A Hospital can be a dangerous place to be when you are sick
By: Stephen Huff
“Nosocomial” is defined as, “of or having to do with a hospital.” So nosocomial illnesses are those caused by or introduced in a hospital.
The danger of infections in hospitals first came to public attention with Florence Nightingale’s work in the 19th century. Years later, Joseph Lister developed antiseptic surgery, reducing the number of deaths from infections following surgery to well below the 50% mortality rate during that period. Underplayed by the media, few people know that nosocomial illnesses are a leading cause of death in the United States of America. They exceed deaths caused individually by vehicle accidents, AIDs or breast cancer.
According to Russell L. Blaylock, M.D, “Of all the potentially deadly threats to patients, one of the most preventable is hospital-acquired infection, which accounts for 100,000 deaths each year. Other sources suggest the numbers are slightly lower, i.e. as low as 88,000. Postoperative infections prolong the patient’s hospital stay by an average of 11 days, adding about $58,000 to total costs of each stay.”1
The Center for Disease Control (CDC) estimates the cost of treating hospital acquired infections at about $5,000,000,000 yearly. With the advent of anti-biotic resistant pathogens, treatment of many of these infections is becoming more difficult.
“For the surgical patient, postoperative wound infections are also a problem. When the infection becomes overwhelming, bacteria can enter the bloodstream, creating a condition called sepsis.”
“It is estimated that sepsis occurs 250,000 times each year in hospitalized patients and will kill 62,000 of them. While some patients bring the infection with them, in many cases it is caused by bacteria in the hospital.”2
What might the press do with any other profession responsible for this many deaths on an annual basis?
A fairly wide variety of sources can be responsible for infections in hospitals. Some of the apparent causes include poor nutrition both before and during a hospital stay, poor hygiene in the handling of patients, food, utensils, etc., failure of hospital personnel to wash hands often or thoroughly enough, and improper design of or poor hygiene in the ventilation systems serving the hospital. This last item, according to at least one source, accounts for 10% of hospital related infections3. Since the hygienic state of HVAC systems only account for 10 percent of the infections that means that 90 percent are other causes, so this is not a cure-all, but merely a step in the right direction.
The CDC has already recommended a wide variety of actions to take for reducing the possibility for infections caused by ventilation systems. These recommendations range from the very basic to more sophisticated actions.4 Having inspected ventilation systems of a number of hospitals, I can say that if even the most basic of these recommendations were applied in all hospitals nosocomial illnesses could be noticeably reduced.
1) A first recommendation is to keep the HVAC systems clean, which translates into a number of actions.
- The environment around the HVAC systems should be thoroughly inspected at least once a year.
1. Any source of contamination in the vicinity of the outside air intake should be noted and actions taken to deal with any found. This includes exhaust fans, fume vents, sewer gas vents, standing water, bird and other animal debris, etc. This is particularly relevant for systems running on 100% outside air as is the case with many hospital systems.
2. Outside air volume should be measured. Calculations should then be made to determine if the volume of outside air meets the current indoor air quality standards or state mandates.
3. Filters should be inspected for type, fit and cleanliness.
4. The condensate water drain system should be inspected for hygiene and proper functioning. This includes proper slope to allow complete drainage, plus trapping and venting of the drain line, and where the drain pipe empties.
5. The interior of the air handler and ducts should be inspected for accumulation of dirt, debris, fiberglass, mold and other microbial growth especially on coils.
- Air ducts should be cleaned as indicated by the inspection.
- Coils should be cleaned by pressure washing and then sanitizing with an EPA registered sanitizer designed for use in HVAC systems. Cleaning should be done once a year or any time microbial growth is detected on them.
- All components should be cleaned to National Air Duct Cleaners Association (NADCA) standards with appropriate measures taken for preventing cross contamination.
- Good filtration should be used in the system, i.e. minimally two-inch pleated filters. HEPA (High Efficiency Particulate Arresting) filters should be used for operating rooms and recovery rooms. There are HEPA systems available that can produce an indoor air quality environment more sanitary than a “clean room”.
- Any necessary steps should be taken to ensure that air does not bypass the filter. Filters might need to be taped together to prevent air from passing between them. Gaskets and spacers should be used as needed and kept serviceable.
2) The ventilation system should be properly air balanced, including such areas as contagious disease wards being negatively air pressurized to help prevent the spread of pathogens. Other areas should be positively pressurized to ensure that potential pathogens are not introduced from other locations.
3) Appropriate inspection and testing by qualified indoor air quality personnel should be done regularly under normal circumstances. More extensive testing is called for when outbreaks of suspected indoor environment related infections are observed.
Pathogenic molds also need to be addressed. The most common of these are species of Aspergillus. Several are known as opportunistically pathogenic, i.e. infectious to persons with impaired immune systems. Many who are hospitalized have weakened immune systems either due to an illness or following an operation. Exposure to these molds can result in a lung infection actually known as Aspergillosis, with symptoms including coughing up blood.
Some newer technologies show promise for reducing the frequency of nosocomial infections. Ultraviolet lights installed in HVAC system airstreams can reduce the number of viable microbes in the air by killing many with UV radiation. Another method uses positive and negative oxygen ions to cause particulate including microbes to fall out of the air.
There are many actions available to combat illnesses that originate in the hospital. I have suggested some basic, sensible steps that can be taken to lead to an improved environment. As is often the case, before solutions can be implemented, first we have to admit that nosocomial illnesses are a continuing and serious problem. Proper steps must then be taken to reduce them. Lister and Nightingale took significant steps, but there is considerably more work to be done.
Stephen Huff is Director of Indoor Air Quality Investigations for The Machado Environmental Corporation located in Glendale, California. He is a Certified Microbial Consultant and a Certified Indoor Environmental Consultant. He is also author of the book, Breathe Free or Die – The Layman’s Guide to MOLD and other Indoor Air Quality Problems.
Copyright C 2011 by Stephen M. Huff, All rights reserved
1The Blaylock Wellness Report, Issue 6; “Survive Your Hospital Visit”, Russell L. Blaylock, M.D., Editor. Page 1.
2Ibid. Page 2
3Conference Report, “An alternative Approach to Infection Control”; Symposium held 12th July 2000 at the University of Leeds, UK. Page 1.
4Center for Disease Control; “Guidelines for Environmental Infections Control in Health-Care Facilities”; Lynne Sehulster, PhD, Raymond Y.W. Chinn, M.D. Pgs. 8-11.