Read part 1 of this blog post here.
The Limits of Hospital Surface Cleaning
Infection outbreaks have been traced to all kinds of contaminated surfaces: sinks, computer keyboards, supply carts, stretchers, IV poles, telephone handles, stethoscopes, blood pressure cuffs, ultrasound machines, ECG leads, and ventilators.
It is unrealistic for cleaning crews to fully and frequently disinfect every surface in the hospital. Cleaners often do not have the time, the training, or the most effective cleaning products. But even if they did, surfaces would still become contaminated, because pathogens return — often within a few hours.
An American study found that within 3 hours of disinfection, bacteria on hospital bed rails had rebounded to unacceptable levels.
“Our study suggests that cleaning approximately every 2 hours would be necessary to maintain the population of this pathogen at the proposed non-detectable level,” the researchers wrote.
This finding is important, as bed rails are the most contaminated surfaces in a hospital room, and pathogens are easily transferred from bed rails to healthcare workers’ hands. Another study found VRE bacteria were transferred to gloved hands nearly half of the time after contact with bed rails. And the transfer happens quickly: 46% of handprint cultures grew VRE after 5 seconds of contact with the bed rail or side table in a patient’s room.
Another challenge is that pathogens have remarkable staying power in the hospital environment. VRE can survive for up to 58 days on countertops. Clostridium difficile can last 5 months on hospital floors, and just a few spores can transmit infection in a vulnerable patient. MRSA, E. Coli, Acinetobacter, and Klebsiella can remain viable on surfaces for more than 300 days.
“There is no easy way to clean a hospital or to keep it clean,” cautions Scottish microbiologist Stephanie Dancer, M.D., in a review of hospital surface cleaning strategies.
It is therefore unsurprising that patients have a 40% elevated risk of contracting a MRSA infection when they stay in rooms previously occupied by a patient infected with MRSA.
“The danger extends far beyond the handful of patients who stay in that room, spreading from room to room to potentially affect the entire facility,” warn American researchers.
Airborne Transmission: “a major public health concern”
Even the best hand hygiene and surface cleaning will not suffice because, as research shows, about one-third of all hospital acquired infections — notably MRSA, Acinetobacter, Clostridium difficile, influenza, and norovirus — involve airborne transmission.
As one research team has noted, “Airborne transmission of infectious disease is a major public health concern.”[i]
Vomiting, sneezing, coughing, talking, and even breathing can release infectious microbes into the air, where they can hover for hours before being inhaled by patients or landing on IV poles, stethoscopes, and countless other surfaces.
An American research team estimated that at least 13,000 particles of a virus can be released into the air in a single vomiting episode. Individuals can be infected with as few as 20 viral particles.
“When one person vomits, the aerosolized virus particles can get into another person's mouth
and, if swallowed, can lead to infection,” the researchers wrote. “Those airborne particles could also land on nearby surfaces like tables and door handles, causing environmental contamination.”
Conversation in the operating room can increase the bacterial load of air and contaminate the facemasks of surgeons and nurses. Medical providers within 6 feet of influenza-infected patients can be exposed to infectious doses of the virus.
Smaller, lighter particles can float in the air for hours and travel long distances via air currents, while larger particles quickly settle on surfaces. A single infected patient walking to a hallway bathroom can pose a major threat.
Even hospital cleaning procedures can launch pathogens airborne. “Activities known to liberate particles into the air, such as bed making and curtain drawing, may contribute to the spread and aerosolization of C. difficile,” a British team concluded.
Pathogens are not just propelled into the air via sick patients; they are also carried into hospitals on the clothing and bodies of visitors and staff and swept via air currents into emergency entrances, lobbies, corridors, stairwells, and patient rooms.
That is why many hospitals in Hungary, and throughout Europe, are installing Novaerus’ ultra- low-energy technology in common areas as well as high-risk rooms. The technology is far more effective than HEPA filters, which only trap — rather than kill — dangerous microbes. Also, pathogens caught in a HEPA filter can expose maintenance staff to infection.
Once installed, Novaerus technology works 24 hours a day and does not depend on hospital staff remembering to follow cleaning protocols or having time to disinfect between patients. The technology is safe for continuous use around vulnerable patients, making it the perfect choice for busy examination rooms, emergency rooms, and surgeries.
“This is the most effective and efficient technology,” Szíjjártó says, “and we have the lab results to prove it.”
Novaerus Destroys Odors and Allergens
While infection control is the primary reason hospitals are installing Novaerus units, odor control is an important benefit that healthcare workers appreciate.
“About 80% of hospital patients are in beds where there is no ventilation system (HVAC) installed in the ward and there is some kind of odor issue,” says Gergely Szíjjártó. “The reduced odor is something doctors and nurses mention all the time – they love it.”
Hospital employees also value the reduction of allergens and pollutants, especially in areas where indoor air quality is of particular concern. For example, pathology labs are often located in basement areas with poor ventilation, causing higher concentrations of formaldehyde, lab alcohols, and other pollutants.
Of course, infection control remains the most important reason to air-disinfection technology.
With the rise of superbugs and the aging population, infections will only become more prevalent and difficult to treat. Ultra-low-energy plasma technology is an important strategy to augment air filtration, hand hygiene, and surface cleaning.
It is impossible for hospitals to completely separate infected patients from vulnerable patients, so it is important to disinfect the air they share.