A 57-year-old man was taken to a hospital emergency room after accidentally bumping his head on a hanging pipe in a garage. To help minimize the excessive bleeding, the mans head was immediately cleaned and then bandaged. Then, he waited for more medical attention. Like many big-city emergency departments, this one is busy throughout the day, every day. The man did not see an emergency staff member for almost two hours, during which he did two things: watch all the activity in the emergency room and, quite unflatteringly for the hospital, notice how dirty it was.
According to the man, some floor areas did not look like they had been mopped clean in days. The countertops appeared clean, but a closer inspection revealed fingerprints and sticky areas. Railings and ledges around the bed and even some of the electronic equipment in the room also had fingerprints and looked soiled. Concerned about the conditions of the room, the man avoided any high-touch or commonly touched surfaces as much as possible. There was a hand-sanitizer unit mounted on the wall, which he used frequently, but the room had no faucet or sink, so handwashing was not possible.
Once treated, this mans health concern was no longer his head, but rather the possibility of contracting some far more serious healthcare-acquired infection (HAI). Should he be concerned in this day and age when the public is much more aware of the need for infection prevention and control? Arent systems and procedures already in place in most American hospitals that help prevent the spread of disease in medical settings?
The answer to these questions is yes, we should still be concerned and no, many medical facilities still have not taken enough steps to stop the spread of infection.
The Infection Control Situation Today
The transmission of microorganisms, which reside on various surfaces in the medical setting, can cause a variety of health-related problems. According to a June 28, 2007 report on New Hampshire National Public Radio, HAIs affect approximately 2 million people each year, resulting in the deaths of nearly 100,000 people annually, making this the 10th leading cause of death in the U.S.
Whats more, the costs can be staggering. The same report estimates the costs to treat these diseases ranges from $7 billion to as much as $27 billion annually.1 The cost implications are becoming such a concern that the U.S. Centers for Medicare and Medicaid is now taking action. The organization will begin collecting data on illnesses patients pick up at hospitals while under treatment for other conditions. For Medicare and Medicaid patients, this may mean that the government will stop paying hospitals for treating hospital-acquired illnesses, which puts more of the financial burden on the medical facilities.
Many infection control practitioners are well aware of this problem. One survey of infection control practitioners found that nearly one-third of those surveyed believe infection control remains a top priority in U.S. hospitals and almost as many believe current technologies and techniques used to combat the spread of hospital infections are in serious need of updating.2
Similarly, another survey conducted in December 2004 revealed that infection control practitioners at not-for-profit U.S. hospitals and healthcare systems believe 1 in 3 hospitals need to improve infection control systems, funding, staffing, and prevention. The respondents also think considerably more attention in the form of hygienic cleaning, specifically in surgical areas, must be placed on preventing the spread of infection and that hand hygiene is not adequate.3
Locating the Problem
Its actually a very positive sign that these infection control specialists believe surgical areas need more attention when it comes to stopping the spread of disease, says John Richter, a research engineer at Kaivac, Inc.. We know that just because a surface looks clean, [it] has little bearing on how clean and healthy it really is.
Richter says that some healthcare facilities are turning to adenosine triphosphate bioluminescence (ATP) rapid-monitoring systems to help locate potentially harmful microorganisms on surfaces and to identify surfaces that need cleaning attention. First developed in the 1970s, these systems can more precisely detect surface contaminants compared to systems used before. However, they tended to be slow and the equipment was expensive. Fortunately, in recent years, these systems have become much smaller, cost effective, easier to use, and can report results in as little as 15 seconds.
Using these systems, hospital staff can better detect where germs and pathogens are located and take steps to remove them, protecting patient health and outcomes, says Richter. But, just as many infection control practitioners indicate, many of the cleaning systems used today need to be updated first.
Richter advocates for a re-evaluation of cleaning methods. Using ATP and other measurements, we now know that some conventional cleaning systems, such as mops, buckets, and microfiber cleaning cloths, simply do not effectively remove contaminants from surfaces, says Richter. Whats worse, these same studies indicate they may actually be spreading contaminants from one surface to another.
Instead, Richter recommends that infection control specialists as well as hospital housekeeping staff consider the following cleaning systems and procedures:
For a variety of surfaces, including floor cleaning, restroom cleaning, and on food-preparation surfaces, a high-flow fluid extraction system works well. These systems combine automatic chemical metering and injection, an indoor pressure washer, and a wet vacuum into a single integrated unit. Tests indicate they can be as much as 60 times more effective in reducing bacterial contamination than conventional cleaning, such as the use of buckets and mops.
For non-floor flat surfaces, flat surface cleaning (FSC) systems are recommended. These systems incorporate motorized chemical injection to apply diluted cleaning chemicals and disinfectants onto a microfiber applicator pad. The surface is wiped down with the microfiber pad and a hand-held squeegee is used to remove the cleaning solution, simultaneously removing contaminants as it dries the surface. FSCs have been shown to remove up to 80 times more bacteria from flat surfaces than traditional cloths and wipes.
Finally, for irregular or sensitive surfaces and touch points, such as door handles, remote controls, call buttons, bed controls and railings in hospitals, as well as keyboards and telephones, disposable wipes work very well. Some wipes have just been introduced in the professional cleaning industry which allow users to add their own cleaning or disinfectant solution. This enhances flexibility and cost effectiveness. The refillable wipes can also be used dry.
Many infection control practitioners are concerned that proper hand hygiene measures are not in place in the medical setting. Proper hand hygiene saves lives, says Jim Glenn, CEO of Resurgent Health and Medical, which manufactures automated handwashing and compliance monitoring systems. We have known this for more than 100 years, yet it still remains a problem.
According to Glenn, this is because many medical facilities, such as the emergency room discussed earlier, simply do not have adequate or enough sinks and faucets installed. Further, doctors, nurses, and hospital staff are extremely busy, which means they often overlook properly or adequately washing their hands.
He recommends the following hand hygiene procedures in a medical facility:
Wash hands before and after treating different patients
Hands should also be washed repeatedly with the same patient, for instance after examining or treating different body sites on the patient
It takes at least 30 seconds for hands to be washed and rinsed properly
The temperature of the water should be approximately 100 degrees Fahrenheit.
However, even this may not be enough, says Glenn. The skin is a dynamic structure and microorganisms can find several convenient locations, especially if hands have become dried or chapped, in which to live. This can result in increased risk in the spread of disease.
Some healthcare facilities are now automating the handwashing process. Frequently used in food processing facilities and laboratories, these systems have rotating cylinders and provide a high-pressure, low-volume spray of water that can reduce pathogen transmission by more than 99.9 percent, according to clinical studies. The entire cleaning process takes about 12 seconds.
Healthcare facilities install these systems where they can be used quickly, easily, and conveniently adds Glenn. Ultimately, they help eliminate the problems that prevent proper hand hygiene, such as convenience and time.
Although we have still not been able to stop hospital-associated illnesses, fortunately we are becoming more aware and educated on how they occur and what can be done to prevent them. New cleaning systems and technologies, the ability to locate potentially harmful microorganisms, as well as more thorough and automated hand hygiene systems are all helping us move in the right direction. On top of the health concerns, this is likely one reason medical costs continue to escalate, adds Glenn. We simply have to incorporate more hygienic and effective ways to make hospitals healthier, safer places.
Beth Pullin is a writer for the professional cleaning, healthcare, and building industries. She may be reached at firstname.lastname@example.org.
1. Figures vary depending on different studies and because it is often difficult to determine if illness was actually acquired during the hospital stay.
2. Harris Interactive®, conducted August 2003 and reported in January 2004.
3. VHA Inc. a healthcare cooperative.