Jordan Ellis
Hospitals are meant to be places of healing, but they can also be hotbeds of germs and infections. While hospitals may appear spotless, microbiologists and researchers have found that dangerous bacteria and viruses can quickly contaminate surfaces and objects, putting patients at risk. This contamination can occur through indirect or direct contact, droplets from sneezing or coughing, or even sharp objects like needles. In addition, studies suggest that patients themselves may bring in germs from their homes or acquire infections from unsanitary facilities, germ-infected instruments, or the hands of healthcare workers. To prevent the spread of infections, hospitals implement standard precautions, such as handwashing, disinfecting, and the use of protective gear. However, ensuring effective sanitation and infection control in hospitals remains a challenging task.
| Characteristics | Values |
|---|---|
| Germs brought in by patients | Staphylococcus aureus, Corynebacterium striatum, Enterococcus faecalis, Escherichia coli, Staphylococcus, Streptococcus |
| Germs brought in by healthcare workers | Staphylococcus aureus, Staphylococcus, Streptococcus |
| Germs on hospital surfaces | Bed rails, ultrasound equipment, hospital room floors, pens at registration desks, over-the-bed tables, cloth dividers, curtains, armrests |
| Germs on medical equipment | Ultrasound equipment, plastic covering on ultrasound probe, medical instruments |
| Germs spread through direct contact | Direct contact with an infected person, bloodborne pathogens, used needles or instruments |
| Germs spread through indirect contact | Fomite transmission, bacterial infections, viral infections |
| Germs spread through sprays and splashes | Droplets from sneezing or coughing |
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What You'll Learn
Patients bring germs into hospitals
Another study found that hospital room floors are quickly and frequently contaminated with antibiotic-resistant bacteria within hours of patient admission. This creates a route of transfer of potentially dangerous organisms to patients. For example, bacteria can be transferred from floors to patients' socks, bedding, and nearby surfaces. In addition, visitors to hospitals can bring in germs that can be passed on to patients or staff.
Hospitals have rigorous and specialist cleaning practices to prevent the spread of infection. However, some bacteria, such as MRSA and C. difficile, can be challenging to eradicate, even in the cleanest hospitals. These bacteria can be spread through contact with contaminated surfaces, equipment, or staff uniforms. Proper handwashing and laundering of uniforms are essential to prevent the spread of bacteria.
Furthermore, studies have shown that healthcare workers do not always clean their hands as frequently as they should. This can contribute to the spread of bacteria within hospitals. It is important for patients and visitors to speak up and remind staff about hand hygiene to minimize the risk of infection.
Overall, while hospitals implement various measures to prevent the spread of germs, patients, visitors, and staff can unintentionally bring germs into hospitals, which can have significant implications for infection control.
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Hospital staff don't always wash their hands
Hospitals are hotspots for bacteria and germs, and while many of these germs are brought in by patients, hospital staff also play a role in their proliferation. A study in 2010 reported that just 40% of healthcare workers complied with recommended hand hygiene guidelines. This is concerning as handwashing is one of the best ways to prevent the spread of germs and infections.
There are several reasons why hospital staff may not always wash their hands. One issue is the placement of sinks or hand sanitiser dispensers, which are not always conveniently located. Sometimes, there may be no soap or sanitiser available in the dispensers. In addition, healthcare workers may be concerned about the drying effect of frequent handwashing on their skin, or they may not fully appreciate the importance of hand hygiene. In the often-chaotic hospital environment, handwashing can be overlooked as staff prioritise other tasks.
Some healthcare workers are resistant to change and prefer to stick to their old routines, especially surgeons, who can be superstitious about altering their habits. Additionally, hospital leadership may be ineffective, fostering a culture of mediocrity rather than excellence.
To improve hand hygiene compliance, hospitals should invest in alcohol-based hand sanitiser, which is often more effective and convenient than traditional handwashing. Installing video cameras with views of sinks and hand sanitiser dispensers, combined with data feedback, has been shown to significantly improve hand hygiene compliance. Patients and their loved ones can also play a role by reminding healthcare personnel to clean their hands.
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Bacteria on hospital floors
Hospital floors are a hotspot for bacteria and can quickly become contaminated with antibiotic-resistant bacteria within hours of patient admission. A study by researchers with the Northeast Ohio VA Healthcare System found that nearly half of the rooms tested positive for MRSA within the first 24 hours, and MRSA, C. difficile, and vancomycin-resistant enterococci (VRE) pathogens were identified in 58% of patient rooms within four days of admission.
Contamination often starts on the floors but can then move to patients' socks, bedding, and nearby surfaces. This transfer of bacteria from the floor to patients occurs despite current control efforts, as noted by Curtis Donskey, MD, senior author of the study and hospital epidemiologist at the Cleveland VA Medical Center.
The risk of bacterial infections in hospitals is not limited to the floors. Other surfaces such as bedrails, ultrasound equipment, doctors' white coats, elevator buttons, and even plants and flowers in hospital rooms can also harbor bacteria. For example, a small study found Staphylococcus aureus, which can cause infections like boils and toxic shock syndrome, on about 23% of doctors' white coats, with some of these coats also testing positive for the antibiotic-resistant strain MRSA.
To protect against bacterial infections, standard precautions and hygiene protocols are essential. This includes regular cleaning of surfaces with chemical disinfectants, frequent hand hygiene using soap or antimicrobial soaps, and respiratory hygiene, such as covering coughs and sneezes. Additionally, it is important to follow recommendations for certain vaccinations, such as hepatitis B and the annual flu shot, for hospital staff.
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Contaminated medical equipment
Hospitals are hotspots for bacteria, with germs on hospital surfaces and equipment creating a route of transfer of potentially dangerous organisms to patients. Contaminated medical equipment is a significant contributor to this issue.
Medical equipment, both critical and non-critical, can become contaminated with pathogenic and non-pathogenic bacteria, leading to healthcare-associated infections (HAIs). Critical medical devices include semicritical and critical medical devices, which require high-level disinfection and sterilisation, respectively. Non-critical medical equipment, on the other hand, includes items such as blood pressure cuffs, stethoscopes, call buttons, infusion pumps, lead wires, and oxygen flow meters. While these items are considered non-critical because they come into contact with intact skin, they can still become contaminated and contribute to the spread of infections.
Studies have found varying rates of contamination on medical equipment. For example, Boyce et al. reported a contamination rate of 25% with MRSA on an intravenous pole, while Rutela described rates of up to 36% for GNR and 12% for VRE on keyboards. In another study, researchers observed healthcare personnel using equipment such as blood pressure cuffs and stethoscopes on multiple patients without proper disinfection between uses. This lack of disinfection contributes to the spread of bacteria and increases the risk of infection for patients.
The issue of contaminated medical equipment is not limited to inpatient settings. Emergency departments (EDs) also face challenges with equipment contamination. One study found that after manual decontamination, 25% of tested objects in the ED were still contaminated with clinically significant microorganisms. This highlights the need for effective decontamination methods in high-volume clinical areas.
To address the problem of contaminated medical equipment, hospitals should implement comprehensive infection prevention programs. This includes establishing effective policies and procedures for cleaning and disinfection, as well as safe handling and storage practices for all equipment. Additionally, healthcare providers should presume that surfaces and equipment are "unclean" rather than relying solely on visual assessments of cleanliness. Newer technologies, such as adenosine triphosphate (ATP) testing, fluorescent marking, hydrogen peroxide, and ultraviolet light, can also be utilised for compliance monitoring and disinfection processes.
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Bed rails and linens
Fungal infections at a pediatric facility were once traced back to bed linens. Unless linens are sanitized well between patients, bacteria will remain and may infect the next patient. Linens are disinfected during laundering and are generally free of vegetative pathogens, but they are not sterile. Laundering cycles consist of flushing, the main wash, bleaching, rinsing, and souring. Clean linens are then dried, pressed as needed, and prepared for distribution back to the facility. Clean linens provided by an off-site laundry must be packaged to prevent inadvertent contamination during loading, delivery, and unloading.
Textiles and fabrics used in healthcare settings are often contaminated with microorganisms from body substances, including blood, skin, stool, urine, vomit, and other bodily tissues and fluids. When heavily contaminated, fabrics can contain bacterial loads of 10^6–10^8 CFU/100 cm^2 of fabric. Disease transmission attributed to healthcare laundry has involved contaminated fabrics that were handled inappropriately, such as the shaking of soiled linens.
Bed rails, while useful for preventing falls, have also been associated with adverse events. Between 1985 and 2009, 803 incidents of patients becoming caught, trapped, entangled, or strangled in bed rails were reported to the FDA. Of these, 480 people died, and 138 were non-fatally injured. Bed rails can also induce agitated behavior and make patients feel isolated or unnecessarily restricted.
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Frequently asked questions
Hospitals are filled with sick people, many of whom are fighting off infections. These infections can be transmitted to other patients, staff, or visitors via direct or indirect contact, or through sprays and splashes.
Germs can spread through direct contact, such as a sick person touching someone else. They can also spread through indirect contact, where an infected person touches and contaminates an object or surface that is then touched by an uninfected person. Germs can also be spread through sprays and splashes when an infected person sneezes or coughs.
There are several standard precautions that can be taken to prevent the spread of germs in hospitals, including hand washing, disinfecting surfaces, wearing masks, and wearing protective gear when exposed to infectious material. In addition, it is important to properly handle and disinfect equipment and isolate patients with known or suspected infectious diseases.
