December 13, 2004
The Silent Killer: Hospital Infections Claim More Victims
By Michael D. Shaw
Hospitals are supposed to treat illnesses, not breed them. But the epidemic of infections—an easily preventable problem, I might add—threatens to destroy the integrity of our most acclaimed healthcare facilities. The press reports about this outbreak are legion: overworked medical personnel and sick patients, worsened by negligible hygiene standards, create an environment that is a breeding ground for bacterial infections. The Centers for Disease Control estimate that as many as 2 million of these infections occur annually, and many sources put the number of deaths caused by them at about 100,000 per year—just in the US.
In Canada and the United Kingdom these issues repeatedly make headlines, and more often than here. The death count continues to rise, despite the existence of various options that would affordably remedy this scandal. Instead, so-called prestige hospitals leverage their name recognition as a popular (but wholly ineffective) means of sidestepping this public health concern. Translation: infections do not discriminate based upon the individual rankings of—or the Ivy League credentials enjoyed by—famous research hospitals; and winning this battle will require personal will and scientific fact.
Indeed, patients often mistakenly use the words “clean,” “disinfected,” and “sterile” interchangeably, universally assigning respect to hospitals that undoubtedly distinguish among these categories. That is, differences exist between a medical instrument that is clean, which is absolutely necessary, and an object that is sterile, which is a certifiably higher standard of care. Or, put another way, all medical devices may be clean but not all medical instruments are sterile. And therein lies one of the root causes responsible for the exponential rise in hospital infections.
At my own company, Interscan Corp, I often remind employees and friends—particularly those who plan to undergo elective surgery, or those for whom more immediate medical attention is an obvious priority—that, to state things bluntly, standards matter. That medical instruments, including endoscopic devices, should always be sterilized (rather than merely high-level disinfected)—lest some otherwise healthy patient become another statistic in the long catalogue of hospital errors. Which, of course, elicits that most logical question: How should hospitals sterilize medical equipment?
The most reliable method for the effective sterilization of medical instruments that cannot take the heat of steam is ethylene oxide (EtO). EtO is a proven and well-documented sterilant, whose reputation has suffered unjustly in past years. So-called replacement methods have proliferated, with results that have not always lived up to the hype. Cutting costs is a high priority in hospitals, and the siren song of more loads or procedures per day has its allure. Fortunately, recent developments in “EtO acceleration” technology now allow two cycles per day. Virtually any gas sterilizer can be retrofitted—at reasonable cost—to accommodate this breakthrough. How many nonsocomial infections could be prevented if we returned to sterilization, rather than merely high-level disinfection?
So what should patients know about these issues, and what measures can hospitals adopt to realistically combat this problem? As emphasized previously, people need to demand the highest yet most practical standards from members of the medical community. To this extent, and in conjunction with procedures already used by several prominent institutions, EtO should become a primary agent against the rise of bacterial infections. There may be some minor objections to the widespread use of EtO, which concern issues of cost or long-term monitoring of this gas. These protests—no matter how sincerely delivered—are just that, minor (and thus insignificant) complaints. We should never allow money to be the final arbiter between life and death. At the same time, easy-to-follow, if often ignored, standards in aseptic technique and basic cleanliness must be implemented and enforced.
In the future, pressure from multiple sources will force hospitals to seriously fight the rise of bacterial infections. The long-term benefits, for patients and doctors alike, are substantial: higher survival rates, quicker recovery times, increased admiration for hospitals within their respective communities, and the standardization of real infection control. No one would deny these rewards, and no one should obstruct this movement.
Hospital infections are silent killers that we can all defeat. We can truly end this battle, but it requires the wholesale adoption of standards that guarantee verifiable results. EtO is a big part of the solution, and it has been here all along! We can further monitor its efficacy with sophisticated analytical tools, hardware many medical professionals already use. But we must never allow petty considerations to dictate profound outcomes; our lives are too precious for such discussion. Let us win this great fight.