Health
Hospital 'super-bugs': what you need to know for a cleaner, safer, hospital stay Print E-mail
Written by Judy Wynne, 2008   
Judy Wynne's interest in HAIs was purely professional until she went into hospital as a heart patient last year. Her advice could help you avoid the dreaded MRSA and C. difficile.

The idea for my campaign to help patients help themselves grew from the fears of my clients. I work as a physical therapist and almost without exception those being admitted to hospital were worried about the so-called 'superbugs'.

Each year in the UK, 11.5 million people are admitted and one in nine of those will end up with a Hospital Acquired Infection (HAI). In the year to March 2007 there were 6,378 reports of MRSA and 55,884 reports of Clostridium difficile (because mandatory reporting for C. difficile is for 65+ age group the true figure is probably some 25 per cent higher).

The vast majority of these infections were acquired in hospital, the very place where they go to get well. This country has one of the highest rates of MRSA in Europe (with a slight decline this year) and the latest reports show that C. difficile cases are rising.

Our healthcare trusts are battling hard to regain the levels of hygiene and cleanliness that we knew when the ward cleaners reported to the matron or ward sister. But budgets have been cut and cleaning services have been contracted out. So it is time for us, the public - as patients or visitors - to take up the challenge to keep ourselves and the hospital environment cleaner and safer for all.

I knew that infections are carried from ward to ward, staff to patient, patient to patient, visitor to patient, but I still needed an insight into the real problems faced by the Infection Control Teams. How could I observe exactly how this transmission process operated? Unfortunately, I was given the opportunity as a patient myself.

Last April I was unexpectedly admitted for open heart surgery. A genetic aneurysm of the aorta had been discovered, which was big enough to rupture with dire consequences.

I was allocated a bed immediately. However, I insisted on going home to inform my relatives, cancel clients and pick up my nightie and toothbrush. Most importantly, I gathered up the samples of infection control products I had been given while doing my campaign research. I also took in a notebook.

Ward 1

The first week, feeling fine apart from slight breathlessness, I dressed normally every day and between being prodded and poked, x-rayed and scanned, I prowled the hospital corridors, sat in the ward, in the day rooms, observed the cleaners, checked for dust and dirt (as I had in my previous incarnation as a nursing home manageress) and I scribbled copious notes.

To my relief the place was pretty clean. Most of the staff were washing their hands and using the hand gels; the cleaners were doing an excellent job and sanitising soaps were provided for patient use in the washrooms and showers. So how were these bugs transmitted?

Know your enemy

Please read this. It is important that you understand how infections are transmitted. This understanding will allow you to reduce your chances of infection from yourself, staff, visitors or the medical and domestic equipment that surrounds you in the ward, toilets and washrooms.

Measures taken to combat MRSA and C. difficile will also protect you, to some degree, from many other HAIs.

MRSA

Methicillin Resistant Staphylococcus Aureus (MRSA), which has become resistant to some antibiotics, is a mutation of the common and easily treatable SA bacteria. Nearly 30 per cent of the population are colonised with SA (colonisation is not the same as infection). A growing proportion of those colonised are carrying the MRSA strain.

Until MRSA enters your system through an opening in the skin, the bacteria will not cause you harm. It can survive anywhere on the skin, most commonly the groin, anal and pubic area, the armpits, under the breasts and in the nose.

Any break in the skin - a rash, fungal infection (such as athlete's foot), open spots and certainly surgical wound sites, or the opening for a cannula or catheter - is an access point for bacteria that can cause a soft tissue infection. If the infection passes into the bloodstream it will cause more serious illness.

MRSA infection is not age-related and can be passed easily from one person to another.

Clostridium difficile

A smaller percentage of the population (3-15 per cent) carry C. difficile in the gut. So long as the 'good' bacteria that are a normal part of our gut flora, can overcome the 'bad' bacteria we will not develop symptoms. But use of antibiotics will often kill off the 'good' as well as the 'bad' bacteria, which allows C. difficile to multiply and produce the toxins that can cause the symptoms - diarrhoea, bowel inflammation, colitis, pain and nausea.

Those most at risk are: the elderly (80 per cent are over 65), the immune suppressed, those having repeated antibiotic therapy those having repeated enemas and those undergoing gut surgery.

To become infected C. difficile bacteria or spores must be ingested by mouth. It is vital that your hands are washed clean when touching your toothbrush, your knife and fork, eating or when touching your mouth for any reason at all. Bacteria on your hands can be transmitted to your mouth and from there into your gut. Be especially vigilant in the toilet and washroom areas, and when eating.

Remember: C. difficile spores are not killed by alcohol gels.

Ward 2

I have no recollection of the two days I spent in the intensive care unit post-surgery. My son tells me that the staff were wonderful and the ward was immaculate.

Ward 3

Within a day or two I felt surprisingly fit and out came the notebook again.

Completely different cleaning routine and infection control measures were in place - different ward sister, different regime. And now came my chance to observe my fellow patients and their visitors.

I spent my time in bed recording the daily routines with a clinical interest: patients washing hands but not immediately before eating; lots of neighbourly swapping of magazines, sitting on beds, helping new patients with TV controls; accepting sweets with no thought of washing hands beforehand. The bugs were having a field day!

What went on in the washrooms and toilets I have no idea, but things were to change. Every time I went to the toilet I took with me a sanitiser for the toilet seat, the taps and the door handles. Daily I cleaned my bed frame, the visitors' chairs, my locker top, over-bed tray and when no one was looking I even sprayed the curtains around the bed.

This generated interest and within a couple of days the rest of the residents of the ward were won over. I spent a few minutes explaining the infection transmission routes and supplied another sanitiser for the ward. This was particularly important as other patients were using our toilets. It was heartening to see the results. As soon as the patients were given the information about extra precautions that they could take, they put them into practice - and you can too.

Before admission

Some patients, but not all, will be tested pre-admission for MRSA colonisation. If your test is positive your admission could be delayed. MRSA colonisation is most likely in:
  • Those who have been on antibiotics in the previous three months;
  • Those who have been in hospital in the previous 12 months;
  • Those who are being admitted from a care home.

If you fall into one of these categories it would be wise to discuss with your doctor using an antibacterial body and hair wash before admission. You will be asked to use one once admitted and you should continue to use it during your stay.

It is important to maintain the integrity of your skin so use a good-quality emollient barrier cream on any rough, dry or cracked areas. Ask your doctor for treatments for any fungal or skin infections. Any break in the skin can be an entry point for MRSA. Continue to use the barrier cream during your stay.

Make sure all your personal items - deodorant, facecloths, toothbrush and toothpaste, shaving kit, toilet bag etc. - are spotlessly clean and sanitised. Buy new if necessary.
Launder any nightwear, dressing gown, daywear and towels to be used in hospital. Remember that bacteria can live on fabric, so a daily change after washing is advisable.

Arm yourself with antibacterial body wipes, sanitising surface wipes and non-alcohol hand cleaner. Hand gels provided by trusts are mostly alcohol-based and can make hands sore and cracked if you have sensitive skin - but if nothing else is available do use them.

To ensure that your gut is armed with beneficial bacteria to fight infections take probiotics in tablet or drink form for two weeks before admission.

During your stay

While in hospital you must clean your hands many times during the day - before and after eating (this includes sweets, sandwiches, fruit - in fact any time your hands go near your lips or mouth); after touching any surface around the ward (bed frames, chairs, curtains, magazines, anything that may have been touched by others).

And most importantly, before and especially after using the toilet, commode or bedpan. Remember that others who may not be as careful as you will have touched the toilet seat, taps, basin and doorknobs in communal toilets and bathrooms.

To wash or use hand gels? Both! Remember, alcohol gels do kill MRSA but do not kill C. difficile, so hand-washing is vital. Use your barrier cream after washing.

For your safety, do not touch dressings or bandages, catheters, drips or other tubes into your body, stitches, clips, drains on wounds or the wounds themselves. Any bacteria on your hands can transfer into the skin opening and cause infection. Keep the surrounding skin clean with antibacterial body wipes but be careful not to disturb dressings.

Sanitising wipes should be used on toilet seats, taps and door handles every visit. Bed frames, bedside cabinet, over-bed tray, light switches, ward furniture chairs and reading matter, TV and remote control are all common potential infection sites and should be kept clean throughout your stay, supplementing normal ward cleaning by using your sanitising wipes.

If you are worried that your doctor or nurse has not washed their hands, or cleaned the stethoscope or BP cuff before touching you and you are too embarrassed or nervous to ask, don't panic. Use your body wipes to give the skin a quick clean or ask a relative to do so.

Your nose and throat may be colonised with MRSA. Be careful when blowing your nose. Dispose of the tissue carefully, wash your hands and use gel.

Continue to take probiotics during your stay, especially if you have been taking antibiotics. Whilst you are on a course of antibiotics the 'good' bacteria may not survive, so make sure that you restore the balance as soon as your course ends.

Normal stomach acid helps to kill off dangerous bacteria, so if you are taking proton pump inhibitors (e.g. Omeprazole) discuss an alternative with your doctor while you are on antibiotics or in hospital. Do not stop taking any medicine without your doctor's consent as you could risk ulceration to do so.

If you are a visitor

Always wash your hands and use hand gels provided before going onto a ward, before touching the patient and when leaving.

Help the patient keep themselves and their environment as clean and infection free as possible.

Read the advice given to the patient and support them by keeping the bedside clean and clutter-free. If they are unable to do this themselves, use sanitising wipes and do it for them.

If possible shower and change into clean clothes before visiting. Your clothes can harbour bacteria. Do not sit on the bed.

Limit the number of visitors to two or maximum three at a time; do not bring babies or children on to wards. Keep to visiting times.

If you are suffering from any infection - a sniffle, a cold, diarrhoea or sickness - don't visit. A mild infection for you could be devastating for someone more vulnerable. Your nose may be colonised with MRSA, so if you do wipe your nose while on a ward dispose of the tissue carefully and wash your hands, then use gel.

Do not use patients' toilets.

Although this is not the whole picture, the public do have a critical role to play in keeping infection out of our hospital wards. With knowledge comes awareness and that leads to informed action. As Claire Rayner of the Patients' Association said, "An informed patient is a safer patient," and I for one agree.

With a nursing home management background, Judy Wynne, a 57-year-old physiotherapist, had an insight into the needs of an ageing population and an understanding of the hygiene and infection control measures required to keep this vulnerable group safe.

A growing awareness of the infection problems in hospitals and a desire to involve patients in their own health protection measures inspired Judy to source the best products currently available and put them together in a convenient carry pack which can be used in hospitals, nursing homes or even in hotels and cruise ships!

The Infection Protection Pack brings together the latest technology, products that are trialled, tested and approved to European Safety and Efficacy Standards and uses only products that are kind and safe to the skin It includes antibacterial body and hair wash, skin wipes and hand mousse and antibacterial and sporicidal surface cleaners and wipes.

The information sheet gives a clear explanation of how the different bacteria are transmitted and what measures to take to protect yourself. It also contains guidance for your carers and visitors.
 
The Infection Protection Pack and information are available for £37.50 plus P&P and can be ordered by phoning 01455 458099.

For the education and guidance information only, send a stamped addressed A4 envelope to: Patient Protection Products/Information, 277 Main Street, Thornton, Coalville, Leics LE67 1AJ or tel: 01530 230161.
 
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