Monday Medical: Preventing infection a team effort

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Yampa Valley Medical Center has set a goal of zero for hospital-acquired infections.

Recognizing that preventable infections can cause harm to patients, YVMC continues to follow recommendations of national agencies, including Institute for Healthcare Improvement, Centers for Disease Control and Prevention and the Joint Commission.

YVMC is participating in IHI's 5 Million Lives Campaign, a national effort to reduce harm to patients. A key campaign initiative is to prevent surgical-site infections and hospital-acquired, drug-resistant infection such as "MRSA," or methycillin resistant staph aureus.

Steve Hilley, infection prevention nurse, closely monitors risk-reduction programs at YVMC.

"Unfortunately, despite our best efforts, infections can still occur," Hilley says. "This is why, during the pre-operative consent process, your surgeon will always discuss with you the risk of infection."

"Preventing surgical-site infections begins well before the patient comes into the hospital," YVMC chief quality and patient services officer Judy Zuccone said.

"Patients can reduce the risk of developing an infection by being in the best possible health prior to surgery."

Smoking, excessive drinking, obesity, a history of previous infection or chronic illness are examples of factors that decrease the body's ability to fight infection.

YVMC encourages every patient to meet with a pre-operative nurse to establish a thorough medical history. The primary care physician may require an examination. Tests may be ordered to ensure that the patient is in good health or to determine if any medical intervention is needed prior to surgery.

"YVMC follows guidelines from the IHI and CDC for the prevention of MRSA infections," Zuccone says. "Certain high-risk patients and those who are planning joint replacement or spine surgery are screened within the week before surgery to determine whether they are 'colonized' or carrying MRSA."

MRSA is of particular concern because it is resistant to many antibiotic medications. These bacteria reside in the nose or on the skin of some individuals and can enter the skin through a cut or surgical incision.

If MRSA test results are positive, YVMC patients are pre-medicated with specific antibiotic drugs at least five days prior to surgery to help minimize the risk of infection.

All patients scheduled for surgery at YVMC are given instructions about washing without irritating the skin the night before surgery. Directions also are given not to shave the operative area, as that may provide a way for bacteria to enter the skin.

When a patient arrives at YVMC, he or she is assessed again prior to surgery. In keeping with national guidelines, an antibiotic is generally given immediately prior to surgery in an attempt to lower the risk of post-operative infection. Depending on the type of surgery, antibiotics may be continued for a short period of time after surgery.

Patients who remain hospitalized after surgery are monitored closely for signs of infection. Vigilant hand washing by staff, physicians and visitors is key to preventing infection. Family members and friends who are ill should refrain from visiting the hospital.

Efforts to prevent an infection must continue at home. It is essential that patients avoid contact with those who are sick or who have skin infections. Hand washing and keeping the wound and/or dressing clean is of the utmost importance.

"Don't overdo your physical activity, avoid hot tubs, eat nutritiously, take all medications as ordered and be very careful when changing bandages," advises Dr. Larry Bookman, chief medical officer at YVMC.

"These precautions should be maintained throughout the recovery process, which may be several weeks or even months, depending on the type of surgery," he adds. "Any sign of infection - swelling, redness, or drainage from the wound - should be reported to the surgeon immediately."

YVMC provides patients with instructions on how to prevent post-operative infections when they leave the hospital. Nurses make follow-up telephone calls to check on patients' progress.

When an infection does occur, YVMC investigates the circumstances of the infection in depth, reviewing all aspects of patient care in an attempt to find the cause.

"We look at the surgery preparation, staff members, surgeons, the length of surgery, sterile processing of instruments, which operating room was used and our compliance with standards," Hilley said. "It can be difficult to determine the exact cause, as many factors may contribute to an infection."

Any patient who has concerns or questions about an infection following surgery is encouraged to call his or her physician. Hilley also is available at 871-2430.

Christine McKelvie is public relations director at Yampa Valley Medical Center.

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