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with Rod Moser, PA, PhD

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Wednesday, August 9, 2006

Dirty Places, Part 12: Hospitals/Nursing Homes

There are so many more places that deserve recognition as Dirty Places, but I thought I would sum up the Dirty Dozen with the dirtiest and most dangerous places — hospitals and nursing homes.

This week, my elderly mother was discharged from the hospital and permanently entered a nursing home, and sadly it is going to be a one-way trip. My brothers and I hoped that we would never have to make this decision, but it is no longer safe for her to be in assisted care.

The state of her physical and mental health now requires 24-hour care, not something we can provide. We toured many facilities before making our decision, but my non-medical brothers do not look at those places with the same jaundiced eye. First there are the smells of urine and feces; the sounds of moaning and crying, and the sights of frail elders slumped over in chairs in wheelchairs lining the halls and day-rooms.

Is this really the best we can do for our elderly? Is this what we are getting for $4000 a month? I can assure you that all of us have been losing sleep over this painful decision.

Already, my older brother has experienced problems. He arrived to find that she had soiled herself. She rang her buzzer and they had promised to come and help her to the bathroom, but no one arrived for over twenty minutes. Even in my mother’s state of mind, she was clearly mortified.

As poor as we were growing up, cleanliness was paramount in our home. She changed our sheets and pillow cases every day! She even ironed them. We always had clean clothes. Our one bathroom and tiny kitchen was spotless. She was always on her hands and knees scrubbing the floor. My mother grew up in a family of 13 brothers and sisters in a three-bedroom house with a two-hole outhouse and cleanliness was not always on the front burner. I am sure that her childhood experiences set the stage for her being a clean fiend (her words).

For her remaining days, she deserves the right to maintain those high standards of cleanliness. Perhaps, it is my own childhood experience of living with a clean fiend that motivated me to write about the Dirty Places in the first place.

The chance that my mother will get an infection is high. The CDC reports that over two million people contact nosocomial infections when they are hospitalized, resulting in over 80,000 deaths. Unless the nursing home or hospital staff strictly adheres to standard (or enhanced) precautions, people will die. Those precautions are as simple and commonsense as thorough hand-washing, the use of disposable gloves, and the routine environmental disinfection. Those precautions work, but only if people consistently use them. I do not want my mother to become a statistic.

Although this is a bit off the subject, I have been treating an unusual number of patients in the last several months for Staphylococcal skin infections and abscesses. And, not your garden-variety Staph that half of the population carries either, but MRSA — Methicillin-resistant Staphylococcus Aureus, a type of super-bug that is resistant to certain antibiotics. MRSA infections have been increasing rampant in hospitals and nursing homes since first recognized in 1961, but now they are in my backyard (and yours).

I would like to sum up my Blog series on Dirty Places by emphasizing that all of us are part of the problem and part of the solution. There should be a worldwide “Neighborhood Watch” for hygienic procedures. We must watch out for ourselves as we watch out for the others that share our planet. Viruses and bacteria have thrived on Earth long before the emergence of our species, and they will remain here long after we are extent. In the meantime, we have no choice but to co-exist. Dirty Places (and dirty people) will always exist. We have the continuing responsibility — no, the obligation — to make them LESS dirty.

Now, go wash your hands and have a nice, clean day….

Related Topics: Understanding MRSA, Long-Term Care: Choosing the Right Place

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Posted by: Rod Moser, PA, PhD at 1:00 pm

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