by S. Todd Stolp MD
©July 2010
A great deal of mystery surrounds the experience of hospitalization. With a little bit of luck, we will postpone for many, many years being dubbed an “in-patient.” Nevertheless, we all secretly recognize that for the great majority of us there is a hospital bed waiting somewhere in our futures. Therefore, it might behoove us to learn some of the practical facts of life as a hospital inpatient.
First, it is worth pointing out that these tips are not specific to any one hospital. Whether we are surrounded by the hallowed walls of the Mayo Clinic, the intensive care unit of a transplant unit, or the hustle and bustle of the medical facility on Main Street USA, human physiology behaves the same way. Complications of health care are not unusual in our “western” model of health care for the simple reason that, generally speaking, we only find ourselves hospitalized when we are already ill. Such illnesses open the door to complications and risks that make further illness more likely. One of the most important (and uncelebrated) reasons why we are in a hospital in the first place is to diminish the likelihood that complications will occur as we allow the built-in repair services under our skins to conduct their own repairs. Once the risk of managing our recovery at home is less than the risk of complications while residing in a hospital, it is time for discharge from the hospital.
Which is to say that residing in a hospital – any hospital – is not risk free. Hospital food makes excellent fodder for comedians because the therapeutic value of a home-cooked meal is generally beyond the reach of the inpatient. Hospitals are unfamiliar places with stimuli that are often not conducive to relaxation and comfort, whether emitted from a roommate, from an alarm on an alien bedside device or from the décor. It is not at all unusual for an elderly in-patient to develop some confusion during the night shift because of being confronted with disorienting surroundings upon awakening in Room 327.
More to the point, though, is the fact that hospitals are teeming with war-hardened bacteria and viruses. The organisms that we encounter in health care facilities have often been exposed to antibiotics and antiseptics that tend to encourage the surviving germs to be resistant to the more common weapons at our disposal. Infections acquired in a hospital tend, therefore, to be more difficult to control. For this reason recent legislation has focused upon preventing infections that occur while we are receiving care in a hospital – so-called “healthcare-acquired infections.” When a caregiver does not perform a washing of the hands in the presence of a patient, it is now perfectly within proper etiquette for the patient to request that the caregiver demonstrate a hand washing. This partnership between the patient and the caregiver to decrease healthcare-acquired infections is exactly the intent of these recently passed laws.
Which brings us to the four “W’s” that describe the four most common causes of fevers that may occur after or during a hospitalization. The first is “Wind,” meaning pneumonia (infection in the lungs). While confined to bed, people tend not to breathe deeply and this can cause an elevated temperature simply due to failure to inflate the lungs, or worse yet, infection in the lungs. To prevent this complication, patients are often given a Dr. Seuss-like contraption with a forgetful name which encourages deep breathing during hospitalization. The second is “Water,” which represents IV tubes and devices that provide us with fluids when we cannot eat or drink. Because these devices bypass our guts to gain access to the bag of fluids we call our bodies, they provide a doorway for infection to become established. That is why we should try to keep our IV sites as clean as possible. Thirdly, “Wound,” which stands for infection developing at sites of surgery or injuries that may have been the reasons for hospitalization. Finally, is “Waste,” which stands for urinary tract infections or complications related to constipation. Urinary tract infections are particularly a risk for patients who required the placement of a catheter, or small rubber tube, into the bladder to keep the urine drained during a hospital stay.
Being aware of these common causes for fevers during hospitalization can help patients assist their caregivers to recognize possible complications of illness early, allowing for an earlier treatment of infection. While it is difficult to know how many of the nearly 100,000 deaths due to healthcare-acquired infections that are estimated to occur each year in this country can be prevented, recent research has shown that improvements can be achieved. Preventing healthcare-acquired infections is a team effort worthy of the considerable effort that hospitals, health care providers, public health officials, legislators and diligent patients themselves are putting into improving outcomes.