Sunday, February 7, 2010

A Veterinarian's View on the Control of Human Hospital Related Infictions

First we must define the problem. It is that an estimated 2,000,000 patients who enter human hospitals as patients contract an infection not present prior to their admission. Of those patients in one year in our country 90,000 actually die of their infection. The following adresses only those infections that are the result of bacterial infections that are the major problem. I have been informed that that figure may underestimate the problem as many of the smaller human hospitals do not report on this situation.

Next we should consider some of the efforts made so far in the unsuccessful effort. 1. Sick leaves for all hospital employees obviously affected by symptoms. 2.Hand washing. 3. Constant testing of premises including heating and air conditioning ducts. 4. The use of proven more and more effective bactericidal agents used in cleaning and disinfecting. 5.Other efforts such as discouraging the wearing of long neckties in favor of bow or no ties. Hmmmm.

It seems to this veterinarian that the more dangerous killing organisms are the most difficult to control in human hospitals. To locate the source of these dangerous agents should be a major effort in the eventual control of such a serious problem.
In consideration of potential sources the medical profession has decided that human hands are a major source. That effort, having been tried without improvement the other sources should be investigated. What are they? 1. There is a question as to the more obvious source but I shall put down as source in no order of importance,1. The human mouth. 2.The filth walked into hospitals on shoes. 3.Sanitation of the premisis.

Next logically come the attempts to control this problem. First the for the human mouth. An experiment for a hospital-wide examination of every mouth that enters the establishment should be instigated by requiring everyone to spit into a container for bacterial examination. This experiment should be for a 24 hour period. The hunt would be for specific bacterial organisms most frequently associated with the diseases contracted in that specific hospital. Admittedly this requires a massive temporary enlargement of the bacterial effort with both facilities and the expert bacteriologists searching for the culprits. Ideally each specimen would be examined immediately and after incubation.

Another volunteer human hospital could study the other source of filth and that is the shoes of everyone admitted through the doors. Disposable sterile "booties" or shoe coverings should be handed to all to be worn over shoes. Each pair of "booties" would be removed, folded and placed in an envelope marked with name and address for bacteriologists to seek the bacteria involved. The debris from the shoes would indicate information of public health importance if a pattern of infection was to be found on shoes from a specific geographic area or places of employment.

For another experiment, in one small surgical facility a culture of harmless organisms, perhaps yeast could be sprayed over the facility to try to introduce an agent that would overcome the dangerous bacteria. Very few bacterial organisms can survive in the presence of yeast. After 100 or so procedures were performed in such z facility the effectiveness or not of the attempt could be evaluated.

As a veterinarian, I see another area of perhaps even more potential for good than the above and that is the encouragement of the human immune system. There is much statistical evidence that runners have stronger resistance to many infections than non-runners. For perhaps a volunteer hospital could refuse to permit the entry of any patient who did not run at least once a week. That experiment should be done by a hospital in a large metropolitan area or as part of a huge establishment as the Mayo Clinic, or the Columbia Medical Center facilities. The USATF(Track and Field) approximates 30 million runners who run at least once weekly and it would take a facility in a heavily populated area to find enough runner-patients in need of surgery to fill beds to make it worthwhile.

On visiting the Hog Farm at the University of New Hampshire some years ago to purchase a piglet for a pet a sterile white outer clothing was issued with plastic boots for our shoes, masks and hats and that was not to protect us but to protect the pigs from contracting diseases from us. Wouldn't you think the human medical profession would do as much for their patients as the veterinary profession is capable doing for pigs? Or shouldn't the two professions work together as all medical professions should do?

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