Wednesday, February 09, 2005

Germs in hospitals

Think back to the conditions of a field hospital during the Civil War. You probably envision "doctors" working in shirt sleeves wielding bloody saws. They had no concept of germs, and didn't even bother washing their hands. The guys they operated on lay on old tables or bales of hay. There was no concept of a "sterile operating theater."

Today we are of course appalled by this lack of hygiene. But it is likely that people in 2050 will look back at our hospitals today in the same way. Here's why.

I was in a hospital recently with my son. He was scheduled to have surgery, so they were getting him ready. The surgeon came to talk with us, the anesthesiologist, a number of nurses, etc. One of them was wearing little surgical booties over his shoes, and the bottom of them were black with grime.

So think about this. Why are the bottoms black? Because the floors are dirty. Why are the floors dirty? When I arrived at the hospital, I was outside. I was walking around in my Nikes with super-traction soles. I stepped in motor oil. I stepped in puddles (it was drizzling that day). I stepped in dog crap. Whatever. Then I walk in the door of the hospital. All that filth comes in with me on the bottom of my shoes. It tracks all over the floors. Surgeons and nurses walk on those same floors. Who the heck knows what kind of germs get into a hospital that way? I imagine that the same thing happens with clothing, especially kids clothing.

What is the effect of all of these germs? According to this article:
    The statistics are staggering. According to the CDC, approximately 100,000 people died of a hospital-acquired infection in 2002, though experts believe the number is actually higher.

    Dr. Barry Farr, an infectious disease expert in Charlottesville, Va., notes, “There are about two million people who acquire infections in the hospital each year and become sick. Most don’t die, but some do.”
Those are some rather amazing stats. It really is quite sad when you think about it. Two million people is a whole lot of people.

I can imagine, given those stats, that at some point we decide to get serious about germs in hospitals. At the very, very simplest level this would mean that you take off your shoes when you walk in the door! I am still stunned by this breach of hygiene. The amount of filth and disease that comes in this way must be astounding. I would imagine that other steps are taken as well. For example
  • The hospital is treated like a giant clean room facility, much like a semiconductor manufacturing plant.

  • When you come in you take off all of your clothes.

  • You shower in an antiseptic solution.

  • You wear a disposable, dust-free hospital cover-all

  • It is not too far-fetched to imagine people wearing a full face mask that covers your eyes, nose and mouth and filters your exhaled air. This would prevent a majority of germs from leaving your body. You will not exhale them, and by keeping your hands away from your eyes, nose and mouth, quite a bit of germ transfer is prevented.

  • Do we move to a full-coverage suit similar to a bio-hazard suit, where your entire body is covered? This would prevent falling hair, dead skin cells and almost all germs from getting into the air.
It is easy to imagine that many visitors won't want to go to all of this trouble, which will make video calls into hospital rooms a lot more common.

The following conversation with the grandkids will be uncomfortable:
    Grandkid: I saw an old movie yesterday, and the characters were in a hospital. They were visiting a friend and they were wearing street clothes! And running shoes! I could not believe it. That was made up, wasn't it?

    You: No, that was completely normal.

    Grandkid: Hadn't you discovered germs yet??? I thought they discovered germs in the 1800s!

    You: Well, we had discovered germs, yes. But we really didn't take them very seriously. Millions of people died of infections in the hospital.

    Grandkid: Were you blind? How could you not see all the germs coming into the hospital on people's shoes for the love of God!
And so on. They will be as appalled as we are when we think of surgery in the Civil War.



At 12:00 PM, Anonymous Anonymous said...

Germs can make people sick, but so can a lack of physical contact, or a feeling of strangeness and isolation. Taking off shoes is common sense, and would probably get you half the benefit you want for 1% of the inconvenience, cost, etc. OTOH, injuries to bare feet might cause liability, I'm not sure.

At 12:15 PM, Anonymous Anonymous said...

they could give visitors special sterile slippers or disposable booties while they are in the hospital?

At 9:29 AM, Anonymous Anonymous said...

The most common infection in a hospital is staph. It occurs when the staph bacteria which lives on everybodys skin gets into the bloodstream. Catheters are the most common point of entry.

Basically, people catch staph from themselves when they are in the hospital. There is a company called Nabi that has a staph vaccine in final human trials right now. It could make an incredible difference.

At 12:24 PM, Anonymous Anonymous said...

The 2/5/2005 issue of "Science News" has an article titled "Hospitals motivated to skimp on infection control". It describes the game theoretic pressures on hospitals to be lax on germs. It is online, but you have to be a subscriber to view it.

At 9:13 PM, Anonymous Mike said...

You have misdiagnosed the problem. The problem of infection is not what comes in on visitors feet etc., but what comes in on and breeds on the skins and in the bodies of the patients themselves.

The notion that a hospital should be treated as a giant clean room is completely ludicrous as well as being impractical and unnecessary. What is required in hospitals is adequate and enforced infection control procedures to ensure that the more virulent infections are not transferred by staff between patients. However the problem is unlikely to be completely eliminated as many patients have lowered immunity as a result of their illness.

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Germs are everywhere, it is a serious condition when people are germ-phobics, a friend of mine suffers this condition and it is sad to watch him and knowing that he cant enjoy a lot of things in life.

At 12:39 PM, Blogger appocolypse said...

What about nurses walking thier dogs in the park wearing thier uniforms and carrying home bags of dog poo and then going to care for patients. How filthy is that.

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