Hospital safety: Your responsibility or theirs?

Airline passengers don't review the preflight checklist with the pilot, and restaurant customers aren't expected to check the kitchen and the staff for cleanliness.

But many health care experts say it's wise for hospital patients and their families to ask doctors and nurses to wash their hands, remove unnecessary catheters and explain how they will prevent an infection from developing after surgery.

The advice is an acknowledgement of reality: A hospital can be a dangerous place to spend the night.

Comprehensive infection control is more goal than fact at most hospitals. On hand-washing alone, for example, health care workers comply only about half the time, studies have shown. And one in 20 patients will acquire an infection while in the hospital.

Even so, speaking up for yourself in that setting is not an easy thing to do.

"No one wants to be confrontational with the person you hope will save your life," said Dr. Michael Bell, acting director of the division of health care quality promotion at the U.S. Centers for Disease Control and Prevention in Atlanta.

Nonetheless, Bell and other experts advise patients and their families to be vigilant.

"There are too many harmful things and bad bugs that can hurt you," said Victoria Nahum, an advocate for patient safety whose family faced three hospital-acquired infections in one 10-month period about seven years ago. Hospitals have been on a quest to become safer since 1999, when the Institute of Medicine stunned the medical world with its publication of "To Err Is Human." That study found that tens of thousands of patients died every year from medical mistakes.

But infection control has proven to be a complicated undertaking. Protecting patients requires hospitals to follow new checklists, hand-washing requirements and cleaning regimes. While doctors were free to practice as they saw fit in the past, many hospitals now demand that they follow protocols known to keep patients safe.

"We don't want to take away the art of medicine," Bell said. "We want to make things as goof-proof as possible."

Hospitals are trying to learn from other industries that have strong safety records. Many hospital executives are focused on turning their facilities into "high-reliability organizations" in which staff members take the right steps with every patient every time. But most freely admit that they're not where they want to be.

"Many people, including myself, would say there are dangerous things that can happen in hospitals and there are mistakes — that's where we are right now in American health care," said Dr. Bob Wise, an expert on health care quality at the Joint Commission, which accredits and certifies more than 20,000 health care organizations and programs nationwide.

"The person who is going to be most concerned is obviously the patient themselves and their families. The issue is you can't be there scanning the environment and be afraid. You do have to have some education about where you should be spending your attention and your focus."

At Emory Healthcare in Atlanta, Dr. William Bornstein, the system's chief quality and medical officer, said there's a way to invite patients to help. "What I think is particularly effective is when health care providers say, 'Hey, by the way, if you ever see me forget to do hand hygiene, would you remind me?' "

Fliers posted in Emory hospitals say, "We encourage you to ask your health care providers if they have cleaned their hands."

Nahum and her husband, Armando, dedicated their lives to improving patient safety in 2006 after their brushes with hospital infections. Their son, Josh, who had been hospitalized in Colorado after an accident, died from an infection at age 27.

The couple's most recent focus has been producing posters, now in hospitals across the country, that offer patients links and QR codes connecting them with information on the right questions to ask, depending on what kind of treatment the patient is facing.

"If I had had any of this information when our son was in the hospital, then he might be alive today," Nahum said, "and so I know that it's helping people live and not die."

Dr. Robert Wachter, a professor at the University of California, San Francisco, and one of the nation's leading experts on patient safety, said he understands why patients try to protect themselves. Wachter said he played the role of protector himself when he camped out on a cot in his mother's hospital room when she underwent treatment.

"The fact that patients are thinking this way is an indictment of our health care system," he said. "It's not as safe as it needs to be and it's scary, and it's perfectly logical that patients and families would want to do all they can to keep themselves safe."

But his caveat is that he's not sure it really works. First, it's awkward. Second, even doctors can have difficulty monitoring everything that goes on with a patient they care about, since so much happens behind the scenes.

Plus, Wachter doesn't like the message it sends.

"In some ways it says to patients, 'This is your responsibility for us to do things safely for you, including hand hygiene,' " he said. "Why should it be the job of the patients or family members to make sure everybody cleans their hands? That's the job of the system."