Reminders, Nurses Key In Catheter Removal and UTI Prevention

  

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New research shows that a leading cause of infection in hospital patients could be reduced if reminders are placed in medical records to encourage staff to assess and remove catheters, and if nurses are given the opportunity to remove urinary catheters.

Urinary catheters are the most frequent cause of hospital-associated infections (HAIs) in the United States. Up to 50 percent of those catheterizations are not medically necessary, and the presence of bacteria in urine increases five percent for every day that a catheter remains in place. In many cases, overworked hospital staff fail to adequately assess a patient's need for catheterization, or a physician simply forgets to assess a patient and the catheter remains in place much longer than necessary.

In most hospitals, according to Infection Control Today, removing a catheter is a complicated process. First, the physician must see that the catheter is there. Next, the physician must recognize it is unnecessary and write an order for removal. Finally, a nurse must remove the catheter according to the order.

The study, published in a July edition of Clinical Infectious Diseases, examined the effect of placing a reminder in a catheterized patient's chart that encourages physicians to assess the need for a catheter, or that automatically directs nurses to remove a catheter after a specific time period unless a physician orders otherwise. The study also looked at the effect of allowing nurses to remove catheters without a physician's stop order.

Study results showed that reminder systems reduced catheter-associated UTIs by 52 percent, and that implementing such systems should be a "no brainer" for hospitals.

"Because catheter reminders and stop orders are beneficial regardless of the technology used — from verbal bedside reminders to computer-generated stop orders — these interventions appear to be low-cost strategies that could be implemented in any healthcare system," wrote study author Dr. Jennifer Meddings of the University of Michigan Health System.

If you or a loved one is catheterized or returns home from the hospital with a catheter still inserted, the CDC offers guidelines for patients:

-       Make sure to ask questions so as to understand how to care for a catheter once home from the hospital

-       Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination

-       Always clean hands before and during catheter care

-       Keep urine bags below bladder level

-       Do not tug or pull on the tubing, or twist or kink the tubing

Catheters remain one of the primary causes of hospital associated infections in the US. Patients with catheters or those caring for loved ones who have been catheterized should ask questions of health care providers to determine whether a catheterization remains necessary.

Recovery In a Private ICU Decreases Infection

  

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Hospitals that offer private rooms to patients recovering in an intensive care unit (ICU) find up to a 51 percent decrease in healthcare-associated infections (HAIs).

According to the study, published in the January 10th issue of the Archives of Internal Medicine, up to 30 percent of ICU patients acquire an HAI during recovery. 

"An ICU environment with private rooms may facilitate better infection control practices, therefore reducing the transmission of infectious organisms," study authors wrote. "Conversion to single rooms can substantially reduce the rate at which patients acquire infectious organisms while in the ICU."

The study compared two Canadian hospitals operated by the same university in the same city with similar caregivers. In one hospital, multi-bed ICUs were changed to private rooms. In the other, the multi-bed ICU was left alone.

After nearly 20,000 ICU admissions, researchers found that the hospital with private rooms in the ICU showed a decrease of 47 percent in methicillin-resistant Staphylococcus aureus (MRSA) infections, a 43 percent decrease in Clostridium difficile infection and a 51 percent decrease in yeast infections.

Patients in private rooms also benefited from a ten percent shorter length of stay, which Infection Control Today reports may be due to an average potential 8 to 9 day additional hospitalization required after acquisition of an HAI.

While there is expense in renovating hospital ICUs to allow for private care, there may be long-term savings. The potential cost savings to the healthcare system of eliminating those additional days in the hospital may be as high as $3.5 billion each year in the United States.

Patient Safety Not Improving In Hospitals

  

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Two new studies reported on by the New York Times reveal that, despite efforts to improve patient safety in hospital settings, hospital-associated infections and mistakes have not decreased.

The first study, published in the New England Journal of Medicine found that 98,000 deaths and more than one million injuries occur each year in the US. About 18 percent of patients receiving health services at hospitals in the study were harmed by medical care, and 63.1 percent of those instances were judged to be preventable. Problems specific to older populations included falls and urinary tract infections (UTIs) caused by urinary catheters. Overall, 2.4 percent of problems were directly related to a patient's death.

Another study examined only Medicare patients and found that 13.5 percent of Medicare beneficiaries experienced an "adverse event" during a hospital stay. These events were identified by the presence of "triggers" such as a readmission, a bedsore or the use of a drug to reverse an overdose.

In the study of Medicare patients, 2.9 percent of patients who experienced an adverse event ended up with a permanent injury, and over 8 percent of adverse events were life threatening. The majority of errors, however, were minor and included medication errors, UTIs and low blood sugar in diabetic patients.

Still, in both studies, experts caution that events may be underreported and therefore the true number of undesirable patient outcomes may be even higher.

Recommendations include making public all patient safety data so that members of the public can avoid the riskiest hospitals, implementing checklists so that hospital workers and caregivers avoid mistakes, and computerizing pharmacies so that patients are always given the correct drugs.

Dementia, Delirium in Elderly Patients Linked to Infection

  

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A new study shows that sepsis, an illness that causes inflammation throughout the whole body, could cause physical and mental impairment among the elderly.

Elders who survive sepsis, also known as "blood poisoning," are three times more likely to undergo a severe physical or mental decline according to a University of Michigan Medical School study. The findings may explain why some elderly people lose independence after a hospitalization and end up in need of long term care.

Many years ago, sepsis was a cause of death for many elderly patients who were said to have "died of old age." Today, advances in medicine mean that sepsis is a condition that can be treated -- but elderly patients often survive with severe impairment that robs them of their independence along with physical and mental function.

"Among people with no mental or physical limitations before sepsis, around 40 percent could not walk without assistance in the years after," lead researcher Dr. Theodore Iwashyna said. It is uncertain whether sepsis alone causes cognitive decline, as delirium, often a complication of sepsis, is also associated with worsening cognitive impairment. 

Sepsis occurs most often in infants and in the elderly. Those with compromised immune systems are at high risk, in addition to those with urinary catheters, breathing tubes or artificial joints. As urinary tract infections and bedsores can often lead to sepsis, it is important for hospitals, doctors, nurses and other caregivers to monitor an at-risk patient's health to prevent illness.

Diseases such as flu and pneumonia can also make an elderly person more susceptible to sepsis. This is why vaccinations are important for individuals of all ages.

More research is needed to determine the link between sepsis and cognitive and physical decline. In the meantime, infection prevention in hospital and long term care settings as well as vaccinating the elderly for flu and pneumonia are important ways to combat sepsis.

Private Care, Home Care Can Help Beat MRSA

  

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Methicillin-resistant Staphylococcus Aureus (MRSA) is one of the most frightening diseases that can affect elderly and long term care patients.

A staph bacteria that is unable to be treated by certain antibiotics including methicillin, oxacillin, penicillin, and amoxicillin, MRSA can be painful and even fatal.

While the CDC estimates that 85 percent of MRSA infections happen in a healthcare setting, a new study shows that a low nurse-to-patient ratio and simple hand washing can yield significant decreases in MRSA transmission.

Presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, the study tried different nurse-to-patient ratios in a hospital Intensive Care Unit and found that having a nurse working one-on-one with a patient provided the best results.

“When we finally reduced the nurse-to-patient ratio to 1:1, we saw that this intervention does better than all changes in hand hygiene,” said study researcher Sean Barnes, a PhD student at the University of Maryland. “This is the best scenario, provided it is economically viable.”

Over 18,000 people die each year during a hospital stay that’s related to MRSA. While community-acquired MRSA usually leads to a painful and bothersome skin infection, MRSA acquired in a healthcare setting can cause bloodstream infections, surgical site infections, or pneumonia.

According to the CDC, MRSA is “typically spread in healthcare settings from patient to patient on unclean hands of healthcare personnel or through the improper use or reuse of equipment.”

After it’s acquired, usually the only way to treat MRSA is by draining the infection and sometimes prescribing an antibiotic. Repeat infections are possible.

MRSA can be devastating for someone recovering from surgery or being cared for at home. That’s why it’s important to have a care team with a low nurse-to-patient ratio, and a care team that practices good hand hygiene.

Hand Sanitizer King In Helping Caregivers Kill the Common Cold

  

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A new study shows that ethanol-based hand sanitizers may even be more effective than handwashing in preventing rhinovirus, the virus that causes about a third of cases of the common cold in adults.

While the common cold may seem a harmless annoyance to most people, it can be a severe setback for a caregiver of an elderly person, someone already recovering from surgery or an illness or an individual undergoing chemotherapy.

Elderly patients in long term care settings or nursing homes who contract rhinovirus may develop severe respiratory disease that may even result in death, while illnesses such as pneumonia may follow a cold. The common cold is even more dangerous for those whose immune systems are weakened by chemotherapy. Even otherwise healthy adults with asthma are more likely to suffer from worse asthma symptoms after getting a cold.

Researchers from the University of Virginia School of Medicine and soap manufacturer Dial Corporation have found that ethanol-based hand sanitizers can remove up to 80 percent of rhinovirus from hands – a big difference when compared with soap and water, which only removes 31 percent of rhinovirus from hands. In addition, hand sanitizers containing organic acids may be even more effective at preventing the transmission of rhinovirus, as the organic acids protected hands from common cold germs for up to four hours.

If a loved one is being cared for at home, it might be a good idea to make sure there is a bottle of hand sanitizer in the house. Adults and children who visit loved ones at risk for complications from a common cold should make sure to wash their hands before visiting.

With the ready availability of hand sanitizers, preventing the transmission of the common cold may be easier than ever.

Image: Salvatore Vuono / FreeDigitalPhotos.net

Preventing Pressure Ulcers

  

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Patients who are immobilized after an injury are at risk for pressure ulcers, also known as bed sores or decubitus ulcers. The painful sores result from pressure that restricts blood flow, causing tissue damage.

Up to 22 percent of nursing home patients and up to 32 percent of hospital patients will experience a pressure ulcer, the severity of which may range from irritated, red skin to deep craters that leave bone and muscle exposed. Patients receiving care at home are between 7 and 21 percent less likely to develop a new pressure ulcer than those in a long-term care or acute care setting, respectively, one of the benefits of receiving at-home care.

Among those at risk for pressure ulcers include those who have suffered an immobilizing injury who are unable to relieve pressure by moving themselves, and the elderly who have reduced skin elasticity. Patients who are incontinent or who have a neurological disorder such as Parkinson’s disease or Alzheimer’s disease are also at higher risk for developing pressure ulcers.

The Centers for Disease Control and Prevention (CDC) define the severity of pressure ulcers as follows:

-       Stage 1: A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved.

-       Stage 2: A partial thickness is lost and may appear as an abrasion, blister, or shallow crater.

-       Stage 3: A full thickness of skin is lost, exposing the subcutaneous tissues--presents as a deep crater with or without undermining adjacent tissue.

-       Stage 4: A full thickness of skin and subcutaneous tissue are lost, exposing muscle or bone.

While more than 70 percent of Stage 2 ulcers heal within six months, only 50 percent of Stage 3 and 30 percent of Stage 4 ulcers heal within half a year. Patients with a pressure ulcer can develop blood and bone infections and can suffer from low blood pressure, fever, a fast heart rate and confusion. Serious infections are often fatal.

The National Institutes of Health offers recommendations for health care providers to prevent pressure ulcers in at-risk patients. These recommendations include conducting a full daily assessment of a patient’s skin, changing a patient’s position every two hours, exercising a patient ever y day, keeping skin clean and dry especially after a patient goes to the bathroom, and using special medical supplies such as foam cushions and sheepskin blankets.

Patients who have limited mobility or who are recovering from an injury that leaves them with restricted motion can benefit from in-home care providers who will ensure they have a lower chance of developing a pressure ulcer.

Preventing Urinary Catheter-Associated Urinary Tract Infections

  

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Patients who are hospitalized for surgery or who become incontinent will often receive a urinary catheter. While many catheterizations are unavoidable, studies show that up to 50 percent of catheterizations are not medically necessary. Further, a new survey shows that fewer than half of health care facilities are following recommended guidelines to decrease catheter-associated urinary tract infections (CAUTIs).

One in four patients who enters a hospital will receive an indwelling catheterization, the kind of catheter that is inserted into and remains in the bladder for an extended period of time. Unfortunately, nearly the majority of those catheters are unnecessarily placed and many catheterizations can last longer than medically necessary. According to Infection Control Today, that’s in part because of overworked hospital staff who may not have the time to respond to complex care needs.

As a result, urinary catheters are the most frequent cause of hospital acquired infection (HAI) in the United States. According to an article published in the Annals of Internal Medicine, infection frequently occurs after the placement of a catheter, and the presence of bacteria in the urine increases five percent every day a patient is catheterized. With proper infection control measures, between 17 and 69 percent of CAUTIs could be prevented. That translates to the prevention of up to 380,000 infections and 9000 deaths each year.

To decrease the number of CAUTIs, in 2009 the Centers for Disease Control and Prevention (CDC) adopted guidelines that health care facilities should follow. The guidelines addressed who should receive catheters, how they should be cared for, when they should be removed, and surveillance strategies to ensure the guidelines are followed. Unfortunately, a survey conducted last week showed that fewer than forty percent of health care facilities report that at least three quarters of their providers are applying CDC guidelines.

Patients and their loved ones can do their part to decrease the chance of contracting a CAUTI. While in the hospital, patients are advised to ask their health care provider every day if the catheter is still necessary. The CDC also has guidelines for patients, and recommends that patients do the following when coming home from the hospital with a catheter still inserted:

-       Make sure to ask questions so as to understand how to care for a catheter once home from the hospital

-       Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination

-       Always clean hands before and during catheter care

-       Keep urine bags below bladder level

-       Do not tug or pull on the tubing, or twist or kink the tubing

While a catheterized patient is recovering at home, highly-trained health care providers will be able to monitor a patient’s catheter, preventing infection and giving peace of mind to patients and their families.

Recovering at Home Can Help to Avoid C. difficile Colitis

  

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Clostridium difficile (C. difficile) is a bacterium that was named in 1935 for the difficulty that scientists had in isolating it.[i]  Eighty-five later, C. difficile is anything but difficult to reproduce. It causes an infection of the large intestine known as C. difficile colitis, which is becoming alarmingly common in hospitalized patients and those in other healthcare institutions.  The infection can be very serious—in some cases, requiring surgical removal of the colon.  Less severe cases can also be very challenging to treat, because the treatment itself predisposes one to developing the infection.

C. difficile colitis is common in hospitals, nursing homes, and other environments in which patients with weakened immune systems are clustered.  Antibiotics change the balance of bacteria that naturally exist in the colon, making it easier for C. difficile to flourish.  Most cases can be treated with antibiotics that attack the C. difficile bacteria.  However, they also affect the “good” bacteria living in the colon, which are part of the body’s natural defense against C. difficile.

Even after a C. difficile colitis infection has been cured, the bacteria typically remain in the intestines—they are simply not numerous enough to overcome the body’s immune system and cause an infection.  However, the risk of recurrent infection is high.  Roughly 20% of those who have had C. difficile colitis develop the infection again—usually, within four weeks of finishing treatment for the initial bout.[ii]  After a second case, the risk of another increases to about 40%; after a third case, to about 60%.[iii][iv]  Each bout of C. difficile colitis can require additional hospitalization. It can be something of a self-perpetuating illness.

The risk of developing C. difficile colitis is a compelling reason to limit the duration of time spent in the hospital to that which is truly medically necessary.  While C. difficile exists outside of acute care facilities such as hospitals, one is much less likely to develop an infection while recovering at home or in another private setting.  Good home care providers routinely clean indwelling catheters, such as IVs and Foleys, with antibacterial fluid, and assure good hand and personal hygiene.  Nurses, nursing assistants, and home health aides can also teach other caregivers the simple steps needed to keep you safe from infection while recovering at home.