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Tackling pyjama paralysis to prevent infection
Pat Cattini, Vice-President of the Infection Prevention Society, discusses the importance and advantages of getting patients out of bed, dressed and moving about.
There are widespread benefits to getting patients dressed up and moving around while in hospital. Wearing pyjamas often reinforces the ‘sick role’ and can prevent a speedier recovery, whereas getting patients up and mobile enhances their experience, helps combat muscle loss and can shorten their time in hospital.
Infection prevention is one of the lesser known but vital benefits of combatting ‘pyjama paralysis’ and is yet another important reason to galvanise healthcare professionals behind the new NHS 70 day challenge to end pyjama paralysis. Running from 17 April to 26 June, the Chief Nursing Officer is urging all those who care for older people to help get them up and active, especially if they are in hospital. The campaign aims to achieve one million days of patients being up, fully dressed and mobile.
Inactivity is a key cause of infection in hospital but can be relatively simple to tackle. Moving about increases the heart rate which in turn increases flow of blood and oxygen perfusion to the tissues, helping make them less vulnerable to damage. Pressure ulcers can quickly affect those who are bedbound, which provide weakened and open sites that are prone to skin infection. Infection of this nature is a particular issue for more elderly and vulnerable patients - those also most prone to pyjama paralysis.
The open wounds at risk of becoming infected could be easily prevented through encouraging basic movement, with staff and carers supporting patients to be more mobile. For example, the recent commitment to ending pyjama paralysis at Nottingham University Hospitals led to an 86% reduction in pressure injuries, which usually affect people confined to bed for a long period of time.
Immobility is also an important contributor to the development of chest infections. Repeated point prevalence surveys across Europe cite pneumonia as a major source of hospital acquired infection. When someone is lying in bed they do not breath as deeply as they would if they were up and about, which leads to less effective clearance of secretions, making hospital acquired pneumonia more likely. There is some evidence that increasing mobility has a positive benefit in reducing pneumonia as well as reducing pressure ulcers and getting people home more quickly.
Many bedbound patients also risk infection and incontinence through reliance on bedpans, which increases the chance of urinary tract infections (UTIs), amongst other bladder and bowel infections. NHS Choices estimates that half of all women in the UK will have a UTI at least once in their life and that one out of every 2,000 healthy men will develop one each year. Unsurprisingly, we are now seeing a growing number of UTIs that are resistant to common antibiotics, making it even more important than ever to prevent them. Supporting patients into the good habit of managing their own bathroom routine is an important step to achieve this.
Helping get patients dressed and mobile is a simple but effective way to help combat infection. As healthcare workers we should aim to get as many patients up and moving as possible, to help ensure reduced infections alongside broader health and wellbeing benefits.
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