You don’t expect to go into the hospital and come out sicker than before. But it happens all too often.
If the patient who previously used your room was infected with one of many antibiotic-resistant bacteria, those invisible germs could be left behind to transmit illness to you.
A lot depends on housekeeping.
“Drug resistant germs can live in hospitals if we don’t clean the hospital rooms as well as we should,” said Dr. Deverick Anderson, an infectious disease specialist at Duke University Medical Center.
Anderson will be among the speakers this weekend at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology at Charlotte Convention Center. (Register at www.apic.org)
About 4,000 healthcare professionals are expected for the meeting that will feature more than 60 educational sessions on infection control topics from the outbreak of Zika virus to overuse of antibiotics that has led to drug-resistant strains of bacteria called “super bugs.”
Anderson was lead author of a 2015 study which found that hospital rooms are often not cleaned well enough to combat four major superbugs – methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), clostridium difficile (C. diff.) and acinetobacter.
The study found that using a combination of chemical disinfectants and ultraviolet light to clean hospital rooms reduced transmission by 30 percent among patients who stay in rooms previously occupied by patients infected with of those four drug-resistant bacteria.
“Housekeepers don’t always do as good a job as they should,” Anderson said. But he added that the reasons are complex. “These housekeepers are under tremendous pressure to get in and out of these rooms as quickly as possible (so the next patient can move in). That’s how hospitals make money.”
Typically, hospital rooms are cleaned with strong chemical disinfectants, such as bleach and hydrogen peroxide. “They’re effective, but it’s hard to get them to all the places that they need to go,” Anderson said.
Research has shown that only 50 percent to 60 percent of surfaces in hospital rooms get cleaned after a patient leaves, Anderson said.
From 2012 to 2014, he and his team tested various cleaning methods in nine Southeastern hospitals, including three in the Duke University Health System, one Veterans Affairs hospital and several smaller community hospitals.
They found the most effective strategy combined an extra-deep cleaning – covering at least 90 percent of surfaces – followed by UV irradiation using a 5 1/2-foot-tall robot called Tru-D SmartUVC.
During the study, hospital staffers opened bathroom doors and cabinet drawers and rolled the machine into the center of the room. UV light “disrupts the DNA of these germs” and kills them, Anderson said. For patients coming into the once-contaminated rooms, the addition of UV cleaning reduced the risk of infection by 30 percent.
That’s important because about 5 percent of patients who are hospitalized will develop an infection associated with their hospital care, according to the Centers for Disease Control and Prevention. Such hospital-acquired infections kill about 75,000 patients each year.
And some of these infections are getting harder to treat because of our nation’s overuse of antibiotics.
At least 30 percent of prescriptions for antibiotics in the United States are unnecessary, according to the CDC. These drugs are usually prescribed for viral illnesses – which do not respond to antibiotics.
This overuse results in bacteria that become resistant to the antibiotics that once were able to kill them. Newer, stronger antibiotics have been developed to fill the gap, but some bacteria are even resistant to the most powerful agents we have.
In May, for the first time, researchers reported finding a person in the United States carrying a super bug that is resistant to “antibiotics of last resort.”
A 49-year-old woman in Pennsylvania was found to be carrying a strain of E. coli that is resistant to a wide range of drugs, including colistin, according the journal of the American Society for Microbiology. Colistin is the antibiotic of last resort for particularly dangerous super bugs.
This is the scenario that health officials have been dreading. “It basically shows us that the end of the road isn’t very far away for antibiotics…,” CDC Director Tom Frieden said.
Duke’s Anderson said the report of a single case doesn’t mean the resistant bug is widespread – yet. “This is almost like a warning signal,” he said.
The best thing people can do to protect themselves is to be their own advocates, Anderson said. Don’t take antibiotics for viral illnesses. And, if you’re in the hospital, ask health-care providers to wash their hands and explain the cleaning protocol.
“They should be able to give you an answer quickly,” Anderson said, “and they should be proud of what they’re doing.”
UV cleaning in Charlotte hospitals
- Carolinas HealthCare System has used Tru-D SmartUVC for more than two years. Nine machines are stationed at Carolinas Medical Center, CHS NorthEast and CHS Lincoln and can be rotated to other hospitals as needed. They are used in rooms after the discharge of patients who have had infections with multidrug resistant organisms.
- Novant Health has been using UV light for five years and has three machines, called ARTZ Mobile Room Germicidal UVC Solution. They are stationed at Presbyterian Medical Center in Charlotte, Forsyth Medical Center in Winston-Salem and Thomasville Medical Center but can be used in other hospitals as needed. They are used primarily in rooms after discharge of patients with “highly infectious” conditions.