Weekend reading: the life and spread of microbes in the average hospital room

We in healthcare and health tech know how deadly nosocomial or hospital-acquired infections are. Current CDC estimates are that in US hospitals, there are 1.7 million infections and 99,000 associated deaths each year (up from a previous estimate of 75,000) PatientCareLink. Most of us know that visiting a patient in a hospital room means also making sure hands are washed, clothes and shoes are clean, and that we bring a container of industrial strength bleach wipes for cleaning surfaces versus flowers.

However, it was news to this Editor that few studies have been done on the actual hospital room environment–the microbiome–and how the microbes in the room interact with the patient and the staff.  Sue Barnes, an RN who spent 30 years as the National Leader for Infection Prevention for Kaiser Permanente, reviews a newly published study in Science Translational Medicine (24 May, abstract available only). The study collected bacterial cultures from the ‘patient zone’ around the bed, every surface in the hospital room, and swabbed the hands and noses of patients and staff, along with the shoes, shirts, and cell phones of staff members. The problem is much more complex than simple cleaning.

  • Patient skin and the microbial makeup of room surfaces became more similar over time. Non-ambulatory patients were less so, as they had less contact with external surfaces.
  • The longer patients were in the room, the more genetic resistance to antibiotics the organisms acquired. This is despite the lack of association with antibiotics save topicals. The author suggests that regular cleaning may be the reason–only the strongest survive.
  • The hospital room is most threating to the most vulnerable, such as babies in a neonatal ICU
  • “In the Lax study, several bacterial samples taken more than 71 days apart were identical, leading the investigator to conclude that either ubiquitous skin-associated microbial strains had “seeded” the environment by sequential room occupants and staff, or that there were radically persistent bacteria in the environment despite cleaning with quaternary ammonium compounds daily and bleach at discharge. (Ed. emphasis) The risk to patients from pathogens remaining in hospital rooms from previous patients is a finding now confirmed by multiple studies including these two (earlier) studies.”
  • Manual cleaning is often incomplete, and soft surfaces such as linens even if clean pick up contamination enroute or in the room.

“The bottom line is that the findings from this study underscore the importance of patient and environmental hygiene to reduce infection risk. It also validates what we know regarding the limitations of manual cleaning and disinfection that we have trusted for decades. Instead, we now see the ongoing presence of dangerous pathogens in the hospital environment despite regular cleaning using standard protocols.”

click to enlargeGone in 90 seconds? It’s obvious that with superbugs, manual cleaning is not and never going to be enough. At the NYCEDC/Health 2.0’s Pilot Day/Digital Health Marketplace 2017 this Editor attended last week, one of the seven funding program winners was PurpleSun. PurpleSun has developed a 90 second ‘surround’ system to disinfect using intense UV light. Tested at Northwell Health in a perioperative setting in addition to traditional cleaning methods, it killed MRSA in 15 seconds and c.difficile in 60 seconds. Impressive! As in my TTA 31 May article, this should be a hot technology area–and on trend as solving simple (or not so simple) but vitally important problems.

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