AVOIDING  HOSPITAL  ACQUIRED  INFECTIONS (HAI)

 

Preventing you spreading infection, if that is the cause of your admission to Hospital, or preventing you getting infected whilst you are there, is a primary concern of the British Hospital.

All have heard of severe infections acquired with Hospital germs, and many even know some of the names, such as MRSA, which means Methicyllin Resistant Staphylococcus Aureus. Unfortunately there are a few other bacteria which emerge as resistant also, mainly in Hospital, but occasionally as in infections acquired in the community. It is well known that using adequate control programmes, hospital acquired infections can be reduced significantly, and the emergence of bacteria resistant to antibiotics can be controlled.  To that end, the Hospital’s Infectious Diseases Service runs a Programme called Control of Hospital Infection, and they are also responsible for a second program called Rational Use of Antibiotics, and both save lives, and save 

The Programme to control Hospital Infections, undertaken by the doctors of the mentioned Service, with two specially trained Nurses, and assisted by the specialists in the Microbiology Laboratory, involves many tasks, the most relevant being continuous  surveillance of HAI in critical care areas (adult and children’s intensive care units), in neonatology (premature infants and sick new born babies), in the hemodyalisis (artificial kidney) and in certain surgical areas. Also important are the vigilance of appearance of multiresistant bacteria (MRSA and VRE – Vancomycin Resistant Enterococcus-), the updating permanently of standards and recommendations to prevent HAI, incidental and programmed  teaching programs to all health care workers involved in patient care, and many research activities such as monitoring epidemic outbreaks, looking at modifiable HAI risk factors, 

The second Programme, Rational Use of Antibiotics, on the other hand implies that the Infectious Disease specialist team will be aware daily of all the antibiotics prescribed to each and every patient throughout the Institution; they will be in close touch with the Microbiologists who report immediately on the emergence of the different germs and their strains, and their sensitivity to a wide range of antibiotics, so that using the right antibiotic for the correct and shortest time possible will help avoid the emergence of the dreaded 

Of critical importance has been the undertaking of a vigorous campaign of Washing of Hands, directed to all the Staff in the Hospital. When hand washing is done systematically before or after touching a patient, the possibility of health care workers transmitting bacteria from one patient to another decreases dramatically. It is well known that after the 2nd or 3rd day in Hospital, a person’s buccal flora changes, and the new germs, usually harmless to the host, may be harmful to another patient with weakened immune system. The washing of hands addresses this problem. This is also one of the reasons for which physicians try to send you home as early as possible, as once home, the bacterial flora goes back to normal very 

Special care is taken when a patient is readmitted shortly after leaving Hospital, or if the patient is brought in directly from another health care Institution, which includes old people’s homes, as the risk of being carriers of multiresistant bacteria is very high. They get nose and mouth swabs on admission, and if the results are positive, it means that they are carriers, and must be isolated and treated 

We keep a record of all these situations, and compare them to our numbers in previous months and years, and to international standards. This helps to identify trends, and to analyze all problems as soon as they arise.  In the year 2001 the Medical Director presented at a World Congress on Safety and Quality in Medicine the British Hospital’s results of three recognized markers of good infection control: patients with assisted mechanical breathing, and/or those with tubes in the veins for intravenous feeding, and/or patients with tubes in the bladder to drain urine out of it. In all three situations, the Hospital’s figures were well within the range accepted by the Center for Disease Control in Atlanta, Georgia, with whom all  Institutions benchmark. Our figures continue to be 

Since last year our team, like those in many other Institutions, is tightening up even further, aiming for zero tolerance to infection, both in the above mentioned and in surgical 

Besides this heavy task, and that of attending patients in the out-patient department and admitted patients, the Infectious Disease team supervises the Vaccination Center, and runs a Clinic for advice to travelers on vaccinations and  preventing infections in  whatever destination they wish to travel, and they also are responsible for attending to travelers returning with signs of infections contracted abroad, and of foreigners who during their stay in Argentina develop symptoms suggestive of infections contracted in previous 

Other important activities of this team are pre and postgraduate teaching,  participation in academic activities at national and international congresses, publishing their results and findings in journals and books, clinical and epidemiological research, and the coordination of a very successful intravenous prolonged antibiotic treatment of patients discharged from Hospital to their homes with serious infections (TAPAD – Tratamiento Antimicrobiano Parenteral Ambulatorio Domiciliario), which also allows earlier discharge from Hospital.

 

Dr. Ernesto Efrón
Chief of Infectious Diseases
Hospital Británico
Buenos Aires.                           Translation:  Dr. John Emery