I have divided this blog post on hospital surgery into five installments. They treat different aspects of hospital surgery in general and my surgery in particular.
The first three parts apply to virtually every reader of this blog:
– 1: What Everyone Must Know (This Post) – hospital documentation and infection prevention
– 2: That Scary Anesthesia – minimizing the risks from anesthesia
– 3: Recovery & Departure – what you can expect after waking from surgery
The final two parts apply to men only, especially men over fifty. They talk about my specific surgery:
– 4: Prostate Enlargement Versus Cancer – problems of the prostate and their cure
– 5: Prostatectomy Cures BPH – prostatectomy as the definitive cure for an enlarged prostate, also known as BPH
We’ll now proceed to discuss hospital surgery in general, and the serious problem of hospital infections in particular.
Hospital Surgery is Quite Common
Hospital surgery is far from rare in the U.S. Surprisingly, I only found one study that tells us just how common it is.
You may know surgeon Dr Atul Gawande from his best-selling books about the human side of medicine. He is also the co-author of a 2008 study counting the expected surgical procedures during an 85-year lifespan. An average U.S. citizen can expect six hospital operations: 3.4 in-patient and 2.6 out-patient. In addition, he or she can expect 3.2 invasive “procedures” that do not require a hospital operating room.
The most common operations for men are coronary angioplasty, wound debridement and groin hernia repair. For women they are cesarean section, gall bladder removal, and lens and cataract surgery. This is a very wide range of procedures. However, the discussion in parts 1, 2 and 3 of this blog will apply to almost all in-patient hospital surgery.
Scope of this Blog
I have previously written about two related topics
– The increasingly serious problem of hospital-acquired infections.
– Obstructive sleep apnea, a condition that can kill you if the anesthesiologist does not properly protect you during hospital surgery.
This blog is different from most on ArtChester.net. Instead of talking science, I’ll relate my personal experience with hospital surgery in mid-May. You may find this to be helpful preparation for the hospital surgery that almost every one of us will eventually undergo. You may be interested to see the extreme steps that (what I believe to be) a typical modern hospital takes, to protect their patients. Or you may enjoy my story simply because you can sit back and say, “Thank goodness that I didn’t have to go through that!”
Choice of Hospital
In my local area there are several large, well-respected hospitals. I chose Grosse Pointe’s Beaumont Hospital in part because my surgeon often operates there. In addition, my family doctor is on staff at Beaumont and they have an excellent reputation for successful outcomes, lack of complications and overall quality.
On balance, I am very happy with this hospital, despite minor complaints to be mentioned in a later installment. I have no reason to believe that other hospitals in my area might be inferior, because I simply don’t know. And I am not in a hurry to find out!
Paperwork Related to Hospital Surgery
It’s no surprise that hospital surgery entails a great deal of documentation. The patient sees this in printed form, and digital copies also reside in the hospital’s data system. I’ll summarize these here. The most important part of today’s blog will be to discuss infection prevention in some detail.
– Confirmation of insurance and contact details (via a phone call with the Admissions Department).
– Medicare notice of patient rights.
Beaumont Hospital Information Brochures:
– Welcome letter from President and Chief Medical Officer.
– Your Guide to Surgery (how to prepare, what to expect).
– Patient and Family Guide (comprehensive information plus contact numbers).
– Rapid Response Team (how to get help in case of problems).
– Understanding Pain Management (types of pain control, and patient options).
– My Beaumont Chart (Beaumont’s online medical records for patient access).
– Room Service Menus (Heart Healthy / Regular; and Soft / Mechanical Soft).
– Feedback forms to recognize excellent staff performance.
– Preventing Blood Clots While Hospitalized (information plus advice for patients).
– Brochures on “quitting smoking” and “meals for the homebound” (neither relevant to me).
– Medication reminder card for patient use.
Documents Specific to my Surgery:
– Scheduling form specifying date, location and type of surgery.
– Filled out and submitted by me: complete medical history, list of prescriptions and supplements, contact information.
– Surgical Preadmission Testing Orders: instructions for me to get a number of blood tests, plus an EKG and surgical clearance from my cardiologist.
– Pre-Procedure Instructions.
– Prohibition against aspirin and other blood thinners for 7 days prior to surgery.
– Prep for Prostatectomy (bowel cleansing instructions).
– Detailed instructions for preventing infections: home showering prior to surgery, steps taken by hospital, wound care after surgery.
– Discharge Instructions and Physician Orders (detailed post-surgery instructions).
– Surgical Pathology Tissue (description of removed tissue to be biopsied).
Printouts Provided by Hospital Nurse:
– Benign Prostatic Hypertrophy (this appears to be a typo for “hyperplasia”).
– Foley Catheter Placement and Care (description, problems to watch for).
– Urinary Leg Bag (detailed care and antiseptic instructions).
– Laxative, Stool Softeners.
Prevention of Infection in Hospital Surgery
Regular readers may recall my 2014 blog about hospital infections. Since then, the problem of surgical site infections has gotten worse, not better. The World Health Organization underlined its seriousness in November 2016 by issuing its first-ever Global Guidelines on the Prevention of Surgical Site Infection.
Rise in Antibiotic Resistance
One of the problems making infections more serious is the spread of antibiotic-resistant bacteria.
Journalist Michael Jorrin has detailed the alarming world-wide increase in antibiotic resistance. He points an accusing finger at pig farmers in China, who fatten their porkers with tons of colistin, one of the antibiotics of last resort. However, he also deplores all livestock production relying on antibiotics to fatten animals for market.
Traces of these antibiotics linger in every ounce of non-organic chicken, beef and pork that we eat. More critically for world health, animal antibiotics join over-prescribed human antibiotics in stimulating the spread of antibiotic-resistant strains of bacteria.
Since our arsenal of infection-fighting medicines is shrinking drastically, it becomes all the more important to prevent infection. This is especially true in a hospital, where medical procedures may breach or weaken the normal defenses of the body. In addition, it’s known that bacteria can be spread from patient to patient by bedrails and other surfaces in the hospital room.
Beaumont Hospital’s Anti-Infection Program
As mentioned above, one of the Beaumont Hospital handouts dealt with preventing infections. It estimated an incidence of surgical site infections of 1% to 3%. This sounds better to me than the 2% to 5% I have seen quoted, and CDC’s estimate of 4%. Therefore, hopefully Beaumont’s anti-infection program is showing success.
One side of the handout had a detailed discussion of surgical site infections, steps being taken by the hospital and steps to be taken by the patient. The other side gave detailed instructions for cleansing, disinfecting and hygiene the night before and the morning of surgery.
Here are a few features that were new to me, but which seemed to make sense:
– It is customary to remove hair surrounding a surgical incision. However, the hospital has banned all use of razors or shavers. The staff uses only a clipper that’s designed not to scratch the skin, since even a small abrasion can give entry to bacteria.
– Antibiotics are given to the patient intravenously prior to and during surgery, as well as within the following 24 hours.
– The night before surgery patients are instructed to shower, then wipe the entire body with chlorhexidine gluconate (CHG) antibacterial solution, excepting only the head and the genital area. They must dry with a freshly laundered towel. They then don clean night clothes and sleep between clean sheets with clean pillowcases.
– The patient repeats the entire showering and cleaning procedure the morning of surgery, again drying with a fresh towel.
Additional Anti-Infection Steps
I learned from my surgeon that in addition to extensive cleansing and disinfecting protocols, he bathes the surgical area with an antibiotic solution prior to closing the incision.
As an illustration of the extreme seriousness with which our local medical community takes infection prevention: I acquired a finger infection (paronychia) for which I consulted my dermatologist. She pointed out that infecting bacteria had probably entered my finger through a torn spot in my cuticle. She went on to say that she regularly lectures her (female) patients to not push back their cuticles. The cuticles are one of nature’s barriers to keep foreign bacteria out of the body, and should not be disturbed. (I imagined a customer trying to explain that to her manicurist! But I refrained from comment.)
This concludes Part 1 of this five-part blog on hospital surgery. Part 2 discusses the anesthesia process in detail, especially the steps hospitals take to minimize its considerable risk.
Image Credit: Photos taken by Art Chester