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Date of publication: September 2006 Date of review: April 2007 Author: Dr Rod Warren Consultant Medical Microbiologist & Director of Infection Prevention and Control Sister Pam Warren: Specialist Nurse in Infection Control RJAH Trust 2005
The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG Tel: 01691 404000 www.rjah.nhs.uk
Patient information leaflet
What happens if I catch an infection anyway? Despite all our precautions, you might be unlucky enough to have a bacterium that is especially likely to spread and put other patients at risk of infection. Staff would probably then move you to a single room. Remember that not all oozing or nasty wounds are due to infection. Not all bacteria cause an infection when present; they may just be on the surface and not causing harm. If you are moved to a single room because of infection: Some staff may wear gloves and aprons when attending to you Your visitors will be asked to report to the nurse in charge for advice before entering your room You should normally stay in your room and not visit other people or areas unless this is specifically arranged by ward staff. For those who acquire infections, information leaflets are available on every ward computer to be printed out for you and your relatives. These leaflets cover most infections. If you want further information or explanation after reading this, please talk to the ward or medical staff. If they cannot answer the question they may be able to arrange for a member of the infection control team to see you. Where can I, or my relatives, get more information? If you still have further questions or want someone to ask questions for you or your relatives, please ask staff to contact the Patient Advisory Liaison Service (PALS). Even if they cannot immediately give you answers, they will seek further information for you from the hospital and us.
Risks of infection after surgery at the Robert Jones and Agnes Hunt Orthopaedic Hospital The papers and TV are full of stories about superbugs in hospitals and about promises to eradicate them. What sort of infections can occur after surgery? We all have bacteria, good and bad, in and on our bodies. Eliminating them entirely is neither possible nor is it always desirable. Infections occur when the bacteria get through our defences into the body. Surgery opens up routes for the bacteria to get in, and this cannot be avoided. Concerns include: The MRSA bacterium that can cause wound infection. This is simply an antibiotic-resistant strain of Staphylococcus aureus (Staph. aureus) a bug we normally have that is often found harmlessly on the skin surface, in the nose or in the environment. The ESBL E coli, and Klebsiella other antibiotic-resistant bacteria, which live in the gut and can spread to the bladder after urinary catheterisation and cause urinary infection. These urinary and blood stream infections in this hospital are uncommon. If they occur here, there is almost always a history suggesting they were caught elsewhere. Clostridium difficile a bacterium that causes diarrhoea after antibiotics Recent publicity includes views, theories and advice that might give you the wrong impression of what is important. Whatever you have been told about the rest of the country, the risk of infection at our hospital is small. This leaflet tells you the essentials of the advice the hospital gives to you and staff to keep the risk at its current low level. How well does this hospital perform in preventing infection? For surgical wounds, our rates of infection have been consistently low since 2002. National infection rates are higher than our rates. These rates are for infection detected whilst in hospital after the surgery.
National rates Hip replacement Knee replacement 1.60% 0.90% RJAH rate 2001 1.40% 0.43%
RJAH rate 2002 0.45% 0.44%
RJAH rate 2003 0.44% 0.28%
RJAH rate 2004 0.52% 0.41%
RJAH rate 2005 0.57% 0.23%
We have been voluntarily monitoring these infections for the whole year since 1997 using the current national standards. If you are especially worried about MRSA We can tell you that at our hospital the infection rate is: Two in 4,000 knee Seven in 5,300 hip replacements These low rates of infection are representative of other orthopaedic operations in this hospital. Figures are not available for infections that develop after the hospital stay either on a national or local basis. You will have heard about national MRSA figures. These relate to the severest MRSA infections where the bacteria get into the bloodstream from an infection you have somewhere. The infection might, for example, be from a bone infection, a drip or line, a sore, or after surgery. The infection is counted against the hospital where it was diagnosed, even if it was caught elsewhere. In the four years this information has been collected in our hospital (2001 to July 2005) nine people with MRSA bloodstream infections were reported. Only one case was related to surgery. This hospital sees more than the average number of people with Staph. aureus and MRSA infections because of its specialist role and because this is a common organism causing infections in bones and joints. This does not mean they caught the infection here. Can I check up on the Robert Jones and Agnes Hunt and other hospitals before I decide where I want my surgery done? All blood stream infections with Staphylococcus aureus are reported nationally and the percentage that are due to MRSA in people cared for in a hospital reported. This information is on the internet at www.dh.gov.uk under "MRSA surveillance". In addition, every hospital for three months in a year must now report nationally all surgical wound infections that occur during a hospital admission where new hips or knees are inserted. Comparative data between hospitals for one quarter in 2004/5 for one and joint infections is on the web at www. hpa.org.uk/ infections/topics_wz/surgical_site infection/ManSurv. htm and for Wales (with trust names kept anonymous) at www.wales.nhs.uk/documents/379/All%20%20ortho%20ssi%20 report%202002%20Draft%202.pdf
The previous information from the Nosocomial Infection National Surveillance Scheme, which this hospital took part in and we have quoted above is not published nationally. However many individual hospitals have this information and you could ask for it. What does this hospital do to control infection? The hospital takes infection control very seriously. It has an infection-control nurse specialist and a consultant medical microbiologist who advise on infection control measures. The hospital has seven special ultra-clean-air theatres for surgery. All staff are told, and encouraged, to clean their hands between attending to individual people by hand washing and/or alcohol hand rub. The latter is available for their use in every patient area. This is particularly important when looking at wounds or attending to dressings. What can I do to help? If you are a patient, please feel free to remind any member of staff who might have forgotten to clean his or her hands before and after attending to you. Despite what media reports suggest, friends, family and visitors who are not staff are rarely a source of infection to patients. They do not need to take any hand-washing precautions unless advised by staff. However, visitors who have had sickness or diarrhoea should not visit you until two days after they are completely well. In pre-operative assessment clinics, you should be asked about possible sources of infection. You will be asked if your teeth are all in a good state before a new joint replacement. If they are not, dental surgery may be absolutely necessary. If you are having hip surgery you may be asked to become a bone donor. We would then ask you questions to check for risks of bloodborne infection You will also be asked about whether you have been in hospital before, or if you or your family regularly visit a nursing or residential home. Depending on your answers, you may be asked to give permission for samples to be taken to see if you have acquired unwanted bacteria. We might then need to organise some additional treatment before your operation to reduce the risk of infection. Please do not shave around the area to be operated on before coming into hospital. Whilst in hospital do not interfere with any dressing. If it becomes wet, ask a nurse to look at it.