In the wake of the Oregon college shooting, House Minority Leader Nancy Pelosi is calling for a Select Committee on Gun Violence. Some 20,000 people die in the U.S. each year from gun homicides and gun-related accidents. But politicians are overlooking another problem that takes many more lives each year than guns, and is far easier to solve.
A staggering 29,000 people in the U.S are killed each year by a hospital infection called C. diff., short for Clostridium difficile. It’s the No. 1 hospital-infection killer in much of the nation, causing more deaths than Staph infections. And the remedy is straightforward: cleaner hospitals.
But it’s hard to know which is worse, the dying or the lying. Hospital personnel often tell patients and families that antibiotics are to blame for C. diff. Don’t believe it. The real culprit is dirty hospitals.
Patients get C. diff through oral-fecal contamination, meaning traces of one patient’s diarrhea get into another patient’s mouth. Disgusting. And how does that happen? Inadequate cleaning.
C. diff spores invisibly contaminate virtually all the surfaces in a hospital, including wheelchairs, privacy curtains, call buttons, over-the-bed tables and bed rails. It can linger for months. Patients touch these surfaces, then pick up food without washing their hands first and swallow the germ along with their food. Once in the gastro-intestinal tract, C. diff can cause severe diarrhea and deadly complications.
Just being assigned to a hospital room after a C. diff patient is risky. At one hospital, three patients treated consecutively in the same room got C. diff. One died from it.
A patient who contracts C. diff in a hospital is 4.5 times more likely to die than another patient with the same diagnosis who manages to avoid getting C. diff.
Patients on heavy doses of antibiotics are especially vulnerable because these drugs kill other bacteria in their gastrointestinal tract that would keep C. diff under control. But antibiotics don’t cause C. diff. Unclean surroundings do. Almost everyone who gets C. diff picked up the germ during a hospital or nursing home stay or a visit to the doctor.
Rigorous cleaning is the answer. In a pilot project, the Mayo Clinic reduced C. diff by 85 percent by doing just one thing: Wiping frequently touched surfaces around patients’ beds once a day with a bleach wipe. So why isn’t every hospital doing it?
Bleach is used because C. diff is encased in a shell that makes it harder to kill on surfaces, even harder to kill than the AIDS virus. However, it’s harder to kill on surfaces but easier to deal with in every other way. It’s about cleaning, not drug addiction or unsafe sex.
Why hasn’t the Centers for Disease Control and Prevention responded with the passion it brought to the AIDS epidemic in the 1980s? What should be done?
First, hospitals should be inspected for cleanliness, including testing for bacterial contamination levels. After all, in cities such as New York, Los Angeles and Washington, D.C., restaurants are routinely inspected for hygiene and results made available to the public. But not hospitals. And you always have the option to stay home and make your own dinner.
Astoundingly, the Joint Commission, which accredits most hospitals in the U.S., doesn’t actually measure bacteria surface contamination. Its inadequate inspections include “observation of the physical environment,” but a hospital can look neat and tidy and still harbor bacterial killers. As part of its hospital inspections, the Joint Commission should be testing operating rooms and patient environments the way food processing plants and the cutting boards in restaurants are tested.
Secondly, the CDC should aggressively encourage hospitals to adopt high-tech methods of room cleaning. Surveys of hospital rooms along the Eastern seaboard, from D.C. and New York to New Haven and Boston, show that hospital cleaning personnel routinely overlook half the surfaces in a patient’s room, such as the call button and bedrails.
Some hospitals, such as Johns Hopkins in Baltimore, are successfully deploying robotic cleaners — hydrogen peroxide room foggers, pulsating ultraviolet light machines and other technologies — to reduce bacteria in minutes, offsetting the fallibility of cleaning staff. Dilute hydrogen peroxide, a new non-toxic technology, will even enable hospitals to operate automatic cleaners 24/7 with the patient safely remaining in the room.
And yet, year after year the CDC dawdles, claiming “a better understanding” of these technologies is needed. That would be reasonable if patients were not dying in large numbers because of dirty hospital surfaces. The CDC’s dithering gives hospitals an excuse to do too little.
In the meantime, if you’re visiting someone in the hospital, bring a canister of bleach wipes and a pair of gloves. You could save a life.
Betsy McCaughey, Ph.D., is founder of the Committee to Reduce Infection Deaths, a national campaign to stop hospital infections, and a senior fellow at the London Center for Policy Research.
