Biggest Breakthrough in Healthcare

A 180-degree change in how doctors and hospital administrators think about germs is likely to almost eliminate the biggest risk of being hospitalized: getting an infection.

Until now, doctors and hospital administrators routinely dismissed questions about cleanliness by saying "germs are everywhere." But at last week's meeting of the Society for Healthcare Epidemiologists of America in Atlanta, the focus was on making patients' rooms germ-free by testing for bacteria after cleaning and using ultra-violet light and room fogging machines.

Finally, the medical community is acknowledging that inadequately cleaned rooms and equipment are to blame for infections and doing something about it. "There's been a complete turnaround," says Dr. Curtis Donskey from the Cleveland Veterans Affairs Medical Center.

In 1970, when antibiotics cured most hospital infections, the Centers for Disease Control and Prevention and the American Hospital Association advised hospitals to stop testing surfaces for bacteria. Visually clean was enough, even though bacteria are invisible.

To this day, most hospitals don't test, even in operating rooms, and neither does the Joint Commission that accredits U.S. hospitals. Meat processing plants get a more rigorous inspection for cleanliness.

Patients have no control over which room they're assigned, but it's the biggest predictor of who picks up a hospital germ such as VRE (vancomycin-resisitant Enterococcus), according to Tufts University researchers. A germ from one patient lingers on a bedrail or other object for even two weeks and then is picked up on the hands of a doctor treating another patient — a deadly chain reaction. Even when doctors and nurses clean their hands, they become re-contaminated seconds after washing — as soon as they touch a keyboard, bedrail or other bacteria-laden object.

The deadly HIV virus is easy to kill on surfaces. But the most prevalent hospital infection, Clostiridum difficile or C. diff, has a hard shell that makes it toughest to kill. Dr. Robert Orenstein of the Mayo Clinic in Rochester, Minn., reduced C.diff by 80 percent by wiping surfaces around the patient's bed daily with bleach and testing surfaces regularly to guard against the biggest challenge — human oversight.

Human error is prompting the development of automated disinfection devices.

Bleach wipes work better than these options, but only if cleaning is thorough. It usually isn't. A 2007 survey of hospitals from Washington, D.C, to Boston showed that cleaners overlooked half the objects. Toilet seats were cleaner than over-bed tables.

Ultra-violet disinfection devices, being adopted by hundreds of hospitals, are effective wherever the light hit directly, but less so going around beds or corners. Hydrogen peroxide vapor machines, also being rapidly adopted, fill the room evenly with a germ killing fog, regardless of corners or angles, but require a dedicated operator and sealing the room for at least a half hour.

Another alternative likely to be on the market soon uses peracetic-acid, which sterilizes the room without leaving it wet. Still another, silver-based Steriplex, kills even C. diff without being toxic. The Huntsman Cancer Hospital in Utah reports zero infections in a bone marrow transplant unit during a three-month trial using Steriplex.

Some doctors at the Atlanta meeting predict it will take five years for the Joint Commission to decide how hospitals should test surfaces and whether machines are cost-effective. Five years — another 500,000 deaths at current rates. No wonder many hospitals aren't waiting.

How much more evidence is needed to prove that a clean room is better than a dirty one?

The Atlanta meeting also showcased a new study that will likely change how hospitals are constructed or renovated. Memorial Sloan Kettering Cancer Center in New York City and two other hospitals found that outfitting intensive care units with copper bedrails, overbed tables, IV poles, computer mice and other frequently touched surfaces cut infection rates by more than half. Copper continuously kills bacteria before they can contaminate caregivers' hands. The scientists called the findings "far reaching."

Betsy McCaughey is a former lieutenant governor of New York, founder of the Committee to Reduce Infection Deaths and the author of "Beating Obamacare." She reads the law so you don't have to. Visit www.betsymccaughey.com. To find out more about Betsy McCaughey and read features by other Creators Syndicate columnists and cartoonists, visit the Creators Syndicate web page at www.creators.com.

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