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This article is from the In-Depth Report The Crisis of Antibiotic Resistance
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Clean Sweep: Hospitals Bring Janitors to the Front Lines of Infection Control

Hospitals bring janitors to the front lines of infection control

Within hospitals, these resistant, hardy organisms are ubiquitous. A review article last year found that 10 percent of hard and soft surfaces in hospital rooms may be contaminated with gram-negative bacteria and that 15 percent of them may be contaminated with C. diff. A study at the University of Iowa Carver College of Medicine, published online in April, demonstrated the potential infection risk posed by the privacy curtains around hospital beds. In an initial survey, 95 percent of curtains in 30 rooms harbored VRE or MRSA. When the curtains were replaced, 92 percent became recontaminated within a week.

Operation Clean Team

Recently hospital cleanliness has become a matter of reputation, especially since the federal government's Hospital Compare Web site started posting institutions' rates of health care–associated infections. Cleanliness is also becoming a bottom-line issue: in 2008 the federal Centers for Medicare and Medicaid Services ceased reimbursing hospitals for the treatment of any infections that those hospitals caused—a controversial carrot-and-stick venture that, according to new research, has successfully begun to lower infection rates.

Institutions also employ infection-control specialists, who track infections and investigate their causes. Yet when the problem is bacteria on surfaces, eliminating them depends on the building-services crews. “This is the level in the hospital hierarchy where you have the least investment, the least status and the least respect,” says Jan Patterson, president of the Society for Healthcare Epidemiology of America. Traditionally, medical centers regard janitors as disposable workers—hard to train because their first language may not be English and not worth training because they may not stay long in their jobs.

At N.Y.U. Langone in 2010, Phillips and his co-workers launched a pilot project that redefined those formerly disposable workers as critical partners in patient protection. Janitors, they realized, know better than anyone else which rails are touched most frequently and which handles are hardest to clean. The Langone “clean team” paired janitors with infection-control specialists and nurses in five acute care units to ensure that all high-touch surfaces were thoroughly sanitized. In its first six months the project scored so high on key measures—reducing the occurrence of C. diff infections and the consumption of last-resort antibiotics—that the hospital's administration agreed to make the experiment routine procedure throughout the facility. It now employs enough clean teams to assign them to every acute care bed in the hospital.

Shielded Surfaces

Even the most aggressive disinfecting regimen might miss something, though. Thus, some researchers are tackling a once unheard of goal: rooms that clean themselves. Most of their early work focuses on engineered coatings and textiles that rebuff infectious organisms or kill them.

A company called Sharklet Technologies imprints the surface of catheters with a pattern that mimics the scaly texture of sharkskin, an innovation inspired by the realization that sharks, unlike whales, do not develop encrustations of algae. In the company's peer-reviewed research, the engineered surface makes it difficult for bacteria to cling and multiply.

Other projects capitalize on the long-recognized antiseptic properties of precious metals, chiefly silver and copper. Metal ions seem to interfere with crucial proteins within bacterial cells. Those results are similar to the effect of some antibiotics, but the metals, unlike drugs, do not provoke resistance.

Research by the company EOS Surfaces shows that bacteria in patients' rooms cannot survive on wall panels sheathed in copper, and a study funded by the Department of Defense at three hospitals, including Memorial Sloan-Kettering Cancer Center in New York City, demonstrated an association between copper-coated “high touch” surfaces in rooms—the call button, intravenous pole and bed rails, among others—and lower infection rates. PurThread Technologies is developing a proprietary alloy of copper and silver, which it melts into polyester and spins into yarn that is eventually woven into textiles ranging from sheets to scrubs.

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