Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

You shouldn't have to worry about getting sick because of an infection you may pick up when you're getting treated in a hospital or other health care setting. Unfortunately, you have reason to be concerned.

Healthcare-associated infections (HAIs) are infections that patients get when recovering from surgery or receiving treatment for other conditions. The most common complication of hospital care, HAIs contribute to 99,000 deaths each year and cost billions of dollars to treat.

They are preventable, although careful steps must be followed. Today, several types of HAIs are on the rise.

A set of new reports released last month by my agency, the Agency for Healthcare Research and Quality (AHRQ), found that we've made very little progress in eliminating most kinds of HAIs in older patients. The reports show that blood infections after surgery and infections from urinary catheters inserted after surgery continue to be a problem. For younger patients, other data show some improvement, but much more work needs to be done.

Once certain types of bacteria get into your bloodstream, the infections they cause become hard to treat even with powerful medicines. Very ill patients and those recovering from surgery are most at risk. So, too, are older patients and those with chronic medical problems.

My father recently discovered he was carrying a germ called MRSA (methicillin-resistant Staphylococcus aureus), which can often cause an HAI. He was lucky that the MRSA germ did not lead to an infection. But the 1.7 million patients who get an HAI each year in U.S. health care facilities are not so fortunate. These patients tend to get sicker and stay in the hospital longer. Some even die as a result.

Preventing HAIs in the first place is crucial. To that end, Department of Health and Human Services Secretary Kathleen Sebelius last year called on hospitals to reduce by 75 percent blood infections resulting from catheters, or lines, that give patients medicines or collect blood samples.

This initiative is part of a major Federal effort to prevent and reduce all types of HAIs. AHRQ plays a lead role by funding and testing promising solutions to this problem. My Agency also provides proven tools and information to help health care providers improve care and reduce or prevent HAIs.

One project AHRQ funded, for example, led to a near-total elimination of infections arising from central lines at more than 100 Michigan hospital intensive care units (ICUs). Another project helped several Indianapolis hospitals reduce MRSA infections in the ICU by 60 percent.

Health care providers around the Nation are learning from these approaches. My Agency and others are spreading the word about how to use these strategies to get rid of other types of infections.

Patients also have a role to play in preventing these dangerous infections. You can take basic steps to lower your risk of getting an HAI, such as:

  • Making sure you wash your hands. Simple steps, such as practicing proper hand hygiene, played a big part in Michigan hospitals' success in lowering the rate of certain HAIs to zero. Don't hesitate to ask your family members to wash their hands when they come into your room.
  • Asking questions of your doctor, nurses, and others caring for you. We have a saying at AHRQ: “Questions are the answer.” Talking about your care with your medical team will help ensure that everyone is paying attention. Ask hospital staff before and after they change bandages or touch you: “Have you washed your hands?” Or ask, “How do you prevent HAIs?” Part of the success in Michigan was the fact that doctors and nurses stopped and reminded each other about basic infection control practices. You can play a part in that, too.
  • Don't be afraid to speak up. If you notice your bandages are not clean, dry, or attached around wounds, tell your nurse. If a friend or family member has a cold or is not feeling well, tell them to avoid visiting you in the hospital. If you are concerned about something, or something doesn't seem right, speak up.

I hope to tell you some day that you no longer need to worry about HAIs. Results of AHRQ-funded research, like that in Michigan, give me hope that these infection rates can be radically reduced. But it will take all of us playing a role to make that a reality.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
New National Initiative to Fight Health Care-Associated Infections (Transcript)

Agency for Healthcare Research and Quality

2009 National Healthcare Quality & Disparities Reports
http://www.ahrq.gov/qual/qrdr09.htm

Questions Are the Answer
http://www.ahrq.gov/questionsaretheanswer/

Healthcare-Associated Infections: Tools and Resources
http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/hais.html

Centers for Disease Control and Prevention
Healthcare-Associated Infections (HAIs)
http://www.cdc.gov/ncidod/dhqp/healthdis.html

National Patient Safety Foundation
Preventing Infections in the Hospital: What you as a patient can do
http://www.npsf.org/paf/i/

Current as of May 2010
Internet Citation: Healthcare-Associated Infections: They Can Happen to You. May 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/050410.html