The recent outbreak of SARS has dramatically increased the awareness of hospital-acquired (nosocomial) infections. Although epidemic, the number of deaths from SARS pales compared to the number of deaths that occur annually from other nosocomial infections. Over 5 percent of all patients entering healthcare facilities acquire an infection, nearly double the number just a short ten years ago. In the United States alone, the CDC estimates that nosocomial infections account for over 100,000 deaths per year with a concomitant increased health care cost of over 5 billion dollars per year, probably an underestimate as the CDC relies on voluntary disclosure from healthcare organizations. Major contributors to this increase in nosocomial infections include the emergence of antibiotic-resistant bacteria, poor hygiene practices by healthcare providers, understaffed healthcare facilities, substandard practices and apathy. Although the healthcare industry has successfully avoided dealing with this escalating problem in the past, it is probably only a matter of time until plaintiff attorneys pursue this matter that continues to result in wrongful deaths and personal injury. The healthcare industry could therefore be facing a major crisis as the public gains more awareness, particularly with the prospect of highly publicized lawsuits.
These contagious diseases constitute major health threats, particularly in intensive-care units, surgical wards, transplant units, neonatal units, cancer wards, and burn wards. Nosocomial diseases include: 1) viruses such as influenza, parainfluenza, enteroviruses and respiratory syncytial virus (RSV), 2) bacteria such as Legionella, Clostridium difficile, Pseudomonas aeruginosa, antibiotic-resistant Enterobacter, antibiotic-resistant Staphylococcus and Burkholderia cepacia, and 3) fungi such as species of Aspergillus and Candida. Clostridium difficile, for example, is normally asymptomatically carried in less than 2 percent of the non-hospitalized population, but is carried asymptomatically in over 20 percent of hospitalized patients and over 50 percent of neonates. Of these organisms, the airborne transmitted organisms such as RSV, the viral and bacterial influenzas and pneumonias, and Aspergillus cause respiratory disease. Most of the other organisms are transmitted by person-to-person contact or via contaminated medical instruments, typically causing urinary-tract infections, bloodborne infections, or sepsis.
In general, healthcare facilities have responded to this threat by increased infection control procedures, concurrent with limiting publicity of the problem. This may change radically due to the SARS outbreak, which initially was primarily spread through exposures in healthcare facilities. In response to the apparent increasing incidence of nosocomial infections, the CDC recently released a guideline with recommended infection control and JCAHO (Joint Commission for Accreditation of Healthcare facilities), the primary accrediting body for healthcare facilities, instituted Standard EC 3.2.1 in January of 2002, mandating infection control monitoring during any construction, reconstruction or renovation of healthcare facilities.
The control of nosocomial infections must entail good infection control practices. These include:
Improved maintenance of facility HVAC systems, containment facilities, and delivery systems such as medical gases,
Policies dedicated to improved infection control, candor, and patient protection,
Improved disinfection practices,
Instigation of monitoring systems to detect potential infectious agents in air, water, surfaces, and personnel, and
Adequate and competent staffing of the facility incorporating higher qualifications for staff and on-going training program to improve staff participation in effective infection control.
For more information on Nosocomial Infections and Indoor Air Quality, please visit Aerotech Laboratories.