We pray and hope that, of all places, hospital employees do their jobs well. Because, if they don’t, people can die. Though we may conjure up a mental image of healing in a pristine, chlorine disinfected bubble, a hospital is anything but. As patients, we find ourselves asking, “Are hospitals clean?”
Are Hospitals Clean? What do the hospital cleaning studies say?
Healthcare-associated infections (HAI) are a leading cause of illness and death in the United States; on any given day, 1 in 25 hospital patients has at least one HAI. The cleaning of hard surfaces is essential to curbing this affliction. Therefore, a survey examining the cleaning, disinfecting, and cleanliness monitoring practices of patient rooms was conducted based on studies spanning the period of 1990 to the February of this year. Reported in the Annals of Internal Medicine, this survey identified eighty such studies, of which 76 were primary and 4 were systematic reviews. The primary setting for most of the studies was the intensive care unit. The studies looked at the levels of contamination before and after cleaning ‘high-touch’ objects such as bed rails, call buttons, light switches, and toilets. Over 65% of these studies focused only on surface contamination as the primary outcomes, whereas less than 35% looked at patient-centered outcomes like pathogen colonization and infection rate. This means that a majority of the studies did not look into whether their cleaning practices actually prevented patients from getting infected with virulent strains.
Cleaning methods need to be compared and reassessed
The results emerging from these studies led the researchers to hone in on three essential factors to an effective cleaning strategy: which cleaning agents were used, how was the cleaning monitored, and what needs to be built into the system for the cleaning and monitoring to work. They found that several studies that used bleach-based disinfecting agents reported reduction in contamination by Clostridium difficile, an organism notorious for hospital-acquired gastrointestinal infections. Whereas, chlorine-dioxide based disinfectants were ineffective against this pathogen. Patients taking antibiotics are especially susceptible to this infection, as antibiotics alter the normal gut bacteria. Therefore, the patient’s drug status needs to be factored into any cleaning protocol. Several other differences were unearthed between common cleaning regimens of hospitals, and some of them were found to be ineffectual.
Focusing on the patient is key to develop better cleaning strategies
It is troubling that such a small proportion of the studies looked at how the patients responded to their cleaning procedures. The results could still be useful though, to educate others about the comparative effectiveness of different strategies allowing for a more streamlined process. This could also spur efforts in identifying patient-related factors that we have been overlooking so far.
