Why Aren't Hospitals Cleaner?

Cardiac surgeon Dr. Jeffrey Rich at work during heart surgery to repair five blockages in a patient, James Walls, at the Sentara Norfolk General Hospital.
Jeffrey MacMillan for USN&WR
The following is a commentary by Betsy McCaughey, chairman of the Committee to Reduce Infection Deaths, a national effort focusing on hospitals. She was lieutenant governor of New York and has published widely in health policy.

Restaurants and cruise ships are inspected for cleanliness. Food processing plants are tested for bacterial content on cutting boards and equipment. But hospitals, even operating rooms, are exempt. The Joint Commission, which inspects and accredits U.S. hospitals, doesn't measure cleanliness. Neither do most state health departments, nor the federal Centers for Disease Control and Prevention.

No wonder hospitals are dirty. New data presented in April at the annual meeting of the Society for Healthcare Epidemiology of America documented the lack of hygiene in hospitals and its relationship to deadly infections. Boston University researchers who examined 49 operating rooms found that more than half of the objects that should have been disinfected were overlooked. A study of patient rooms in 20 hospitals in Connecticut, Massachusetts, and Washington, D.C., found that more than half the surfaces that should have been cleaned for new patients were left dirty.

Germ-coated. Sad to say, cleanliness is not a priority for hospital administrators or most medical professionals. A new University of Maryland study shows that 65 percent of physicians and other medical professionals admitted they hadn't washed their lab coat in at least a week, even though they knew it was dirty. Nearly 16 percent said they hadn't put on a clean lab coat in at least a month. Lab coats become covered in bacteria when doctors lean over the bedsides of patients who carry the organisms. Days later the bacteria are still alive, repeatedly contaminating doctors' hands and being carried to other patients.

From admission to discharge, Dr. Bernadine Healy preps patients and their families for major surgery
The CDC and other organizations urge caregivers to clean their hands between patients, and even advise patients to speak up and request that caregivers have clean hands.

That's a start, but it's not enough. As long as hospitals are inadequately cleaned, doctors' and nurses' hands will be recontaminated seconds after they are washed — when they touch a keyboard, open a supply closet, pull open a privacy curtain, or contact other bacteria-laden surfaces. In a recent Johns Hopkins Hospital study, 26 percent of supply cabinets were contaminated with a dangerous bacterium, methicillin-resistant Staphylococcus aureus (MRSA) and 21 percent with another stubborn germ, vancomycin-resistant Enterococcus (VRE). Keyboards are such reservoirs of deadly bacteria that a few hospitals are installing washable keyboards, including one that sounds an alarm if it isn't disinfected periodically.

Hand to mouth. Stethoscopes, blood pressure cuffs, and EKG wires are used on successive patients without being cleaned. Studies published as long ago as 1978 warn that blood pressure cuffs frequently carry live bacteria, including MRSA, and are a source of infection. In a newly released British report, one third of blood pressure cuffs were found to be contaminated with Clostridium difficile, a germ that can cause lethal diarrhea if it enters via the mouth. It's a short trip from a cuff to a patient's bare arm, then to the fingertips and into the mouth. At a hospital in Galveston, Texas, where a burn patient became infected with VRE, molecular typing traced the bacteria to an unclean EKG wire. The VRE on the wire had been left behind by a patient discharged 38 days earlier.

The good news is that a simple solution—thorough cleaning with ordinary detergents and water—curbs the spread of deadly bacteria. When researchers at Rush University Medical Center in Chicago trained the staff to soak surfaces with detergent rather than merely spraying and wiping, and to clean commonly overlooked objects such as telephones, remote controls, and faucets, the spread of VRE to patients was reduced by two thirds.