PROTECT YOURSELF FROM LIFE-THREATENING SUPERBUGS

Be smart about antibiotics.

• Antibiotics fight infections, but they can cause them too. Because the drugs kill the protective bacteria in your gut, they increase your risk of picking up Clostridium difficile (C. diff ), one of the deadliest hospital-acquired infections, says Arjun Srinivasan, MD, a medical epidemiologist at the CDC. That’s why the CDC no longer recommends antibiotics after an operation if you have no signs of infection. A 2017 study found that when doctors in British hospitals cut back on prescribing Cipro, Levaquin, and other broad-spectrum

antibiotics, the rate of infections from C. diff bacteria dropped a whopping 80 percent. “If your doctor prescribes you an antibiotic in the hospital, ask what infection you have and how long you need to take the antibiotic,” Dr. Srinivasan says.

Clean your hospital room.

• Even though hospitals disinfect rooms between patients, studies show that up to 60 percent of hospital rooms are not cleaned properly. For extra protection, ask a nurse for some bleach wipes or bring your own (bleach is necessary to kill C. diff ). Wipe down the room or have a family member do it. Make sure you swipe in one direction only, and don’t turn the wipe over and use the other side or you’ll risk contaminating your hand. (For a list of hospital germ hot spots, see page 67.)

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Limit IVS, tubes, and catheters as much as possible.

The longer you have one of these devices, the higher your risk of picking up a deadly infection, says Dr. Srinivasan. If you need a catheter, ask whether intermittent catheterization is an option; it can lower the risk of infection by 20 percent or more.

Tell your doctor about diarrhea.

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Loose stools are the first symptom of C. diff, which attacks the intestines. “Sometimes patients don’t tell anyone, because it’s embarrassing,” Dr. Srinivasan says. “But it’s really important to tell us, especially if you’re getting or recently had an antibiotic.”

Brush your teeth.

• Bacteria in your mouth can find their way into your lungs, causing a nasty case of hospitalacquired pneumonia. Studies have found that good oral care while in the hospital cuts your risk by more than a third. If you’re the family member of a patient who can’t take care of himself or herself, ask the nurse to show you how to use a toothbrush or foam swab sticks to clean the inside of your loved one’s mouth, and do it at least twice a day.

Get your flu and pneumonia shots.

• Ideally, you should get these vaccinations before you land in the hospital, but you can also ask for them once you’ve been admitted. Most insurance plans will still pick up the cost. The CDC recommends getting two different pneumococcal shots at least one year apart if you are 65 or older, smoke, or have a chronic condition that weakens your immune system.

• Insist on handwashing. Good hand hygiene is your best weapon against hospital-acquired infections such as C. diff, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Enterobacteriaceae, a family of germs that includes Escherichia coli (E. coli). Ask all care providers and visitors to wash their hands with soap and water every time they enter the room. Don’t forget to wash your own hands before you eat and after you go to the bathroom.

TAKE SPECIAL STEPS BEFORE ANY PROCEDURE

• Ask to be screened for MRSA.

Many people carry these superresistant staph germs on their skin, and they’re harmless as long as you’re healthy. “But if your immunity is compromised or they sneak in through an IV line or an incision, they can have a field day,” causing pneumonia, sepsis (a life-threatening condition caused by an overwhelming immune response to infection), or an invasive bloodstream infection, says healthcare safety consultant Karen Curtiss, author of Safe and Sound in the Hospital. Your doctor can test you for MRSA with a simple nose swab. If the test is positive, he or she can give you an antibiotic that targets the strain.

• Don’t shave in the area of your surgery (and don’t let the nurse do it either). Shaving leaves microscopic cuts and nicks that can become bacterial breeding grounds. The CDC now recommends that hair near your surgery site not be removed unless it will interfere with the operation. “If surgeons need to do it, they should use clippers and not a razor,” Dr. Srinivasan adds.

• Shower with a disinfectant before you go to the hospital. Pick up some Hibiclens, a powerful antiseptic soap that will kill germs on your skin, at your local pharmacy, and shower with it at home the night before and the morning of your surgery. Use it instead of your regular soap or shower gel. “What you’re hoping to do is leave a little residue on your skin,” says Dale Bratzler, DO, MPH, medical director at the Oklahoma Foundation for Medical Quality in Oklahoma City. • Tell your doctor if you have an infection. Even a minor one, such as a sinus infection, can weaken your immune system and increase your risk of complications, Dr. Srinivasan says. The

bacteria from something as simple as a tooth abscess can get into your bloodstream and cause a potentially lifethreatening situation. You and your doctor can weigh the risks and discuss whether to delay your operation.

• Be the first surgical patient of the

day. The room is cleaner, your surgery is less likely to be delayed, and your surgeon won’t be as tired, says Jeanne Dockins, RN, a surgical care nurse in Tucson, Arizona. If you’re wheeled in around 4 p.m., you’re four times more likely to have anesthesia-related problems such as nausea and pain as patients who have surgery before noon, according to a Duke University analysis published in Quality and Safety in Health Care. The authors speculated that the discrepancy might be related to the doctors’ or nurses’ fatigue, swings in their circadian rhythms, and/ or the fact that late-in-the-day surgical patients go all day without eating.

• Get screened for blood-clot risk.

Your risk of developing deep vein thrombosis—a condition in which a dangerous blood clot forms in a deep vein in the leg or another part of the body—is ten times higher when you’re in the hospital because surgery can release tissue debris or other substances that don’t belong in your veins. Being confined to bed also raises your risk. Before your surgery, your doctor should take your medical history and give you a physical to determine your level of risk. If the screening shows you’re at high risk, your doctor can start you on bloodthinning medication, recommend compression stockings, or use a mechanical device to prevent blood from pooling in your legs, Dr. Pronovost says. Getting up and walking as soon as you can also reduces your risk.

• Ask for extra blankets. Surgeons often like to keep the operating room cold so they won’t get overheated in their gowns, masks, and hats while working under the warm surgical lights. But research shows the chill and the effects of anesthesia may give you mild hypothermia, which can cause cardiac arrest and increase your risk of infection. For that reason, many anesthesiologists now use warming devices on patients during surgical procedures. And you should pile on the sweaters and blankets to stay warm before and after surgery.

REDUCE YOUR POST-OP RISKS

• If you’re at all unsteady, get help

to go to the bathroom. Every year, 700,000 to one million patients fall in the hospital, and 30 to 50 percent end up with a serious injury such as a broken bone or a concussion. Wear

skidproof slippers, and call the nurse before you try to get out of bed on your own, says critical-care nurse Kati Kleber, RN, author of Admit One. “People don’t want to bother us when they have to go to the bathroom, so they wait until it’s an emergency. Then they’re in a hurry, which puts them at risk,” she says.

• Use a clean washcloth on incisions.

“I’ve seen patients wash everything else, then use that same washcloth on their incision,” Kleber says. “Um, yuck!” Follow your doctor’s instructions on changing the dressing and caring for your wound, and always wash your hands before touching it.

• Request a physical therapist right away. Your condition and muscle tone start to deteriorate after just a few days of bed rest, says Bobbi Kolonay, RN, an aging life care manager in Pittsburgh. “Even in intensive care, you can do bedside exercises,” she says. This service is typically covered by insurance as long as your doctor deems it medically necessary.

• Ask your nurses to “cluster” your

overnight care. Even though sleep is important for healing, most hospitals disturb patients multiple times during the night. “If you ask, we can often cluster things together so you’re not woken up so much,” says Brittney Wilson, RN, a nurse in Nashville, Tennessee. It’s best to communicate this request as soon as you meet your night shift nurse, Wilson says, so he or she can plan ahead.

PREVENT MEDICATION MISTAKES

• Bring an up-to-date medication

list. Include all your prescriptions and dosages, along with any over-thecounter medicines and supplements you take. Many agencies, including the FDA and AARP, offer a medication list template you can download from the Web. If you’re tech-savvy, you can create an electronic record on your smartphone through a free app such as Carezone or Medisafe; just make sure family members know how to access it.

• Don’t distract your nurse when he or she is programming your IV. “I’m dealing with a lot of numbers—your weight, how much is left in the bag, and the rate the doctors want it to go in—and messing it up can be catastrophic,” Kleber says. “I often have to say to patients, ‘Hold that thought. Let me focus here for a minute.’”

• Post a list of your medical allergies. The hospital may already list them on a whiteboard, but nurses could forget to check it, says Dockins. “Sometimes your nurse’s mind might be wandering,” she says. “If you tape a sign over your bed that reads, ‘Allergic to XYZ,’ he or she won’t miss it.”

AVOID COMMUNICATION MIX-UPS

• Keep track of everything. It’s easy to get confused and overwhelmed in the hospital. “Often I have patients who have no idea who was in their room,” says Kevin D’mello, MD, director of quality improvement and patient safety in internal medicine at Drexel University College of Medicine in Philadelphia. Write down your questions, the name of anyone who comes into your room, and a record of your conversation with him or her. Or have a loved one fill that note-taking role.

• Repeat back what you heard. Studies show that patients immediately forget 40 to 80 percent of the medical information they receive, and nearly half of what they do remember is incorrect. So when the medical staff shares an explanation or instructions, repeat what they said back in your own words to make sure you understood correctly.

• Ask for a bedside shift change.

Many errors occur when care transitions from one nurse to the next. If nurses do the handoff in your presence, you can catch slipups and ask questions.

• Read behind your doctor. Studies show that mistakes in patient files often contribute to errors—your chart lists an incorrect body weight, for example, leading your doctor to prescribe a too-high dose of your medication. Under the law, you have a right to see your medical record. A growing number of medical systems make it easy to access through an online patient portal you can log in to right from your smartphone in your hospital room. Check your record for accuracy and point out any errors.

SOME FINAL STAY-SAFE TIPS

• Get out of bed. You’re inevitably going to spend a lot of time lying down, but try to get up as soon as you can. Being active helps prevent bed sores, blood clots, and pneumonia, and research shows you’ll get out of the hospital sooner, says Dr. Bratzler. Ask a nurse or a family member to help you take a short stroll a few times a day.

• Have someone by your side. Nurses can’t always get to a room right away when the call bell or the monitoring alarm goes off. A friend or family member can help make sure medical staff respond quickly if there’s an

urgent need. “I had a friend who went in for a routine hernia operation,” Curtiss says. “The nurses told his wife that he was going to sleep for a few hours, so she went out to run errands. When she came back, he was brain-dead. He had a bad reaction to anesthesia, vomited, and choked to death before the nurses got there.” This might be a rare occurrence, but you don’t want to be the one it happens to.

• Trust your gut. If something doesn’t seem right, speak up. Tell the doctor if the drug he or she is prescribing didn’t work the last time you tried it or if you notice changes in a loved one’s condition. “Sometimes the family will say, ‘I know he doesn’t look different, but he seems confused,’” says Dr. Pronovost, “and sure enough, he’s developing an infection.” When Dr. Pronovost’s team examined adverse events at hospitals, they found that in an astonishing 90 percent of cases, someone knew things were going wrong but the person didn’t speak up or wasn’t heard.

• Ask to record discharge instructions. Study after study has documented that many patients don’t remember or understand what to do after they leave the hospital, meaning they’re vulnerable to complications. One Alabama hospital recorded the instructions so patients could play them back later; this reduced the number of patients who had to be readmitted within 30 days. Steal that strategy by asking the nurse at discharge whether you can tape him or her with your smartphone. Also, make sure you have these four things before you leave the hospital:

(1) A follow-up appointment. Your doctor or nurse may tell you to see your primary care doctor in seven days, but when you call, he or she can’t see you for a month. Before you leave the hospital, ask someone there to call and make the appointment for you. (2) An updated list of medications, with instructions on when and how to take them. Make sure you know which prescriptions you’re supposed to continue and which ones you already took the day you are discharged. If you need new medications, ask the hospital to call them in to your pharmacy.

(3) The number to call if you have a question. Ask how to get in touch with your specific doctor if you have questions after discharge. If you leave the hospital on a Thursday or Friday, get the number for the doctor who will be on call over the weekend.

(4) A list of red flags to watch for.

Don’t rely on the general handout the hospital gives you. Find out which specific symptoms may indicate your condition is getting worse and what you should do if they occur.