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Why Aren't Hospitals Cleaner? More News
U.S. News & World Report
July 23 - July 30, 2007 Issue
COMMENTARY: Not
all deadly infections come from dirty hands. Check the lab
coats
by Betsy McCaughey
Restaurants
and cruise ships are inspected for cleanliness. Food processing
plants are tested for bacterial content on cutting boards
and equipment. But hospitals, even operating rooms, are exempt.
The Joint Commission, which inspects and accredits U.S. hospitals,
doesn't measure cleanliness. Neither do most state health
departments, nor the federal Centers for Disease Control
and Prevention.
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| BEFORE YOU CHECK IN... |
If your hospitalization is prescheduled, heeding these tips before you go will
lower the likelihood of infection while you're there.
Bug the surgeon. Surgeons
know their infection rate for each of the procedures they perform. Don't be afraid to ask about a surgeon's infection rate for your procedure. Choosing a surgeon with a low infection rate could save your life.
Get tested. Ask your doctor
to test you for MRSA, a potent strain of bacteria that shrugs off all but the most powerful antibiotics. You
might be carrying it in your nose or on your skin. It generally won't make you sick unless it gets inside
your body˜usually via a catheter, a breathing device, or a break in the skin such as a surgical incision.
A simple nasal or skin swab will tell the tale. If you test positive for MRSA, precautions can be taken, including
giving you the correct antibiotic before surgery.
Debug yourself. Begin
showering daily with chlorhexidine soap five days
ahead of a scheduled surgical procedure. The soap,
available without a prescription, helps remove bacteria
lurking on the skin, waiting to invade an incision. Remember
that a cesarean delivery is surgery, too.
Snuff the smokes. Smoking
hampers circulation in the body, impeding infectionfighting blood cells. Patients who smoke are three
times as likely as nonsmokers to become infected at
the site of their surgery. Cut down. Better still,
quit, at least for a while. |
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No wonder hospitals are dirty. New data presented in April at the annual meeting
of the Society for Healthcare Epidemiology of America documented the lack of
hygiene in hospitals and its relationship to deadly infections. Boston University
researchers who examined 49 operating rooms found that more than half of the
objects that should have been disinfected were overlooked. A study of patient
rooms in 20 hospitals in Connecticut, Massachusetts, and Washington, D.C.,
found that more than half the surfaces that should have been cleaned for new
patients were left dirty.
Germ-coated. Sad to say, cleanliness is not a priority for hospital
administrators or most medical professionals. A new University of Maryland
study shows that 65 percent of physicians and other medical professionals admitted
they hadn't washed their lab coat in at least a week, even though they knew
it was dirty. Nearly 16 percent said they hadn't put on a clean lab coat in
at least a month. Lab coats become covered in bacteria when doctors lean over
the bedsides of patients who carry the organisms. Days later the bacteria are
still alive, repeatedly contaminating doctors' hands and being carried to other
patients.
The CDC and other organizations urge caregivers to clean
their hands between patients, and even advise patients to speak up and request that caregivers
have clean hands (box, Page 85).
That's a start, but it's not enough. As long as hospitals
are inadequately cleaned, doctors' and nurses' hands will
be recontaminated seconds after they are washed—when they
touch a keyboard, open a supply closet, pull open a privacy
curtain, or contact other bacteria–laden surfaces. In
a recent Johns Hopkins Hospital study, 26 percent of supply
cabinets were contaminated with a dangerous bacterium, methicillin–resistant Staphylococcus
aureus (MRSA) and 21 percent with another stubborn germ,
vancomycin-resistant Enterococcus (VRE). Keyboards are such
reservoirs of deadly bacteria that a few hospitals are installing
washable keyboards, including one that sounds an alarm if
it isn't disinfected periodically.
| ...AND AFTER
YOU'RE THERE |
Once in the hospital, taking these steps will help keep
bugs at bay and bolster your resistance as well:
Clip, please. If body hair has
to be removed, request clippers. A razor can create nicks that are like an openhouse
invitation to bacteria.
Would you mind? Ask the
staff to clean their hands before
touching you. If you're
worried about being pushy, a
family member or friend can
make the request. Keeping
alcohol–based hand cleaner
on the bedside table makes
it easier to say apologetically,
"Excuse me, but would
you mind cleaning your
hands with this so I can see
you do it? Thanks. It would
make me feel better."
Don't trust gloves. If caregivers
don gloves without
cleaning their hands first, or
pull them on and touch the
bedrail or privacy curtain, the
gloves are contaminated.
Keep germs at bay. Wash
your own hands often, avoid
putting them to your mouth
(an entry point especially for C. difficile), and don't let
your food or utensils touch
furniture or bedsheets.
Tube or not tube? Avoid a
urinary tract catheter if possible —it lets germs in as well as urine out. Sometimes
catheters are used less for medical reasons than because a busy staff doesn't have time to walk patients to
the bathroom. Often a catheter is left in because it is out of sight beneath the sheets.
By the third day, the risk of infection has increased substantially.
If you must have a catheter, ask your doctor or nurse frequently: "Do I still need this?" |
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Hand to mouth. Stethoscopes, blood pressure cuffs, and EKG
wires are used on successive patients without being cleaned.
Studies published as long ago as 1978 warn that blood
pressure cuffs frequently carry live bacteria, including MRSA,
and are a source of infection. In a newly released British
report, one third of blood pressure cuffs were found to be
contaminated with Clostridium difficile, a germ that can cause
lethal diarrhea if it enters via the mouth. It's a short trip from a
cuff to a patient's bare arm, then to the fingertips and into the
mouth. At a hospital in Galveston,Texas, where a burn patient
became infected with VRE, molecular typing traced the
bacteria to an unclean EKG wire. The VRE on the wire had been left behind by a patient
discharged 38 days earlier.
The good news is that a simple solution–thorough cleaning
with ordinary detergents and water–curbs the spread of deadly
bacteria. When researchers at Rush University Medical Center
in Chicago trained the staff to soak surfaces with detergent
rather than merely spraying and wiping, and to clean commonly
overlooked objects such as telephones, remote controls, and
faucets, the spread of VRE to patients was reduced by two thirds.
Even the cash–strapped British National Health Service
recognizes that intensive cleaning is a bargain compared with
the cost of treating infections. By nearly doubling cleaningstaff
hours on one ward, a hospital in Dorchester reduced the
spread of MRSA by 90 percent, saving 31/2 times the added
cleaning costs.
Hospitals once tested surfaces for bacteria, but in 1970, the
CDC and the American Hospital Association advised them
to stop, saying testing was unnecessary and not cost effective.
MRSA infections since then have increased 32–fold, and numerous
studies have linked unclean hospital equipment and
rooms to infections. Yet the CDC's latest guidelines still deem
routine testing for bacteria unnecessary. "If you culture on a
regular basis, you're always going to find something," says
Denise Cardo, who runs the CDC's division of healthcare quality
promotion. "You don't want the labs to be used for that
instead of tests on patients."
Are we to believe that it is less important to test for bacteria
in operating rooms than in hot dog factories?
 Testing is essential because bacteria are invisible. A study
in the Journal of Hospital Infection showed that 76 percent
of various hospital sites checked by researchers had unacceptably
high levels of bacteria, although only 18 percent of
them looked dirty. In another study, Boston University researchers
found that cleaning improved significantly once they
sampled surfaces for bacteria and showed cleaning personnel
the areas they had missed.
Unreasonable standard? You'd think that a hospital accredited
by the Joint Commission would be clean, but it's no guarantee.
California hospital inspectors, investigating complaints from
the public, found that 25 percent of hospitals where conditions
were unsanitary had been inspected and accredited by the
Joint Commission within the previous year.
If Joint Commission inspectors walk into a noticeably
messy and unclean patient room, they will trace back to
find out how that happened, explains Robert Wise, vice
president for standards and survey methods. Otherwise,
Joint Commission standards don't specify how rooms
should be cleaned or what bacterial levels are unacceptable.
Asked whether bacterial levels should be measured,
Wise answers: "You can only ask hospitals to do so much."
That seems to be the CDC's attitude as well. For over 30
years, the CDC has been collecting monthly data recording
a sharp rise in drug–resistant hospital infections. A new
report from a nursing organization, the Association for Professionals
in Infection Control and Epidemiology, shows
that the CDC has consistently underreported MRSA in hospitals,
giving them an excuse to do too little.
In 2005, health officials in Ireland and Scotland began
rating hospitals annually for cleanliness—red (the dirtiest),
amber, or green—and publishing the ratings. The first-year
results made headlines, putting pressure on the worst Irish
hospitals to clean up and earn higher marks in 2006.
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BETSY MCCAUGHEY is
chairman of the Committee to Reduce Infection Deaths (www.hospitalinfection.org),
a national effort focusing on hospitals. She was lieutenant
governor of New York and has published widely in health
policy. |
In England last month, Gregory
Barker, a member of Parliament, rolled up his sleeves and worked
a shift with the cleaning staff at a hospital in his district. "Hospital
cleaning is a vital part of patient care," he said in a statement
released by his office. Where are his counterparts in
Washington, D.C.? Congress has been virtually silent
about hospital infections—and no member has displayed
any interest in picking up a mop.
AAAASF
Underscores Importance
of Spore Testing as Part of its
Patient Safety Initiatives More News
OR Today Magazine
January 2006 Issue
With the renewed industry-wide initiative to
reduce the incidence of infections resulting from improperly
sterilized equipment, the American Association for Accreditation
of Ambulatory Surgery Facilities’ (AAAASF) is reiterating
the role of its Standard 220-040 in promoting patient safety.
The AAAASF Standard mandates that a “weekly spore test
is performed and the results filed for each autoclave”.
AAAASF maintains that despite some industry discussion about
how often spores should be tested, the Association’s
recommendations for weekly spore testing conform with the recommendations
of OSHA, AAMI, CDC, JCAHO, AORN, ADA, AHA and many insurance
companies.
“We recognize that our Gold Standard of 100% compliance
may seem overly stringent at times, but health care professionals
should not compromise on patient safety. While it may seem
unrealistic to smaller facilities, like fertility clinics that
make less frequent use of the autoclave, to conform with the
standard, the AAAASF Board has continually supported strict
regulations to verify that every facility’s sterilization
process is destroying microorganisms and spores,” said
James A. Yates, MD President of AAAASF.
HEALTHIER
HOSPITALS More
News
New
Law To Make Infection Rates Public
Timothy Bolger 08/04/2005 12:01 am
For more than 2 million Americans each year,
a hospital visit ends not in health but in sickness.
A new state law will now make statistics on infection rates at every hospital
in the state available to the public, so that patients—and workers and
insurers—can avoid facilities with a history of high infections. Gov.
George Pataki signed the bill a week after the Press published a story on the
subject ["Hospital Hell," July 14].
Details of the data gathering are yet to be ironed out, but the law establishes
a statewide database of all hospital-acquired infection cases. In part, the
idea is to push hospitals to enact stricter patient-safety measures by revealing
the worst offenders.
"I am just very pleased that the bill has passed and been signed by the
governor, and we hope that it will be an important first step towards improving
cleanliness in New York's hospitals," says Betsy McCaughey, founder and
chair of the Committee to Reduce Infection Deaths. Her organization, the chief
proponent of this potentially lifesaving legislation, is already moving for similar
laws to be enacted in other states. NY's law puts it in league with Texas, Virginia,
Florida, Illinois, Missouri and Pennsylvania.
Infections acquired in hospitals account for approximately 103,000 deaths nationally
each year, making it the fourth most common cause of death. In New York State
alone, hospital infections kill at least 7,000 people annually.
"Making risk-adjusted data available to the hospital community and the public
will promote improvement and patient safety," says Sen. Kemp Hannon (R-Garden
City), chair of the Senate Health Committee.
The reporting system will require hospitals to inform the New York State Department
of Health as to the number of infections acquired from surgical wounds, central
line placements, ventilators and urinary tract catheters.
"The governor will establish an advisory work group comprised of government,
industry and community leaders to develop guidelines," says Robert Kenny,
spokesperson for the state health department, adding that hospitals won't begin
reporting until January 2007 and results won't be public until 2008.
Eliminating infections acquired in hospitals is not unachievable, McCaughey
says. Her group hosts annual forums for hospital administrators to learn
how infection rates can be reduced and how improving hospital hygiene not
only saves lives, but also millions of dollars in treatment fees and lawsuits.
"It doesn't cost more per year to prevent infections," she says. "It
costs much less."
Clean hospitals: one step closer
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