococcus Aureus (MRSA), which is difficult to combat.
This resistance is the result of excessive use of antibiotics. In the Netherlands we are very cautious about antibiotics, which means that only 1 percent of Staphylococcus aureus is resistant. In England, where doctors are quite generous with bactericidal agents, that percentage is around 40. In the US it is even more than half.
A patient who is a MRSA carrier is treated in quarantine so that the bacteria cannot spread. Such seclusion can last a few days or even the entire recording period.
The patient in isolation must shower thoroughly every day and receive a nasal ointment to prevent infection with their own bacteria.
An MRSA infection is often more serious than other hospital-acquired infections. A random sample in March 2007 showed that 45 patients in Dutch hospitals had an MRSA infection at that time.

11. Are hospital infections becoming less common?
No, the risk of a hospital infection in our country has been the same for years. But actually this stable figure gives a distorted picture of reality, because the patient population is changing. The elderly are getting older and premature babies, who previously had no chance of survival, are more likely to survive thanks to medical intervention. Both vulnerable groups are extra sensitive to infections and thus push up the risk figures.

12. Does it matter which hospital you are in when it comes to the risk of an infection?
The risk figures differ per hospital. Some of those settings are at the lower limit of 2 percent and others at the upper limit of 10 percent. This is partly because some hospitals are more careful about hygiene rules than others. But hospitals are difficult to compare. For example, academic centers usually score worse because they accept more severe and weaker patients who often have to undergo complicated operations. If a hospital scores far below the standard, the government steps in to determine the exact cause and improve hygiene. Through targeted actions, hospitals can significantly reduce the number of infections.

13. How do you know if your hospital is performing well?
You can’t know. Hospitals don’t release their infection rates. Not all hospitals have a standardized way of collecting infection data. This makes it impossible to compare figures and estimate their value.

14. What can you as a patient do to reduce the risk of an infection?
Patients hardly infect each other directly. They don’t have to worry about visitors either. It is important to wash your hands regularly to avoid infecting yourself. Do not pick at wound dressings and leave the hoses you are connected to alone. Healthy food and drink is important for optimal condition and resistance. Micro-organisms then have less chance. As long as you don’t touch the flower water, flowers can’t hurt. Bacteria and viruses do not walk or crawl.

With thanks to Thea Deha (WIP Working Group Infection Prevention), Birgit van Benthem (Center Infection Control National Institute for Public Health and the Environment RIVM) and Jan Wille (Prevention of hospital infections through surveillance Prezies/ Quality Institute for Healthcare CBO).