What Hospitals Don't Know About Infection Control
Despite the high level of complications and mortality associated with health care-acquired infections, a new study by a University of Pennsylvania research team documents large gaps in scientific knowledge about which methods and materials are most effective at disinfecting hospital rooms and other spaces in health care facilities.
The findings are significant because currently, it's estimated that more than 700,000 patients are infected by pathogenic organisms each year and 75,000 of them ultimately die from those infections. That's an average of about 2,000 new infections and 200 avoidable deaths occurring daily across the country.
Published in the Annals of Internal Medicine, the study by LDI Senior Fellows Craig Umscheid and Jennifer Han and team analyzed the last 25 years worth of scientific literature on the topic of how the surfaces, furniture and equipment of health care facility spaces were cleaned, disinfected, monitored and evaluated for infectious contamination.
Umscheid, MD, MSCE, is an Assistant Professor at Penn's Perelman School of Medicine and Director of the Penn Medicine Center for Evidence-Based Practice. Han, MD, MSCE, is an Assistant Professor of Medicine in the Division of Infectious Diseases at the Perelman School of Medicine.
Pathogenic surface contamination
In an online video accompanying the article, Umscheid explained, "We were basically trying to address three questions: what interventions exist?, how can hospitals ensure that when they clean the rooms, those rooms are actually cleaned well?, and third, what methods would increase the effectiveness of environmental cleaning or monitoring?"
The study notes that "pathogens frequently contaminate the patient environment, including both porous surfaces (such as curtains) and hard, nonporous surfaces (such as bed rails and medical equipment)."
"Most of the studies we looked at were focused on the effects of single cleaning or disinfecting agents or single monitoring strategies," said Umscheid. "They weren't comparing one to the other to see which was more effective."
He added that, "the outcomes they were using were ones that don't matter to patients, like 'Do I get colonized less frequently if you use one agent versus another?'"
Critical to infection reduction
In a press interview, Han, who was lead author on the project, said, "The cleaning of hard surfaces in hospital rooms is critical for reducing healthcare-associated infections... Researchers now need to take the next step and compare the various ways of cleaning these surfaces and monitoring their cleanliness in order to determine which are the most effective in driving down the rate of hospital-acquired infections."
An Annals editorial that accompanied the Umscheid/Han paper noted that, "Hospital cleaning processes are often far less than ideal. Even under study conditions, using structured educational and procedural interventions for housekeepers, a maximum of only 77% of surfaces studied were adequately cleaned... service workers are sometimes a marginalized part of the health care staff and may not always appreciate or be appreciated for the patient safety aspect of their work. Effective communication and education are essential, as are actionable, meaningful outcome measures."
"As antimicrobial options for treating multidrug-resistant bacterial infections decrease," the editorial continued, "the importance of accurately identifying routes of (the) spread of health care-associated infections and implementing effective preventive interventions becomes even more critical."