Infection Control Today - 07/2004: Perspectives

Can Hospital-Acquired Infections be Stopped?

ByPaul L. Simmons

Nosocomial-related deaths, whereby90,000 die each year, are up 33 percent in 10 years. Where and when will it end? The cost in dollars to thehealthcare industry is $5.5 billion, a major factor in rising healthcare costs.

The Centers for Disease Control and Prevention (CDC) has saidthat 50 percent of infections can be eliminated by better procedures; however, since the numbers are rising, either there is noeffort to change those procedures or the numbers of admissions has increased bymore than 33 percent and the percentage of nosocomial infections per 100admissions has been lowered.

The healthcare industry has no one source of information toturn to. The CDC has some very good information but falls short of addressing orproposing a comprehensive program to deal with nosocomial infections. Variousother sources of information address specific problem areas, but the totalprogram is yet to come.

The solution to the problem will start with the hospitalengineer. From there it will go to housekeeping, then to the nursing staff andon to the medical and surgical staff. It will address construction details,utility systems, the selection of interior finishes and even interiordecoration. It will deal with the various laboratories and theirprocedures, both in the lab and their sources outside the lab in other parts ofthe facility. Environmental systems will play an important role, and there aremany commonsense things that remain unaddressed.

Nosocomial infections are not a new problem, and thesupporting industries have not been sitting on their hands in coming up with newtechnology to address many of the important, needed improvements. For example, alarge percentage of nosocomial infections are related to urinarycatheterization. There are now new Food and Drug Administration (FDA) approved,patented devices or systems that can reduce urinary tract infections by 80percent or more. Those systems are available, and doctors and nurses must insistthat they are used. Another example is in the area of disinfectants; 90 percent of the products used have toxic bases which limitstheir use, allowing many areas to go unattended. Now, new EnviromentalProtection Agency (EPA) registered disinfectants are available that can be usedon all surfaces, including drapes, bed spreads, carpet, telephones, televisionand all metal surfaces found in a patients room.

The market is flooded with new products in this area, andthere is a scam on every corner. Disinfectants must be non-toxic by Occupational Safety andHealth Administration (OSHA) standards), biodegradable (even by Germanstandards), user-friendly and environmentally safe (i.e., none of theingredients should be on the EPAs list of the top 10 environmentalcontaminants).

Those contaminants are ammonia, chlorine, phenol, phosphoricacid, sulfuric acid, methanol, ethylene glycol, hydrochloric acid, zinccompounds and acetone. It is amazing how some manufacturers attempt to hide thedangers. Here is an example that appears on an EPA approved (registered)label of hospital-grade disinfectant: With X product, only one product isneeded to clean and disinfect all surfaces.

Then directly under that, on the EPA-approved label, is thefollowing: Do not use on acid-sensitive surfaces such as marble, or softmetal such as copper, brass or aluminum. Avoid splashing X solution on textilesor carpets. X may be used on carpeting or other textiles only if area is testedfor color fastness before use and treated area vacuumed while dry.

The problems are much deeper than currently recognized. Yes,procedural changes are desperately needed, but the problem will continue toworsen and there is a more serious problem that is not currently recognized andtherefore not addressed.

As infections increase or the industry accentuates itsinfection control programs, more and more disinfectants are used. Many of thoseare toxic and claim they are made by infection-control product manufacturers andwhen applied to hard surfaces, the killing power remains for several hours. Thisindicates that there is a toxic residue present and when a person (patient orcaregiver) comes in contact with those surfaces, the residue will be picked upon the hands or clothing of the individual.

The effects of toxic poisoning are not immediately recognizedbut have a long-lasting or permanent effect. We are all exposed to toxicity inour environment from the air we breathe to the water we drink and even in someof the foods we eat.

Regulations designed to eliminate toxicity in the environmentare gradually tightening to reduce those toxins we breathe or ingest. However, while those regulations address the toxicity in theenvironment, the healthcare industry uses an increasing number of toxicdisinfectants, hand gels and sterilants, knowing that the products are toxic andthat, patients, visitors, healthcare workers and vendors are being exposed tothese toxic products.

One could easily forecast the future by comparing thehealthcare industry to the tobacco industry. Tobacco companies were aware of thedamaging effects of their products but continued to sell them and recommendtheir use. As a result, the tobacco industry barely survived the massivemonetary damages accessed by the courts. Hospitals, nursing homes, surgerycenters, clinics and other healthcare settings are knowingly using toxicchemicals in their infection control programs, ignoring the dangers and the factthat technology has advanced and there are non-toxic (even by OSHAsstandards) to take the place of those toxic materials used.

As the public becomes increasing more aware of the symptoms oftoxic poisoning and realize that the hospital where they were treated knowinglypoisoned them, lawsuits could be as common as those in the tobacco industry. Think of it this way: Two ounces of phenal, gluteraldehyde orquantenary ammonia, if ingested, would result in sudden death. On a daily basis,healthcare personnel puts two ounces of one of those chemicals in a gallon ofwater and spreads it all over the facility, on the surfaces we touch, in the airconditioning ducts, on the floors, walls and virtually every other surface.

No one will die as a result of this action, but millions willreceive less than lethal amounts of this toxicity. If we look even further, thestory gets more bizarre. A 500-bed hospital will use 5,000 gallons of thesetoxic products per year. Where do those 5,000 gallons go? When used in followinginfection-control program protocol, it is applied to surfaces. Once on thesurface, it either evaporates into the atmosphere or is flushed down the drain.So, people are being poisoned by direct contact. The air is being contaminatedby the evaporation of the product and our water supply is contaminated by thechemicals flushed down the drain.

If the industry is to attack this problem, it will be one stepat a time. Each step must result in the lowering of the incidences of nosocomialinfections. While the hospital engineer addresses the basics of an infectioncontrol program, doctors must take advantage of the new technology in theurinary tract arena, and the infection control practitioner must insist on theuse of non-toxic, user-friendly, environmentally safe materials compatible andbiodegradable products throughout the facility.

Paul L. Simmons is a recognized authority and consultant ingood manufacturing practice (GMP) regulations. He also has extensive expertisein plant and process design for the genetic, pharmaceutical, device, diagnosticand hospital industries. With a background of 29 years in pharmaceutical andmechanical engineering, Simmons is an expert in engineering compliance and haswritten six textbooks on the subject. He has written many technical papers fornational trade journals, as well as published an extensive list of technical andprocedural manuals. His main area of interest has been in the area of GMPcompliance programs and infection control, with extensive experience innosocomial infections.