Patients take home a lot of things when they leave the hospital -- get-well cards, maybe a plant or stuffed animal, even the occasional disposable plastic medical device that might come in handy during recovery.
But one thing they'd prefer not to have as a keepsake is an infection acquired in the hospital. Such infections occur in at least 5 percent of all hospital patients, and perhaps 20 percent of patients in intensive care units.
Hospitals use a variety of techniques to try and avoid the spread of such germs, everything from special ventilation systems to rigorous rules on hand washing by staff between patient contacts.
A recent study by researchers at Johns Hopkins Hospital and five other institutions found that it might be just as important for patients to scrub.
More than 2,600 intensive care patients got a daily neck-to-toe sponge bath with a mild solution of the same antibacterial soap that surgeons typically use before operating. A similar number of patients in each hospital got the same bath with regular soap and water.
Weekly swab tests of the patients found that 32 percent fewer of those getting the antibacterial baths were colonized with drug-resistant staph and 50 percent had fewer infections with drug-resistant Enterococci strains -- the two most common hospital-acquired superbugs.
Dr. Trish Perl, a co-author of the study and director of infection control at Hopkins, said adding the antibacterial to the daily patient care routine carries only the cost of the soap, since the baths are already being done.
"Because these bacteria have built up resistance to many of the most common antibiotic drugs used to kill them, our goal is to stop them from infecting patients or spreading from patient to patient, as we are left with few options once they colonize and infect a patient,'' Perl said.
More patients are also walking out of hospitals without something -- the blessing of their doctors.
A new report from the federal Agency for Healthcare Research and Quality found that the number of hospital stays that ended with patients leaving against the advice of medical staff has increased by nearly 40 percent between 1997 and 2007 -- more than 368,000 in the final year.
About 22 percent of the patients who left against advice were uninsured and men were about 1.5 times more likely to leave than women. Most patients who left had chest pain with no determined cause or alcohol or drug conditions.
Another recent report shows that one thing fewer and fewer patients, visitors or staff are able to do in a hospital, even outside the hospital, is smoke.
A survey of hospitals found that as of February 2008, 45 percent of the nation's hospitals had adopted "smoke free campus" policies, meaning that smoking is banned on all parts of the property, inside and out, and there are no designated smoking areas.
"Besides the 45 percent that already had smoke-free campuses, another 15 percent indicated they would be implementing similar types of policies in the near future,'' said Scott Williams, a researcher for The Joint Commission, the nation's main hospital and health care accrediting organization, which collaborated on the survey with the Henry Ford Health System's Center for Health Promotion and Disease Prevention in Detroit.
"It is safe to assume, on the basis of these results, that the majority of U.S. hospitals will have smoke-free campuses by the end of 2009,'' Williams added. The survey covered 1,1916 hospitals accredited by the commission.
As recently as 1992, when the commission first set standards requiring hospitals to ban smoking in all but separate, ventilated areas, fewer than 3 percent of hospitals extended an indoor ban to include the entire campus.
(Contact Lee Bowman at BowmanL(at)shns.com)
Medical Journal
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