Posted by Arjun Vellayappan on Sun, Jul 31, 2011 @ 07:57 AM
Yesterday we blogged about the growing problem our healthcare system is facing with hospital-acquired infections. Today, we’ll investigate a bit further into these infections by examining urinary tract infections which are most common HAI. According to recent statistics, UTIs account for around 40% of all hospital-acquired infections which makes them crucial to stop.
Recent studies have concluded that “the risk of infection increases as the duration of catheterization increases”[1] so the best solution may be to reduce patients’ length of stay in hospitals. The problem is that less “than 1 in 10 hospitals in this country used [the simple methods] for preventing unnecessary catheterization”.
This is dangerous because urinary tract infections like other nosocomial infections increase morbidity and mortality, prolong hospital stay and increase patient care costs. The methods of preventing these infections are hazy and not fully agreed upon which makes patient care tough.
Patients and their loved ones can do their part to decrease the chance of contracting a UTI. 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.
[1] “Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study”, Clin Infect Dis. (2008) 46 (2): 243-250.
Posted by Hotel Recovery Blog Manager on Wed, Jan 19, 2011 @ 09:30 AM
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.
Posted by Hotel Recovery Blog Manager on Wed, Dec 29, 2010 @ 08:00 AM
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.
Posted by Hotel Recovery Blog Manager on Wed, Dec 15, 2010 @ 09:00 AM
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.
Posted by Hotel Recovery Blog Manager on Sat, Jul 17, 2010 @ 05:06 PM
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.
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