When it comes to hospital safety, experts say, patients have a right to question cleanliness to prevent infections.
Airline passengers don’t review the preflight checklist with the pilot, and restaurant customers aren’t expected to check the kitchen and the staff for cleanliness.
But many health care experts say it’s wise for hospital patients and their families to ask doctors and nurses to wash their hands, remove unnecessary catheters and explain how they will prevent an infection from developing after surgery.
The advice is an acknowledgement of reality: A hospital can be a dangerous place to spend the night.
Comprehensive infection control is more goal than fact at most hospitals. On hand-washing alone, for example, health care workers comply only about half the time, studies have shown. And one in 20 patients will acquire an infection while in the hospital.
Even so, speaking up for yourself in that setting is not an easy thing to do.
“No one wants to be confrontational with the person you hope will save your life,” said Dr. Michael Bell, acting director of the division of health care quality promotion at the U.S. Centers for Disease Control and Prevention in Atlanta.
Nonetheless, Bell and other experts advise patients and their families to be vigilant.
“There are too many harmful things and bad bugs that can hurt you,” said Victoria Nahum, an advocate for patient safety whose family faced three hospital-acquired infections in one 10-month period about seven years ago. Hospitals have been on a quest to become safer since 1999, when the Institute of Medicine stunned the medical world with its publication of “To Err Is Human.” That study found that tens of thousands of patients died every year from medical mistakes.
But infection control has proven to be a complicated undertaking. Protecting patients requires hospitals to follow new checklists, hand-washing requirements and cleaning regimes. While doctors were free to practice as they saw fit in the past, many hospitals now demand that they follow protocols known to keep patients safe.
“We don’t want to take away the art of medicine,” Bell said. “We want to make things as goof-proof as possible.”
Hospitals are trying to learn from other industries that have strong safety records. Many hospital executives are focused on turning their facilities into “high-reliability organizations” in which staff members take the right steps with every patient every time. But most freely admit that they’re not where they want to be.
“Many people, including myself, would say there are dangerous things that can happen in hospitals and there are mistakes — that’s where we are right now in American health care,” said Dr. Bob Wise, an expert on health care quality at the Joint Commission, which accredits and certifies more than 20,000 health care organizations and programs nationwide.
“The person who is going to be most concerned is obviously the patient themselves and their families. The issue is you can’t be there scanning the environment and be afraid. You do have to have some education about where you should be spending your attention and your focus.”
At Emory Healthcare in Atlanta, Dr. William Bornstein, the system’s chief quality and medical officer, said there’s a way to invite patients to help. “What I think is particularly effective is when health care providers say, ‘Hey, by the way, if you ever see me forget to do hand hygiene, would you remind me?’ ”
Fliers posted in Emory hospitals say, “We encourage you to ask your health care providers if they have cleaned their hands.”
That awkward conversation
Nahum and her husband, Armando, dedicated their lives to improving patient safety in 2006 after their brushes with hospital infections. Their son, Josh, who had been hospitalized in Colorado after an accident, died from an infection at age 27.