HOTSPOTS: The most troublesome bacteria stick around even after routine cleaning.
When hospitals want to make a name for themselves, they spend on reputations and technology—on the esteemed surgeon or the top-of-the-line gamma knife and the star radiologist to operate it. Such investments attract publicity as well as patients seeking the best available health care. Lately, though, some hospitals have been making an unexpected discovery. The kinds of expenditures that truly improve patient care are often not directed at the top of their pay scale, with the famous specialists, but rather at the bottom, with the anonymous janitors.
Hospitals have reached this realization while trying to cope with an alarming trend. Over the past decade the organisms that cause most infections in hospitalized patients have become more difficult to treat. One reason is increasing drug resistance; some infections now respond to only one or two drugs in the vast armamentarium of antibiotics. But the problem also arises because the cast of organisms has changed.
Just a few years ago the poster bug for nasty bacteria that attack patients in hospitals was MRSA, or methicillin-resistant Staphylococcus aureus. Because MRSA clings to the skin, the chief strategy for limiting its spread was thorough hand washing. Now, however, the most dangerous bacteria are the ones that survive on inorganic surfaces such as keyboards, bed rails and privacy curtains. To get rid of these germs, hospitals must rely on the staff members who know every nook and cranny in each room, as well as which cleaning products contain which chemical compounds.
“Hand hygiene is very, very important,” says Michael Phillips, a hospital epidemiologist at New York University Langone Medical Center who has been studying this problem. “But we are coming to understand that it is one of just several important interventions necessary to break the chain of infection that threatens our patients.”
Persistent Pests
The infectious organisms that require all this extra effort became a serious problem around 10 years ago. The first outbreaks were caused by vancomycin-resistant Enterococcus, or VRE, and Clostridium difficile, known as C. diff, followed by a group of bacteria collectively referred to as highly resistant gram-negative organisms: Escherichia coli, Klebsiella, Pseudomonas and Acinetobacter.
This varied lot enters hospital rooms via multiple avenues. Acinetobacter and Pseudomonas prefer to live in the soil and water, but they are carried into hospitals from the outside world on people's shoes and clothes. In contrast, VRE, E. coli, Klebsiella and C. diff thrive inside human beings. These bacteria enter hospitals in patients' intestines and escape when bedbound patients suffer from diarrhea, contaminating the air and equipment around them.
The new scourges are particularly tough to clear away for several reasons. The gram negatives, for instance, have a double wall that gives them extra defenses against antibiotics and shields them from damage by other compounds, including cleaning chemicals. Many of the bugs can survive in low-nutrient environments, such as glass, plastic, metal and other materials that make up a hospital room. Consider VRE. One strain that caused an outbreak at the University Medical Center Utrecht in the Netherlands grew in a lab dish for 1,400 days after being dried in a test that mimicked what might happen in a patient's room. (MRSA also survives on surfaces, but for much shorter duration.)
Because of such abilities, the latest bacterial threats create an infection risk at least as great as health care workers' contaminated hands. “It forces us to raise the cleanliness of the hospital as a clinical issue, just as washing our hands is a clinical issue,” says Cliff McDonald, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention.
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7 Comments
Add CommentOnce long ago, I read an article that during WW II there were hospitals in salt mines. Infection was just about unknown in those hospitals. Perhaps our hospitals could use a salt solution as the last step in cleaning all items that the salt would not destroy and let the items air dry to maintain a salt film. It probably would be an inexpensive experiment.
Reply | Report Abuse | Link to thisDear SA and Ms. McKenna, I really enjoyed your article about the need for innovation and increased safety protocols regarding hospital cleanliness. As an industry insider, I can tell you firsthand that you are correct in your assertion that most hospitals are woefully neglectful in this area.
Reply | Report Abuse | Link to thisI did just want to point out that in your opening paragraph, you made a slight error. Gamma knife is not a generic term, but a copyrighted product name, which is manufactured by Elekta and should be noted accordingly. Also, radiosurgery equipment such as the Gamma Knife are not run by radiologists, but radiation oncologists. Actually, they are run by medical physicists and radiotherapy technicians, but this work is supervised by the radiation oncologist. Otherwise, great article.
So they're calling them "janitors" again, not "custodians" or "maintenance engineers" or some such. But, then, they're calling it "Burma", now, not "Myanmar". A right wing expression of what's what, to remind "the little guy" of his place. "You're job is what we call it, even your nation is what we call it!" You're "at the bottom", even Scientific American says it!
Reply | Report Abuse | Link to thisWith respect to the article, note contra "science" initiated intuitive interpretation of the situation.
For years, "science" has been warning about pathogens mutating to resistant forms because of a claimed overuse of antibiotics and other such treatments. The article describes these organisms as being so prevalent, they can now be found on surfaces in hospitals. "Science's" solution, carry on the same kind of super hygienic assault that "science" claimsproducxed the resistant bugs in the first place! What proof do they have that it wasn't an already overdone sanitary system that created the germs that can live on apparently eminently sanitary surfaces?
Or are they looking foward to the day the New World Order launches a pandemic to control mankind, and they want to have a scapegoat ready, those "at the bottom", the "janitors"?
I think this is a very important part of medical care, and can be considered a response to the "do no harm" part of the Hippocratic Oath.
Reply | Report Abuse | Link to thisThe blame game approach i.e. the medical staff aren't washing their hands often enough. and the cleaning staff aren't doing their job needs to be replaced with a more professional attitude. All actors in the medical system need to accept the fact that they may need to change their procedures because everyone has responsibility to bring about good outcomes for the patients. A hospital is a team
At least one company is already putting metals into their fibers to inhibit growth and spread of bacteria. Norwex has micro silver in its Enviro Cloth, not just sprayed on as most companies do, so they can be machine washed and dried. They are used extensively in Norway and Canada. Take a look at my webpage if you'd like more information:
Reply | Report Abuse | Link to thishttp://pamelaschmeckpeper.norwex.biz/?p=n§id=4
"Doah" !
Reply | Report Abuse | Link to thisIf not washed frequently enough, anything can carry germs . Luckily, cubicle curtains are easy to take care of and just simply need to be thrown in the wash. Our recommendation is to machine wash in water not to exceed 160° F. using Synthetic setting and mild detergent. Be sure to not use bleach or fabric softener. We have some other helpful tips here: http://www.covoc.com/cubicle-curtain-care
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