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Question: My mother has been hospitalized several times for heart problems. Most recently, she was put into a room without any other patients and we had to wear disposable gowns and gloves to visit her. The doctor said my mother was “colonized” by antibiotic-resistant bacteria. The bacteria didn’t actually make her sick, but the doctor said the germs might spread to other patients. It seemed to be a lot of fuss over nothing – not to mention a waste of money for all those disposable garments. Did the hospital overreact?
Answer: Your mother’s doctor is correct. Some people can be carriers of antibiotic-resistant bacteria and yet have no signs or symptoms of infection, says Dr. Mary Vearncombe, Medical Director of Infection Prevention and Control at Sunnybrook Health Sciences Centre.
The organisms live in the patients’ guts or on their skin. The bacteria may never cause them any harm – unless the microbes get into their bloodstream and produce an active infection. For the most part, colonized patients are free from the bacteria’s ill effects.
However, carriers can pass on the microbes to other people, and that’s certainly not a good thing to happen in a hospital, says Dr. Vearncombe.
Many other hospital patients have weakened immune systems, leaving them potentially vulnerable to the microbes. Or, recent surgical incisions provide bacteria with easy access into their bodies.
Hospitals have adopted special cleaning and hand-washing procedures to reduce the risk of germs spreading from person-to-person. But despite these efforts, some patients still pick up harmful bugs.
According to a 2013 report from Canada’s Chief Public Health Officer, more than 200,000 Canadians get infections in health care facilities (hospitals, nursing homes and rehabilitation centres) each year and 8,000 of them die as a result.
To put that death toll into perspective, it is almost equal to the number of Canadians who are expected to die this year from breast cancer and leukemia combined. So, healthcare-acquired infections are a very big deal.
The Public Health Officer’s report also pointed out another worrisome fact: more than 50% of the health care acquired infections were caused by bacteria that are resistant to at least one type of antibiotic.
These so-called “superbugs” pose a huge threat to our health-care system. They make it harder to control common infections. And ironically, hospitals are a breeding ground for resistant strains. The concentrated use of antibiotics in the health care environment sets the stage for a Darwinian struggle in which only the strongest, most drug-resistant bacteria survive.
For these reasons, hospitals take extra precautions with patients who are colonized by antibiotic-resistant bacteria. The safeguards start at the point of admission to the hospital. Patients suspected of harboring these nasty germs are routinely tested. Screening swabs are used to collect bacterial samples from the nose and rectum and then sent for lab analysis.
At Sunnybrook, for instance, the tests check for the presence of two very common drug-resistant bugs – methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE).
Anyone who has been hospitalized within the past year is identified for this type of screening, says Bronwen Edgar, an infection-control coordinator at Sunnybrook. “We just want to make sure they didn’t pick up something when they were previously in a hospital” because the microbes can remain in the nose or gut for a long time.
The fact that your mother had been hospitalized several times for heart problems would have been one reason that she was screened.
Patients found to be colonized by drug-resistant bugs are segregated from others. This means the carrier is usually put into his or her own hospital room. Anyone entering that room – family, friends and health-care workers – must don special protective gown and gloves and take them off when exiting the room.
“We realize this can be frustrating for families,” says Sue Thorne, a Sunnybrook infection-control coordinator. The precautions, however, are justified.
She notes that the microorganism are found in the patient’s nose, feces and urine. If the patient is incontinent, or has loose stools, or is coughing or sneezing, the microbes can be spread into the surrounding environment. By touching the patient or surfaces in the room – bedrails, tables, chairs, countertops, handles, phones – family and friends could easily pick up one of these germs.
“Even the simple act of holding a loved one’s hand can risk spreading the infection if the hands haven’t been correctly washed,” says the report of the Public Health Officer.
Family members could unwittingly carry the microbes to another part of the hospital by using a public washroom or going to the cafeteria for a cup of coffee, explains Ms. Thorne.
Some bacteria can survive “many weeks and even months” on unwashed surfaces, increasing the risk they will spread further afield, warns Canada’s Chief Public Health Officer. However, proper hand washing or use of alcohol-based hand sanitizers can protect you.
Preventing hospital-acquired infections depends on the co-operation of patients and their families and visitors. Of course, that means patients like your mother are subject to extra precautions in order to protect potentially vulnerable individuals.
For some patients, that amounts to a personal inconvenience. But for others, it’s not a major hardship, says Ms. Edgar. “Some people are happy to be in a single room,” she adds.
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Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.
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I am often asked by patients who are colonized if they can hug their grandchildren, play with them as usual, etc., when they get out of hospital. What is the appropriate advice for these patients?
These bugs don’t, in general, pose a risk to healthy people. And they don’t tend to spread from colonized individuals to others so long as proper hygiene practices are followed. That means routine cleaning of your bathroom, and hand washing after toileting.
In the case of colonized hospital patients, some of them may have loose stools or they are incontinent or they’re coughing and sneezing. So they are potentially spreading the germs around. That is why extra-precautions are needed in the health-care setting.
But if they are symptom free – and at home — proper cleaning and hand washing should be sufficient to keep the germs contained.