Initial remarks: This blog, written by Lawrence F Muscarella, PhD, reviews a checklist, or set of instructions, entitled “15 Steps You Can Take to Reduce Your Risk of a Hospital Infection.”
“(The use of antibiotics is the) single most important factor leading to antibiotic resistance around the world” — Centers for Disease Control and Prevention (CDC). Click here.
NEWSPAPER AND MAGAZINE articles routinely report about checklists designed to improve patient care.1-4 One of these articles—entitled “The Checklist” and published in the December 10, 2007, issue of The New Yorker—discusses the success of a specific checklist developed to prevent certain types of healthcare-associated infections (HAIs).3
Click here to read Dr. Muscarella blog entitled “Growing National Concerns about Carbapenem-Resistant Enterobacteriaceae” that address a concerning trend about infections caused by this antibiotic-resistant family of bacteria.
This checklist itemizes five important infection-control steps doctors are to perform prior to inserting a catheter, also referred to as a “line,” into an artery, vein, or the heart. Two of these steps instruct doctors to wash their hands with soap and to clean the patient’s skin with an antiseptic.
Read any of Dr. Muscarella’s blogs about central-line infections and their prevention. For example: read this one (click here), which questions the CDC’s conclusions about the trends and rates of these types of infections in the U.S. between 2001 and 2009; or read this one (click here), which is a peer-reviewed article and questions the conclusions that several studies advance about the performance of a specific initiative for the prevention of these types of HIAs.
But, not every checklist designed to improve patient care advises doctors and other healthcare professionals. Another checklist, for example—which has received media attention and appears on the homepage of a popular educational website: click here—counsels patients.1
Directed to patients, The Wall Street Journal published an article in March, 2013, entitled “Steps for Surgical Patients to Fight Infection” (click here to read it).
This website is the home of the Committee to Reduce Infection Deaths—a not-for-profit national campaign that was founded in 2004 by its chairman, Elizabeth McCaughey (@Betsy_McCaughey), a former Lt. Governor of New York State. According to this website, this campaign is committed to the prevention of HAIs.
Read Dr. Mucsarella blog entitled “Prophylatic Administration of Antibiotics before Surgery: Is is Always Prudent?” that address this aforementioned article published in The Wall Street Journal by clicking here.
Entitled “15 steps you can take to reduce your risk of a hospital infection,” this checklist advises patients how to protect themselves from contracting a HAI, although several of this checklist’s 15 recommendations would also apply to other types of healthcare facilities, including surgi-centers.1
Click here to learn about a program developed by Dr. Muscarella to assist patients prevent hospital-associated infections.
I AGREE WITH many of this checklist’s 15 recommendations, such as its advice to patients:
- to stop smoking well in advance of surgery and
- to ask to have skin hair removed prior to surgery using clippers instead of razors (because razors are sharper and more prone to cuts, nicks, and skin infections).
But, I disagree with this checklist’s Instruction No. 8, which advises patients to remind their doctors of the potential importance of prescribing pre-surgical antibiotics. According to the CDC and FDA, the request by patients for an antibiotic is a major impetus for doctors to over-prescribe these drugs.5
To reduce patient demand for them, the CDC and FDA have cautioned consumers about the misuse of antibiotics.6 A top concern of the CDC, the over-prescribing of antibiotics is reported to be a significant contributor to the emergence of antibiotic-resistant microorganisms.7
Strict control of antibiotic use is warranted,7 and if adequate infection controls are in place, then the risk of an HAI for most healthy patients and for many types of surgical procedures should be low. Indeed, the blanket and routine administration of pre-surgical antibiotics is potentially unnecessary and insidious. (For example, guidelines contraindicate the routine use of vancomycin for antimicrobial prophylaxis.8)
Improper use of antibiotics kills thousands and harms millions every year. — The CDC. Click here for more details.
A more appropriate instruction might have been to have advised patients to ensure that an antibiotic previously determined by their doctors to be indicated,8 based solely on clinical need and empirical data and not prescribed because of impromptu persuasion by patients, is administered prior to surgery both timely and at the proper dose. The CDC states:
“Prescribing antibiotics wisely can significantly reduce the problem.” And, “Not all fevers require antibiotics. The more we use antibiotics, the more we encourage the spread of antibiotic resistance.”