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

July 6, 2017 | by

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,  (more…)

Add hospital-acquired infections to your list, Google Ventures!

May 31, 2017 | by

Google Ventures’ Hot 7 [TTA 23 May] should be a Hot 8. Three recent articles have reminded this Editor that we are no further along in controlling nosocomial, or hospital-acquired, infections–and they are getting worse. They annually kill 75,000 US patients in hospitals and 375,000 patients in nursing homes. Those who get it and survive take months to fully recover, if they can.

  • They keep multiplying. The US’ Eye on Infection, Betsy McCaughey, former NY State lieutenant governor, brings to attention a new one called Candida aureus, a fungus which kills 60 percent of patients it infects. It’s been detected in New York (15 hospitals so far), New Jersey, Illinois, Massachusetts, and Illinois. It is carried on surfaces, sink drains, uniforms, clothing, skin, and devices, the last usually fatal to the patient. Patients can also be carriers.
  • The spread of CRE (carbapenem-resistant bacteria) could be the future of Candida aureus. In 1999, it was first detected at Downstate Medical Center in NYC. By 2008 it reached 22 states and is now a nationwide threat.
  • MRSA and MSSA are widespread, waxing and waning in outbreaks.

The problem has escalated to the point where Mark Sklansky, M.D., a professor of pediatrics at the David Geffen School of Medicine at UCLA, has launched a pilot to ban handshakes in two UCLA neonatal intensive care units–and it’s being debated on whether it’s effective or just consciousness raising.

Ms McCaughey attributes this to lack of action by CDC, despite Congress, in staying with outdated guidelines for how to clean patients’ rooms, ignoring the potential of automatic room disinfection to save lives. CDC underestimates the impact through bad sampling. Hospitals under-report deaths from infection. State authorities are no better in their inaction.

A solution far more aggressive than banning handshakes is screen-and-clean. Israel’s drastically reduced CRE by 70 percent in one year from its 2007 outbreak. Even babies are screened. Automatic room disinfection is not a panacea, but architects have been tackling this in designs for future hospital rooms for years. The most recent concept this Editor saw was at last November’s NYeC Digital Health Conference.

GV, where art thou? FierceHealthcare, Creators.com, NY Post