Infection Control Today - 07/2004: Perspectives

Can Hospital-Acquired Infections be Stopped?

By Paul L. Simmons

Nosocomial-related deaths, whereby 90,000 die each year, are up 33 percent in 10 years. Where and when will it end? The cost in dollars to the healthcare industry is $5.5 billion, a major factor in rising healthcare costs.

The Centers for Disease Control and Prevention (CDC) has said that 50 percent of infections can be eliminated by better procedures; however, since the numbers are rising, either there is no effort to change those procedures or the numbers of admissions has increased by more than 33 percent and the percentage of nosocomial infections per 100 admissions has been lowered.

The healthcare industry has no one source of information to turn to. The CDC has some very good information but falls short of addressing or proposing a comprehensive program to deal with nosocomial infections. Various other sources of information address specific problem areas, but the total program is yet to come.

The solution to the problem will start with the hospital engineer. From there it will go to housekeeping, then to the nursing staff and on to the medical and surgical staff. It will address construction details, utility systems, the selection of interior finishes and even interior decoration. It will deal with the various laboratories and their procedures, both in the lab and their sources outside the lab in other parts of the facility. Environmental systems will play an important role, and there are many commonsense things that remain unaddressed.

Nosocomial infections are not a new problem, and the supporting industries have not been sitting on their hands in coming up with new technology to address many of the important, needed improvements. For example, a large percentage of nosocomial infections are related to urinary catheterization. There are now new Food and Drug Administration (FDA) approved, patented devices or systems that can reduce urinary tract infections by 80 percent or more. Those systems are available, and doctors and nurses must insist that they are used. Another example is in the area of disinfectants; 90 percent of the products used have toxic bases which limits their use, allowing many areas to go unattended. Now, new Enviromental Protection Agency (EPA) registered disinfectants are available that can be used on all surfaces, including drapes, bed spreads, carpet, telephones, television and all metal surfaces found in a patients room.

The market is flooded with new products in this area, and there is a scam on every corner. Disinfectants must be non-toxic by Occupational Safety and Health Administration (OSHA) standards), biodegradable (even by German standards), user-friendly and environmentally safe (i.e., none of the ingredients should be on the EPAs list of the top 10 environmental contaminants).

Those contaminants are ammonia, chlorine, phenol, phosphoric acid, sulfuric acid, methanol, ethylene glycol, hydrochloric acid, zinc compounds and acetone. It is amazing how some manufacturers attempt to hide the dangers. Here is an example that appears on an EPA approved (registered) label of hospital-grade disinfectant: With X product, only one product is needed to clean and disinfect all surfaces.

Then directly under that, on the EPA-approved label, is the following: Do not use on acid-sensitive surfaces such as marble, or soft metal such as copper, brass or aluminum. Avoid splashing X solution on textiles or carpets. X may be used on carpeting or other textiles only if area is tested for color fastness before use and treated area vacuumed while dry.

The problems are much deeper than currently recognized. Yes, procedural changes are desperately needed, but the problem will continue to worsen and there is a more serious problem that is not currently recognized and therefore not addressed.

As infections increase or the industry accentuates its infection control programs, more and more disinfectants are used. Many of those are toxic and claim they are made by infection-control product manufacturers and when applied to hard surfaces, the killing power remains for several hours. This indicates that there is a toxic residue present and when a person (patient or caregiver) comes in contact with those surfaces, the residue will be picked up on the hands or clothing of the individual.

The effects of toxic poisoning are not immediately recognized but have a long-lasting or permanent effect. We are all exposed to toxicity in our environment from the air we breathe to the water we drink and even in some of the foods we eat.

Regulations designed to eliminate toxicity in the environment are gradually tightening to reduce those toxins we breathe or ingest. However, while those regulations address the toxicity in the environment, the healthcare industry uses an increasing number of toxic disinfectants, hand gels and sterilants, knowing that the products are toxic and that, patients, visitors, healthcare workers and vendors are being exposed to these toxic products.

One could easily forecast the future by comparing the healthcare industry to the tobacco industry. Tobacco companies were aware of the damaging effects of their products but continued to sell them and recommend their use. As a result, the tobacco industry barely survived the massive monetary damages accessed by the courts. Hospitals, nursing homes, surgery centers, clinics and other healthcare settings are knowingly using toxic chemicals in their infection control programs, ignoring the dangers and the fact that technology has advanced and there are non-toxic (even by OSHAs standards) to take the place of those toxic materials used.

As the public becomes increasing more aware of the symptoms of toxic poisoning and realize that the hospital where they were treated knowingly poisoned them, lawsuits could be as common as those in the tobacco industry. Think of it this way: Two ounces of phenal, gluteraldehyde or quantenary ammonia, if ingested, would result in sudden death. On a daily basis, healthcare personnel puts two ounces of one of those chemicals in a gallon of water and spreads it all over the facility, on the surfaces we touch, in the air conditioning ducts, on the floors, walls and virtually every other surface.

No one will die as a result of this action, but millions will receive less than lethal amounts of this toxicity. If we look even further, the story gets more bizarre. A 500-bed hospital will use 5,000 gallons of these toxic products per year. Where do those 5,000 gallons go? When used in following infection-control program protocol, it is applied to surfaces. Once on the surface, it either evaporates into the atmosphere or is flushed down the drain. So, people are being poisoned by direct contact. The air is being contaminated by the evaporation of the product and our water supply is contaminated by the chemicals flushed down the drain.

If the industry is to attack this problem, it will be one step at a time. Each step must result in the lowering of the incidences of nosocomial infections. While the hospital engineer addresses the basics of an infection control program, doctors must take advantage of the new technology in the urinary tract arena, and the infection control practitioner must insist on the use of non-toxic, user-friendly, environmentally safe materials compatible and biodegradable products throughout the facility.

Paul L. Simmons is a recognized authority and consultant in good manufacturing practice (GMP) regulations. He also has extensive expertise in plant and process design for the genetic, pharmaceutical, device, diagnostic and hospital industries. With a background of 29 years in pharmaceutical and mechanical engineering, Simmons is an expert in engineering compliance and has written six textbooks on the subject. He has written many technical papers for national trade journals, as well as published an extensive list of technical and procedural manuals. His main area of interest has been in the area of GMP compliance programs and infection control, with extensive experience in nosocomial infections.

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