Infection Control Today - 07/2004: Perspectives

July 1, 2004

Can Hospital-Acquired Infections be Stopped?

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

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.