No hospital visitors allowed PDF Print E-mail
Tuesday, 17 July 2012 00:00

Eric Quizon, son of the late Comedy King Dolphy, in a TV interview said something that they (18 children) often “violated” ICU rule by being beside their father to cheer him up. Like him, most Filipino families who are close knitted to one another, this “violation” is “normal and acceptable”. It will be a grave “offense” if the doctor or nurse will not allowed family members to watch closely (be inside the icu or hospital room) of a critically ill family member. Or else hell will break loose, if the patient will die and no family member was around.

To avoid this issue of sentiment and resentment, it seems that the No Hospital Visitor Allowed Policy is not seriously followed by family members (spouse, children or parents) or probably by the hospital itself. If ever strictly implemented, it applies only to non-family members. Often when we visit someone in the hospital with this rule posted in the door we usually surmised that the patient needs rest or this is the doctor’s advice because the patient is critical at that moment. But once the patient is awake or not in the critical stage, we are allowed to enter.  Unfortunately, most of us are not aware that we are exposing the patient to a more dangerous re-infection if he or she is still not stable.

I am writing this column because I recently visited the father (whom I call Papa) of a close friend in a hospital. Papa is still confined with a severe infection until today, and feels sad to learn that Papa is okay one day then get worse the next day despite all the efforts of his doctors. More dosage and more expensive antibiotics and other medicines are being added since day one. And it pains to see the agonies of Papa’s family. It is a roller coaster ride of emotions for them every day (Papa don’t give up – it’s only an infection that can be easily treated compare to cancer). Like them, I feel Papa can get well soon if there will be no re-infection as the No Visitor policy will be strictly implemnetd to support the good medical management of his doctors and nurses.

Few days ago my close friend and I talked about implementing strictly the No Hospital Visitor for Papa even to family members. That night I browse in the internet about the rules of this No Hospital Visitor policy to give me a clearer understanding of this hospital rule.

My inquisitiveness brought me to an interesting article by Niall Hunter , “Hospital hygiene-is anyone taking charge?,” in www.irishhealth.com. The author wrote that the first audit of hospital hygiene survey conducted in Ireland was revealing – most hospital received poor hygiene rating and had high hospital acquired infections. He asked why and questioned if Ireland hospitals are really taking seriously their hygiene standards and infection control.

Committee members who made the hospital survey also expressed concern that it was still not clear whether key staff in hospitals were being made responsible for hygiene and infection control. They demanded that staff in hospitals be made responsible and properly accountable for hygiene control, and if not, they should be dismissed. And I ponder if this accountability can be applied too in Philippine hospital setting.

Committee members also stressed that there is a particular need for hospital consultants to play a key role in improving and maintaining hospital hygiene. Deputy Dermot Fitzpatrick, who is a medical doctor, told in the meeting that they have to get away from the idea that consultants are some sort of separate 'breed apart' within hospitals. He said it should be stressed that consultants are also responsible for hygiene control as anyone else in a hospital.

Dr Kevin Kelleher outlined a number of initiatives about hospital hygiene to prevent hospital-acquired infection and antibiotic resistance. He suggested a national infection control and cleaning standards, special training to cleaning services staff; publicity campaigns, planned restrictions in visiting hours to hospitals and new survey on hospital acquired infection.

In another internet site, I read the research done by Dr. Betsy McCaughey, Founder and Chair of the Committee to Reduce Infectious Deaths. Her study show that nearly three-quarters of patients’ rooms are contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).These bacteria are on cabinets, counter tops, bedrails, bedside tables, and other surfaces. Once patients and caregivers touch these surfaces, their hands become vectors for disease, she reported.

Her other study showed that when a nurse walks into a room occupied by a patient with MRSA and has no patient contact, but touches objects in the room, in 42% of cases the nurse’s gloves are contaminated by the time he or she leaves the room. Clothing is also a frequent conveyor belt for infections. When doctors and nurses lean over a patient with MRSA, the white coats and uniforms pick up bacteria 65% of the time, allowing them to be carried on to other patients.

Hospitals that are conquering infections require their staff to put on fresh gowns or disposable aprons every time they approach the bedside of patients carrying MRSA—not just infected patients, but all patients carrying the bacteria. Stethoscopes, blood pressure (BP) monitors, pulse oximeters, wheelchairs, and other equipment frequently carry live bacteria. Do doctors and nurses clean the stethoscope before listening to a patient’s chest? Not usually, though the American Medical Association recommends it. And if I may add, cellphones and hand bags can be carriers too. 

MRSA can live for many hours on surfaces and fabrics. When a nurse wraps an inflatable BP cuff around your bare arm, the cuff frequently contains live bacteria, including MRSA. In a September 2006 study, 77% of BP cuffs that are rolled from room to room in the hospital were found to be contaminated.

 

Preventing Infections Makes Hospital More Profitable.

Many hospital administrators worry that they can’t afford to implement these precautions Dr. McCaughey wrote. The truth is, they can’t afford not to, she said. Infections erode hospital profits, because rarely are hospitals paid fully for the added weeks or months of care when a patient gets an infection.

For example, Allegheny General Hospital in Pittsburgh, USA would have made a profit treating a 37-year-old video programmer and father of four who was admitted with acute pancreatitis, but the economics changed when the patient developed an MRSA bloodstream infection. He had to stay in the hospital for 86 days and the hospital lost US$41,813, according to research by Richard Shannon, former Chairman of the Department of Medicine at Allegheny.

Similarly, a woman came into the hospital for stomach-reduction surgery, a procedure that should have produced a US$5,900 gross profit for the hospital. However, when she developed a central line-associated bloodstream (CLAB) infection and had to spend 47 days in the hospital that profit turned into a US$16,000 loss.

In the Philippines setting, we heard of stories of patient who could not afford anymore to stay in the hospital usually ask big discounts from doctor’s fee, make a promissory note to pay the hospital, or in worse scenario, escape from the hospital iof these are not granted. This could have been minimized if only re-infection never occurred as the patient was discharged earlier.

I hope this column today will make our local hospitals review and implement strict hygiene set-up and rules. And for hospital visitors not to insist entering or visiting the patient until the doctor says so. Rich or poor, no one wants to stay in the hospital for long.


By Dante Corteza

Last Updated on Wednesday, 18 July 2012 10:02