Two-Thirds of Hospital-Acquired Infections are Preventable

The new understanding: these people are now considered a vital part of your hospital health-care team.

About 7,000 Canadians die every year that don’t have to.

This is according to Dr. Michael Gardam, who oversees infection prevention and control at the three hospitals that are part of Toronto’s University Health Network. In a statement to CBC’s The Fifth Estate last year he said we have the ability to prevent “about two-thirds of hospital-acquired infections (HAIs).”

The reason this matters so much is the staggering number of people who become infected after they go to a hospital: at least 200,000 a year. Tragically, between 8,000 and 12,000 of those people will die from those infections – each year. In other words, applying Dr. Gardam’s two-thirds statement to the numbers, it means that on average 7,000 Canadians die needlessly every year due to infections they acquire at hospitals across the country.

The number one way to prevent HAIs has focused on hand hygiene, i.e. doctors and nurse should carefully wash their hands before and after each patient visit. But a new Canadian study says we have made a big mistake by overlooking the crucial role played by hospital cleaning staff – or ‘Environmental Services’ (ES) as the study calls them.

The research, published in the American Journal of Infection Control, found that one-third of the respondents – lead infection control professionals – in 119 health-care facilities across Canada, did not rate their hospital’s ES as adequately trained to clean to standards.

What does “clean to standards” mean? It means that if you or I were hired to clean hospital rooms we’d get it wrong. We wouldn’t know, for example, what surfaces to focus our efforts on (the bedrail not the floor), what disinfectants and cleaning products to use, how much we can re-use, say, a cleaning rag – is it actually cleaning surfaces or merely dragging germs from the previous dirty surface and wiping them onto the next one?

The kind of picky detail needed to fix the problem is seen in this example: the use of color-coded housekeeping carts to ensure the appropriate cloths are used on the appropriate surfaces. There are four different colored buckets and clothes – red, yellow, blue and green. Red buckets are for bathrooms only, yellow for isolation rooms, and so on.

However, these kinds of solutions require expertise which can only come from the infection prevention and control people (IPAC), i.e. the highly trained specialist physicians in infectious disease who have to pass their knowledge onto the cleaning people.

And that’s what the study looked at: whether there was a good working relationship between IPAC and ES, if ES are being properly educated and directed by IPAC, and do ES know how to do their job properly.

The one-third statistic mentioned above was disappointing. As was the finding that 37% of hospital infection control experts believe their hospital is not clean enough to prevent the spread of MRSA and other potentially lethal organisms.

“We’re just not achieving the results we need,” said the study’s lead author, Dr. Dick Zoutman, an infectious disease specialist and professor in the school of medicine at Queen’s University in Kingston, Ont. People can get infected if they touch contaminated surfaces, including “high-touch” surfaces such as toilets, bed rails, bedside tables, call bells and door handles, and then their mouths. Hospital staff can  then spread the infection between patients if their hands are contaminated from these surfaces.

Dr. Gardam concludes that a major factor in preventing HAIs is the job done by their cleaning staff. “People don’t really think of them as part of the team, but if you think about how infections are spread in hospitals, they’re actually an incredibly important part of the team that goes far beyond just the cosmetic appearance of the room.”

The bottom line is that hospitals generally undervalue the importance of cleaning staff, Dr. Gardam said.

To see the subtle way that germs travel in hospitals and the important role played by cleaning staff, watch this  highly “infectious” video – “The Bug Zone” – made by some imaginative doctors at Winnipeg’s Health Sciences Center.

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One Response to “Two-Thirds of Hospital-Acquired Infections are Preventable”

  1. D.J. says:

    Interesting informative article.

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