In 19th century Europe (and probably in America, too) women were less likely to die in childbirth if their babies were born at home or even on the street rather than in hospitals. The reason was simple: street and home births almost always involved the doctor or midwife washing their hands, thus minimizing the risk of infection. Doctors of the time rarely bothered to wash between hospital patients. Yum. Ignaz Semmelweiss first noticed this in Austria before 1850. Then Louis Pasteur came up with his germ theory of disease in 1864. Finally Joseph Lister in England (he of Listerine fame) pioneered the use of carbolic acid (phenol) antiseptics and the fight against germs took off in earnest.
Or did it? Each year in the USA the Centers for Disease Control estimates that there are approximately 1.7 million so-called Hospital Acquired Infections (infections that wouldn’t have happened had the victim not been in the hospital) leading to approximately 100,000 deaths.
One hundred thousand deaths is a lot of deaths, especially if every one was avoidable. If you look at morbidity and mortality statistics for the USA you’ll see that very few causes of death have greater than 100,000 annual victims. Heart disease, cancer, accidents, and strokes are all over 100,000 annual deaths, as are chronic respiratory infections, but many of those latter are actually hospital acquired.
Hospitals are not a very good place to be sick, it seems.
We spend a lot of time bitching about the cost of medical care in this country but not enough time, it seems, demanding that our hospitals be cleaner.
Wait a minute! What about the semiconductor industry, couldn’t their clean room technology help make hospitals less dangerous? Maybe… if anyone would bother to try.
This topic came up in a discussion I had recently with an old friend who designs (actually, used to design) clean rooms for high tech companies. He was calling to talk about my stinky Jeep I wrote about last week:
Ozone is interesting stuff. We used it as a biocide in our ultra pure RO-DI water. We’d inject Ozone, then run the water through UV-C light. Between the Ozone and the UV we’d zap every bug in the water. Ozone is a good biocide. UV-C is a good biocide. Combine them and you have an awesome biocide.
I’ve been appalled by the rampant infections in hospitals. Using UV-C it is easy to disinfect the air in the HVAC system and make it bug free. With the right tools a hospital room can be sterilized between patients. Using something like the tool professional carpet cleaners use one can soak, clean, and dry every surface of the room with Ozonated water. I’d then roll in a UV-C light, seal the room, and zap it for an hour or so.
As you know I used to design electronic clean rooms. One of my last projects was to design a pharmaceutical clean room. The differences between the two were interesting and the influence of government was obvious. In the pharmaceutical industry they didn’t care about particles in the air, they wanted the room to be able to be sterilized. Some of those particles are bugs. Electronic filtration was so good it could remove the bugs in the air. Bugs will accumulate in your filters. If you zap the air before it gets to the final filters it will greatly reduce the number of bugs and finding colonies of them in your filters will be rare. The pharmaceutical industry doesn’t worry about eliminating the bugs. Their plan is to be able to kill them when there is a problem.
Hospitals follow the same mindset and have generally believed they can deal with most problems by cleaning and sterilizing after the fact. The circulating air and every person that enters a patient’s room is introducing contamination. Once you understand the full implications of this, you can make hospitals MUCH cleaner and safer.
Many years ago my mother-in-law had surgery and wound up with a nasty infection that kept her in the hospital for months. It was a nightmare. As you entered the ward the smell would hit you. The rooms were not clean. The patients were not clean. The HVAC was not very good and the odors would linger. If the odors can linger, so can the germs.
The hospital building was designed and built in the 1960’s. Back then HVAC designs had low air circulation. In office buildings this led to what was known as “sick office syndrome.” It is easy to imagine what can happen in a hospital setting.
I came up with some innovations in the clean room. The first was to isolate the people (the dirty stuff) from the product (the things you were trying to keep clean). With good layouts and by isolating the airspace I could turn a low grade clean room into a top performer. (I could get better than class 10 conditions around the product in a class 10,000 clean room!) I found ways to take the people out of the clean room and make it a much smaller product only room. I reduced the size of one room by 90%. (A 90% reduction in clean room space is a huge savings in money!)
Given this, one could improve on the design of a patient’s room and make it a lot cleaner. How much room does the patient really need? He/she needs space for a bed and toilet. Given that, one could design a super clean zone for the patient. Does all the equipment and the hospital staff that tends to the equipment need to be in the same air space as the patient? When you start going through the process of re-examining old assumptions and practices, very obvious design improvements present themselves.
Okay, it’s Bob again: you thought I had left, didn’t you?
What astounds me about all this are the 1.7 million Hospital Acquired Infections and 100,000 deaths that could have been avoided. We all have to die sometime, but not this week.
Think of the cost to society. Those 1.7 million infections surely add $10,000 each to the hospital bill. That’s $17 billion. What’s the economic value of those 100,000 deaths, say $1 million apiece? That’s another $100 billion for a total of $117 billion per year, every year.
Why don’t we learn from Intel and AMD and make our hospitals safer for patients?
Because…you know the answer. The incentives are all wrong. Without going all tin foil hat, it is clear that hospitals are paid to deliver care, not prevent care from being delivered in their facilities. You know this song–it has a good beat, but nobody wants to dance to it.
Health care is NOT A MARKET. No one wakes up and chooses to have a heart attack, or liver disease, or diabetes, or a stroke, or cancer. And since it is not a market, market forces do not apply.
Government regulation is an absolute necessity, as distasteful as that may be to many, many Americans. Even in the hospitals of the half-as-expensive and just-as-good rest of the industrialized world, basic (and advanced) sanitation as described above is a rarity. It costs money _now_, and nobody ever wants to spend money now. Even essentially free measures such as the Safer Surgery Checklist aren’t mandated. Because…stupid.
Humans are disappointing.
It is important to note that the customers of hospitals are the doctors, not the patients.
Of course it’s a market. Nobody wakes up in the morning and chooses to have a burst water line or a blown head gasket, but those vital emergencies are handled by the market. Generally you have to pay with your own money for these repairs though. A little more efficient than the health care morass, don’t you think?
and the price is what the market will bear..
How much before you decide to leave the water turned off and shop around for a better deal?
How much before you leave your loved one lying on the floor and shop around for a better deal?
Your house is burning down… how much before.. oh, that’s different.
“A successful hospital is one where every patient walks out having borrowed as much money as possible to pay their bill.”
Market yes, free market no. All markets deviate from the ideal (all transactions voluntary and both sides have perfect information) to some extent, but the healthcare system in the US is a long, long way from that. When I go into the transaction I have no idea what product I need.I can’t shop around for a heart surgeon the way I can shop for a plumber, and I can’t go to Home Depot or Google and find out the fair market value of the parts. Indeed, in the US no-one seems to know the true cost of anything in the healthcare system.
So yeah, it’s a “market”.
in health care, the word is NOSOCOMIAL. when I worked part-time in hospital maintenance in the 80s to get through college a second time, there was a two-nurse staff supervising nosocomial infection control. all our induction (big-ass fan) air handler systems had roll filters and electrostatic filters. the surgical suites also added UV and bank filters in the air intakes. the linen room had UV.
and in the 80s, you didn’t have little sanitizer dispensers hanging on the wall. half the time, doctors and nurses DID wash up at the room sinks, quickly. obviously not the 15 minute scrape-downs you have to do before gloving as you enter a surgical area with scratchy one-use iodine-soaked sponges. everybody had to shower there first, also.
theoretically, it should be better today. but if you get the chance to count the holes in the ceiling tiles, wired for sound and light for a day or two, also count the times a caregiver comes in to stop a pump beeping and hits the sanitizer or gloves up first.
I bet you don’t get to using your toes. and that is with cleaning campaigns and signs and squirt Nazis popping up everywhere saying “sanitize!”
Several months ago I was hospitalized for a little over 24 hours in a hospital that was less than 5 years old. All of the staff, upon entering the room, either hit the sanitizer or gloved up before doing anything. My physician hit the sanitizer upon entering the room, after he touched me, after he touched something in the room, after he touched my wife, and before departing the room. Some hospitals are doing better.
Oh, and everything was EMR. All equipment that was not single use and worth more than a few dollars had a RFID tracker. I had a tracker too, but it was worn on my wrist rather than being injected into me like in The Hunger Games.
Government regulation is what has gotten us to this point! Egad if I hear one more idiotic liberal touting the government. You do know that the IRS is going to be in charge of ObamaCare right?????
In another couple of centuries people will look back at medicine in the early 21st century with the same feelings we have for 18th and 19th century medicine.
Chemotherapy, radiation therapy, heart bypasses, transplants, mastectomies may all be things of the primitive past.
People may shake their heads when reading about multinational pharmaceutical companies peddling quack remedies backed by dubious research, and making huge profits. And selling medicines banned in first world countries to third wold countries.
Hospital-acquired infections will be a source of disgust to future generations. 21st century psychology may be a source of laughter. The vast quantities of chemicals in our food may be a source of horror.
People will say, “I’m so glad I didn’t live in the 21st century – just imagine having cancer then, when it was so widespread, and living with their cruel, ignorant and drastic treatments – which usually didn’t even work anyway!”
Well, you may certainly correct in your predictions, but first of all, kudos to Bob for airing a problem usually poorly perceived by the huge majority of cirizens, and offering good solutions. But let’s not forget that today, it really looks like we won’t even get to a 22nd century with more than a third of our present population worldwide, and the technology the survivors will use might not be any more advanced than the one of the 15th Century…
With notional experience with both electronic and health style clean room the difference distills down to the following:
Electronic: Innovation driven by the results of cost benefit analysis
Health: Regulation driven (compliance kills innovation)
I agree with most everything noted thus far, but I would add that the cost of the Intel and AMD facilities is thousands of dollars per square foot and part of the ability to maintain cleanliness is strict protocol by the workers. You’ll have to really focus in on the cost/benefit analysis…or change the way costs are assessed in our health care system.
Unlike an electronics clean room a hospital does not have to be particle free. It only needs to be germ free. You don’t need the super expensive air filtration system. What you need is the ability to sterilize the air going into a patients room. For the cost to treat a single patient with an infection, you can upgrade a hospital’s air handing system with UV-C sterilization lamps.
unlike an electronics firm, hospitals dont lose money if a mishap results from a dirty environment. On the contrary, a prolonged patient stay and multiple procedures result in more money, not less. Where is the incentive?
prove that. the HVAC is based on mass airflow from induction units, and filtered room air circulators with a little radiator and fan. the back of the radiator is often caked an inch thick with lint, and I gotta tell you, it’s not an annual thing to remove the cabinet and scrape that mat off, it’s too labor-intensive. there is no place in those room units to add a couple UV lights and the wiring. I’ve literally done over a thousand of ’em. it’s going to take a major overhaul wing by wing and new designs in the room units.
I’m sure a lot of this info is known to hospitals, but they lack the money to retrofit existing hospitals. Sure, if you’re building a new facility, you can do all kinds of great things, but everyone else is stuck with what they have and would have to retrofit them for this.
But I sent your article to my wife who is Chief Quality Officer at our local children’s hospital to get her take. Any chance I can get the contact info for your friend that I can give to my wife?
Thanks,
Scott
“What’s the economic value of those 100,000 deaths, say $1 million apiece?”
Since most of these deaths are probably of elderly people (say, 60 years old or older), I suspect that the *economic* value is much lower. It might even be economically a win (shudder!) if they die quickly enough in the hospital without using up lots of resources (a win in the sense that social security and pension costs drop and maybe medicare as well).
Sigh.
Alas, I think you are correct that elderly deaths are less expensive to society and elderly deaths from infection are cheaper, still, than deaths from major diseases. In one sense these people are worth more dead than alive. And as a guy in his 60s, “these people” effectively means people like ME.
Due to personal health reasons, I’m not going to divulge my name this time, but being over 50 and having a health condition making me more vulnerable to infection, I certainly make this comment not lacking in awareness of its cold-sounding nature, I want to first caveat.
But it is a reasonable point as to what is the benefit societally. It also isn’t merely a matter of “over 60” but the health condition of those 100,000; would 90% die anyway in 6 months of other causes – or 10%? If the latter, it’s a real problem, if the former it’s not. As much as we might like to say that it’s worth millions to save a life, given the conduct of people, including such as where we buy textiles from/what we’re desiring to pay, something far less important than health, I think it’s fair to say we, as a culture/society, do weigh those benefits versus costs, and rather coldly. I wouldn’t even call that species-unfair, as much as it may suck on a personal level if you’re that person on the losing side of such an equation.
I did find this data analysis from 2002 at https://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf . It does not say so much though to general prognosis of those dying (which is not to minimize the suffering and great cost of having an infection, period): “The number of deaths associated with HAIs by major site combining the subpopulations was greatest for pneumonia (35,967) and bloodstream infections (30,665). An estimated 13,088 deaths were associated with urinary tract infections, 8,205 with surgical site infections, and 11,062 with infections of other sites.”
For anyone interested, there’s significant data re New York HAIs (Hospital Acquired Infections) at https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2010/docs/hospital_acquired_infection.pdf ; some improvements seem to be being made due to greater scrutiny although the document is extensive and I haven’t gone through all of it by any means.
https://www.tufts.edu/med/apua/consumers/faqs_2_4154863510.pdf has some good data though it’s also specific to MSRA and is also somewhat self-interested.
https://www.webmd.com/skin-problems-and-treatments/news/20071016/more-us-deaths-from-mrsa-than-aids indicates significant risks, even if only speaking of the so-called hospital “super bug” MRSA, for typically non-risk or reasonably healthy populations. But hard to infer solid numbers.
Whatever the case, I do think the idea of this article is interesting, I would like to hear more input from specialists in the medical field as there may be any number of reasons this has been considered and actively rejected, or it may simply be, as often happens, an idea not seriously entertained by anyone in a position to “do something” about it, despite seeming obvious.
Great idea to share, let’s hope we can get some real data/input on it and not mere speculation.
Due to personal health reasons, I’m not going to divulge my name this time, but being over 50 and having a health condition making me more vulnerable to infection, I certainly make this comment not lacking in awareness of its cold-sounding nature, I want to first caveat.
But it is a reasonable point as to what is the benefit societally. It also isn’t merely a matter of “over 60” but the health condition of those 100,000; would 90% die anyway in 6 months of other causes – or 10%? If the latter, it’s a real problem, if the former it’s not. As much as we might like to say that it’s worth millions to save a life, given the conduct of people, including such as where we buy textiles from/what we’re desiring to pay, something far less important than health, I think it’s fair to say we, as a culture/society, do weigh those benefits versus costs, and rather coldly. I wouldn’t even call that species-unfair, as much as it may suck on a personal level if you’re that person on the losing side of such an equation.
I did find this data analysis from 2002 at https://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf . It does not say so much though to general prognosis of those dying (which is not to minimize the suffering and great cost of having an infection, period): “The number of deaths associated with HAIs by major site combining the subpopulations was greatest for pneumonia (35,967) and bloodstream infections (30,665). An estimated 13,088 deaths were associated with urinary tract infections, 8,205 with surgical site infections, and 11,062 with infections of other sites.”
For anyone interested, there’s significant data re New York HAIs (Hospital Acquired Infections) at https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2010/docs/hospital_acquired_infection.pdf ; some improvements seem to be being made due to greater scrutiny although the document is extensive and I haven’t gone through all of it by any means.
https://www.tufts.edu/med/apua/consumers/faqs_2_4154863510.pdf has some good data though it’s also specific to MSRA and is also somewhat self-interested.
https://www.webmd.com/skin-problems-and-treatments/news/20071016/more-us-deaths-from-mrsa-than-aids indicates significant risks, even if only speaking of the so-called hospital “super bug” MRSA, for typically non-risk or reasonably healthy populations. But hard to infer solid numbers.
Whatever the case, I do think the idea of this article is interesting, I would like to hear more input from specialists in the medical field as there may be any number of reasons this has been considered and actively rejected, or it may simply be, as often happens, an idea not seriously entertained by anyone in a position to “do something” about it, despite seeming obvious.
Great idea to share, let’s hope we can get some real data/input on it and not mere speculation.
I believe it all boils down to cost.
Hospitals get more money out of you if you’re in the hospital longer, so why should they spend extra money to clean up their facilities beyond what they do already?
They’d also have to change their mindset of paying as little as possible for (barely) sufficient results.
not any more. insurers and state health agencies are compiling lists, as is the federal government, of hospitals with least complications and quickest turnarounds. it is now a penalty if you keep a patient in a bed if they are not likely to split open and spill on the sidewalk if you discharge them. heart attack is barely an overnight now, and the goal most places is get you diagnosed and stented in an hour or less.
an hour or less.
as in drive-in surgery.
the outcomes are better, the insurers can give 9-figure annual bonuses to the top of the C suite instead of 8-figure, and you can do more procedures. the population is getting older and sicker, and turnaround is important. they used to build 600-800 bed hospitals. the new norm is 350-400 beds with many times the throughput.
True, the throughput is more important these days. However, what I’ve seen as our part of our city has been built up recently is a deluge of outpatient surgery clinics and mid range hospitals (I can’t recall what trauma level they are, but not the top level). I look at the population in our surrounding area and think there’s no way it can possibly support this many medical facilities from this many firms. It would take major influenza epidemic to come close to maxing out the facilities, so I look at all this building and think it’s a waste of money.
But of course somebody has to pay the bill for all of this construction, and it’s passed along to the patient in the form of costs.
People are important too. Back in 1980, I was completing my Ph.D. in Social Psychology at UCLA and was hired to work on a CDC project studying Nosocomial (hospital acquired) infections. CDC wanted to know what the average Nosocomial infection rate was (it was about 5%) and why some hospitals were better at controlling this problem. They hired a bunch of Social Scientists at UCLA to try to identify organizational issues affecting infections. They also hired a bunch of public health scientists from UNC to develop software to diagnose Nosocomial infections (it was and is rarely coded explicitly in the medical record). We interviewed a range of the key management in the hospital with responsibility for infection control – physicians, nurses, etc. We found that the right people working effectively can reduce infection rates. One question we asked illustrates this: We asked nurses how often they washed their hands after handling an indwelling urinary catheter – the answer was 100%. We asked nurses how often they washed their hands _before_ handling an indwelling urinary catheter – and the answer was much less than 100%. Those behavioral differences make a difference in infection rates! Sadly, Nosocomial infection rates haven’t changed much since 1980.
I wonder what people who run hospitals think about this subject. I’d be interested to hear from the administrator of a hospital being built, I’ve seen three go up within 50 miles of my house in the last couple of years….
The placebo effect is remarkably strong, and can be negative as well. If patients are placed in a small tent, they are likely to interpret this as evidence that are very sick and extraordinarily vulnerable. If relatives — germy though they may be — cannot easily visit, some may fear (or assume) that they will never recover enough to live a normal life. Even reducing the “empty” space may lead patients to feel that they are treated by inconsiderate bureaucrats, rather than concerned healers.
Those building hospitals (other than research hospitals) are usually planning to make money. Since reimbursement rates are generally not increased for “better than standard” care, but may be cut for inferior care, there is a strong incentive not to deviate from the published standard, unless it either saves money *for*the*hospital* or encourages patients to choose that hospital over another.
“You might get even sicker at a hospital. But we think that is less likely at our hospital” is not an easy marketing pitch.
Treatment Woes Can Bolster Hospitals’ Profit. That was the title of a recent article in the WSJ and goes a long way in explaining the problem.
Of course health care is a market; it just isn’t a (1) symmetric market with (2) fully informed, (3) fully rational, (4) equally motivated participants. Any one of these differences from the market ideal *can* prevent the market from functioning “properly”, let alone providing a socially optimal solution. The asymmetry of information (see lemons market) and motivation are particularly bad, and the irrationality of a patient currently in pain is extraordinary.
Alas, the current US workaround of having a 3rd party (employer) pay a 4th party (insurer) to act “for the patient” is … also far from optimal. Bad enough that single-payer may be an improvement even from a market standpoint, as government is only a 3rd party with badly averaged incentives to do what the patients “really want”. (As opposed to the current system of a 3rd *and* a 4th party, both with incentives that sometimes explicitly conflict with the patients’ own interests, plus government regulation as a 5th party.)
Sorry, not a market–certainly not worth the name.
Anything that diverges in virtually every point from the definition just isn’t that thing. I decided to use Business Dictionary.
https://www.businessdictionary.com/definition/market.html
Have a look and think hard.
1) Supply and Demand — Fail: Demand for healthcare is totally inelastic, so price finding mechanisms are ineffective.
2) Communicating price information — Read Time’s Bitter Pill; fail.
3) Transactions — there’s one that actually exists in health care
4) Distribution / need and willingness to pay — FAIL — http://edition.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/ “…a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills.” Having a gun to your head is not the same as “willingness”.
This is a “market” in name only. Pretending otherwise simply blinds you to thinking hard about how to solve the utilitarian and social problems caused by the current system. But you obviously are thinking, for which I salute you.
Industrialized nation single-payer systems all produce better cost results with approximate health parity (OK, the US is 30th in infant mortality, down 5 points from last year, so parity is a bit understated in some important metrics).
But even the German regulated multi-payer/mandate system (with over 200 providers of full coverage competing on the basis of additional services), complemented by a host of totally private, market-driven insurers with deductibles and “luxury” services, costs barely more than HALF of the US system. It also happens to be one of the most expensive besides the US.
At least you aren’t falling victim to the straw man of “waiting periods” and “Canada”, as if a baseline costing less than 50% as much and already producing comparable health care ends couldn’t be improved with a fraction of the enormous sum saved in the first place. And, unsurprisingly, only Canada had higher waiting times than the US. Everyone else was better.
https://www.businessweek.com/stories/2007-06-22/the-docs-in-but-itll-be-a-whilebusinessweek-business-news-stock-market-and-financial-advice
An excellent idea but only one of many simple and cheap things the health care industry could do to improve outcomes. I am sure a lot of negative outcomes could be traced to simple miss communication between doctor and nurse and nurse to nurse. If pilots were allowed to fly planes with the casual passing of critical instructions in a hurried conversation as they leave the room I am sure we would have a lot more plane crashes. I suspect something a simple as the pilot checklist would save a lot of unnecessary illness. If pilots had to suck up their egos and follow checklists why shouldn’t doctors have to?
Brian
It appears most if not all posters on this thread are going under the assumption that there are enough staff employees (who actually care) to clean a room to standard between patients. This is often not the case. Another point is that it’s not so much that the patient rooms are the leading environments of where nosocomial infections are being acquired, but more so at centralized points of care – such as the ED or medical imaging departments, physical therapy suites, and yes even the hospital’s cafeteria. The root cause of this issue is most, if not all hospital’s dependence on federal and state spending under it’s various guises. And since that spending is continuously being reigned in, the first thing to be scrutinized and eliminated is the biggest operational expenditure – staffing.
Well…it would appear you answered your own question. In the second to last paragraph. If hospitals make an extra $17 billion (estimated) each year from ‘dirty’ hospitals, they have significant incentive to not make it clean.
Joseph Lister may have been born and studied initially in England but his pioneering work on antisepsis was at Glasgow Royal Infirmary where I work in Scotland. We do not have many of the dreadful drivers you suffer from in the USA in our healthcare system but do have reasonably high rates of nosocomial infection. The causes are multifactorial and not as simplistic as made out. Hand washing is certainly important but not as important as the zealots make out – while many of these infections are acquired in hospital they are not all acquired from the hospital itself or its employees but rather from patients themselves in an immunocompromised sate. For example, there has been much made of the rise in rates of clostridium difficile related colitis. However, it seems that the increase in the numbers of disease with this commensal have not mainly been due to transfer from healthcare workers to patients but rather due over prescription of antibiotics and particularly to the modern habit of prescribing proton pump inhibitors as near routine for sick patients. This latter switches off the gastric acid that normally kills this bacterium off before it gets through to where it does its damage. A venerable thoracic surgeon who taught me stated you could spit on healthy pleura in the thoracic cavity in an immunocompetent patient during an operation and it would have no effect as long as you had good drains at the end of the procedure. A good slosh of any vaguely antiseptic fluid (or even sterile water) at the end of a laparotomy dramatically reduces post-op peritonitis as long as you swill out all nooks and crannies. Indeed many vets only use gloves during operations for aesthetic reasons as human skin commensals have little if any pathogenicity in animals.
The statistics may also be extremely misleading as they are due to diagnostic coding which is notoriously variable. Certainly in the UK many, many death certificates state something like ‘hypostatic pneumonia’ as prime cause of death, and it may be the final yank shut of the curtain but that fails to register the prime cause of death which is what lead to this parlous state of affairs and that may well be lung cancer, dementia or whatever.
Clealry a tech blog looks for a tech solution but even if you make ‘clean’ rooms patients need CT and MRI scans etc. and these cannot be sterilised nor the trolleys used for transfer nor the corridors patients pass through. The goal is antisepsis not asepsis.
In Scottish hospitals no patients are allowed flowers in a room or near a bed in any ward due to the policies of the infection control zealots – this may make sense for ITU and HDU patients but not for elderly grannies several weeks post hip replacement in a rehab ward who are only in hospital still because they need the attentions of the physiotherapists. Nor does it make sense for those patients in hospital who are there in the terminal stages of illness. We must be careful not to dehumanise our institutions and lose the compassionate components of care – in all medicine there are risks and there are benefits that must be balanced, too often the former are exaggerated and the latter forgotten. I for one would like some flowers near my bed if I am in a hospital when the light finally starts to fade.
in Paris there are “dishwasher” Port-o-lets. You put in then a franc – door opens and steam wafts out. You do your business and once the door closes the dishwasher kicks in cleaning if not sterilizing the porta potty. Always that I’ve seen very clean. I thought such would be good idea for patient rooms/ ORs – why not build dishwasher like rooms?
I doubt AMD has any clean rooms any more. They would have gone to GlobalFoundries along with the rest of the fabs.
The high tech solution of zapping every single bug in a hospital room is a waste of time if someone walks into the room and passes a new bug onto a patient. Person to person contact seems like a more likely cause of contamination than air circulation. The only disease that I’ve ever heard of being caused by inadequate air conditioning is Legionnaires Disease and that’s very rare.
Infections can be passed on by visitors, or indirectly from patient to patient by employees moving around the hospital all day, even though they might not be infected themselves. Washing their hands with disinfectant will reduce this a lot but is difficult to do every single time they have contact with a patient.
Yes, good point. I just submitted several links and major sources of infection are not airborne but often from other sources.
It’s not just cost.
You neglected to mention what happened to Ignaz Semmelweiss. He died in an insane asylum, where he was imprisoned for daring to suggest that high infant death rates could be traced back to doctors who did not wash their hands.
Same thing is happening in the world of nutritional lunacy. For 40 years, the government has been urging to eat a diet that is causing more diabetes, CHD, and many other diseases, yet they can’t figure that out — and if outfits like the AHA were to admit that they have been wrong, it would open them up to class-action lawsuits the like of which have not yet been seen.
In order to progress to be made in medicine, it’s similar to progress in science. Old practioners with really bad ideas have to die so that practioners with better ideas can take their places.
Not only did 18th century doctors not wash their hands, but often they just came from the morgue, working on cadavers.
(hope this isn’t a duplicate, it didn’t seem to take it last submission….this is a copy/paste….)
PS written after the below: as stated above and as in the statistics below, it does not seem that air/ventilation management would have that much of an impact on the numbers…
Due to personal health reasons, I’m not going to divulge my name this time, but being over 50 and having a health condition making me more vulnerable to infection, I certainly make this comment not lacking in awareness of its cold-sounding nature, I want to first caveat.
But it is a reasonable point as to what is the benefit societally. It also isn’t merely a matter of “over 60” but the health condition of those 100,000; would 90% die anyway in 6 months of other causes – or 10%? If the latter, it’s a real problem, if the former it’s not. As much as we might like to say that it’s worth millions to save a life, given the conduct of people, including such as where we buy textiles from/what we’re desiring to pay, something far less important than health, I think it’s fair to say we, as a culture/society, do weigh those benefits versus costs, and rather coldly. I wouldn’t even call that species-unfair, as much as it may suck on a personal level if you’re that person on the losing side of such an equation.
I did find this data analysis from 2002 at https://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf . It does not say so much though to general prognosis of those dying (which is not to minimize the suffering and great cost of having an infection, period): “The number of deaths associated with HAIs by major site combining the subpopulations was greatest for pneumonia (35,967) and bloodstream infections (30,665). An estimated 13,088 deaths were associated with urinary tract infections, 8,205 with surgical site infections, and 11,062 with infections of other sites.”
For anyone interested, there’s significant data re New York HAIs (Hospital Acquired Infections) at https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2010/docs/hospital_acquired_infection.pdf ; some improvements seem to be being made due to greater scrutiny although the document is extensive and I haven’t gone through all of it by any means.
https://www.tufts.edu/med/apua/consumers/faqs_2_4154863510.pdf has some good data though it’s also specific to MSRA and is also somewhat self-interested.
https://www.webmd.com/skin-problems-and-treatments/news/20071016/more-us-deaths-from-mrsa-than-aids indicates significant risks, even if only speaking of the so-called hospital “super bug” MRSA, for typically non-risk or reasonably healthy populations. But hard to infer solid numbers.
Whatever the case, I do think the idea of this article is interesting, I would like to hear more input from specialists in the medical field as there may be any number of reasons this has been considered and actively rejected, or it may simply be, as often happens, an idea not seriously entertained by anyone in a position to “do something” about it, despite seeming obvious.
Great idea to share, let’s hope we can get some real data/input on it and not mere speculation.
I’ve spoken to some people in the hospital business about this issue in my native Australia, and it looks like the catalyst that might change attitudes to hospital disinfection is antibiotic resistance. Containment is the only likely effective answer to this looming emergency in the near term and this will lead to a complete rethink in how hospitals are designed and sterilised. Shared bathrooms are for the history books but bleach will make a comeback!
Physician owned hospitals are not allowed to expand and new ones cannot open because the existing hospitals don’t want the competition . Under this regime, I don’t see how hospitals care too much about improving care.
I haven’t read all the posts here, but I did want to underscore that the flow of outside, unclean public visitors into the hospital setting for visitation purposes is huge! That is a big battle to wage and I really don’t think the issue will be solved until that point is addressed. Visitation is one of the major reasons why hospitals are cesspools of germs.
Having a clean air space for hospital procedures definitely makes sense, but the costs of setting up an air filtration system similar to a chip fab is prohibitive. Does anyone know of a more reasonable solution that is available for general clean rooms?
typical.
because something can be done…..let’s do it !
There are so many, many assumptions on this. Semelwiz and Lister looked to see that it worked before making recommendations broadly. Opening up 75% cardiac lesions, tightest possible glucose control, lowring blood pressure as much as possible, mammograms for everyone are a few of the recently debunked good ideas that really weren’t good at all.
What we should learn from the engineers…. 1) test. 2) fewer parts and more uniformity lowers errors and failures. 3) don’t overload memory 4) redundant checks in the system….. I could go on… but these are the main ones.
How much do you want for it?
oops…wrong thread.
In yesterday’s news: http://news.wustl.edu/news/Pages/25490.aspx
“A major study in hospital intensive care units shows that bathing patients daily with an antimicrobial soap and applying antibiotic ointment in the nose reduced by 44 percent the bloodstream infections caused by dangerous pathogens, including the drug-resistant bacteria MRSA.”
I think we can all agree… “DUH!”
[…] https://www.cringely.com/2013/05/27/what-intel-and-amd-clean-rooms-could-teach-hospitals […]
I was married 30 years during which 25 were spent in hospitals, clinics, and doctors offices in three states. I learned two things: The best doctor in the graduating class will not open an office in a boring place in a poor state when he can work on Park Avenue and be paid to live in the most exciting city in America I met way too many of the “others” who should not have been licensed. I’ve been in hospitals that should have been closed for filth and bad practice. Poor states do not have health code standards and do not enforce federal health standards in public places, because there is no money in the local county or city budget for code enforcement.
The last thing I ever dreamed I would do is become a caregiver or build a hospice but I did. And I did it kicking, screaming and cursing an entity that allegedly heals the sick when they can’t diagnose it and didn’t know how to treat it.
The “IT” was my spouse who had seven diseases, lived 13 years after a failed quad-bypass, but couldn’t out run Fibrosis which averages six years on death row for a younger, healthy man, who does not have a lung transplant. This is quite different than the 77-year old with one functioning artery.
I don’t think we were lucky. I did not settle for a mediocre doctor. I followed orders and asked a lot of “how-to” questions. There were no lung infections, flu, bacterias, allergy flares, or virus related illness the last six years of our marriage because hospital visits for routine tests and office calls were not an option. We moved home to quality medical care to treat the evil twins (COPD and Fibrosis) in a palliative setting in-home. The saving grace was the furnace filter.
By the time we came home from the hospital I was already well versed on furnace filters and mold spores. I bought 3M Filtrete filters that trapped particles larger than 0.03 microns of mold spores, bacteria, virus, flu, smoke, dust, and pet dander, I chanced the 90 day filter every two weeks for over 6 years. For this to be effective no window or screen doors can not be opened, and the furnace must run continuously to clean the air. There were no lung infections. The COPD was in remission, but the only thing that could stop the forward march of Fibrosis was death. It did.
There is a caveat. Other companies offer pleated filters. Most of the look alike filters do not list what it captures on the packaging. Checking the filter number with the manufacturer or retailer usually reveals it does little. At the very minimum I want to see mold spores, bacteria, virus, flu, and allergens listed on the package. .Every 3M package sold includes a list.
There is nothing quite like the practical experience with health issues, doctors, and hospitals to highlight the problems with medical care in America. It is the chicken and egg question as to which is worse. Is it the ignorant doctor or the dirty hospital.
It depends upon where one lives and the severity of the problem. In some places its a no-win. In others if you have a great doctor the other issues can be managed.
Stumped? Don’t ever overlook your favorite pet Vet. He knows more about the body than most M.D.’s, and is generally better trained with better diagnostic equipment in his office.
Comment counts have not updated since May 29th.
For the last 6 days (28th to 2nd) the number of comments is 32+13+2+1+4+0=52 not 45, which is from the first two days (32+13=45).
I think we experiencing the end health “care” as we know it.
All-you-can-eat managed healthcare was a terrible idea and is in the throes of collapse.
Actually I hope so, because where it is headed is unsustainable.
The small company I work for has always paid 100% of health insurance premiums, but has just received notice that they will be increasing by 27% next year. Not sure how we are going deal with that.
…anyway, the problem with the clean room approach is patients are not “product”, and won’t appreciate it unless you can do an insane sales job on “isolation medicine”. Pipe in music, make them feel like they are in “2001 a Space Odyssey”…
No. I think the answer was in the first paragraph of your article: a return to in-home patient care. It is happening to some degree without the doctors (internet self-diagnosis Yay!).
Wouldn’t it be cool to have actual doctors participating in the Internet-self-diagnonsis game. They could even offer to send someone over. I’m surprised no-one has though of this as a business. Static information, free. Assisted web consultation — fee. Phone or video consultation … larger fee. In person visit… Larger fee still.
Yabbut…
Did your old friend have a solution for the stinky Jeep?
You got the right idea… wrong engineer. The article is self-contradictory.
Clean all the air and surfaces you want, you haven’t budged the germ count:
air from outside
patients and personell all over the place
patient’s poop all over the place and all over themselves
etc.
so…. the ideas wouldn’t hurt and they’d help my morale…but here’s the right idea…..
The way you lower error rates and failures in all industries is to have fewer parts/components/procedures.
Lower the hospitalizations, lower the breakage of skin procedures
To the degree that people have a choice over which hospital to go to, maybe some of this could be solved by the market if patients knew there was a quality difference between different hospitals. Create some kind of certification system, and then hospitals could advertise that they are a “Certified Cringely Clean (TM)” hospital.
This is why I never read the magazines in the Doctor or Dentist waiting rooms, especially
in cold/flu season.
Hey Bob. The above post on June 11 appears to be out of place chronologically.
Also it took 3 attempts to get my post to show up, while getting the “website is offline” error same as was happening before the new server.
Leaving aside the “Healthcare: market or not?” debate …
Ozone is a respiratory irritant, folks. It’s toxic. Hospitals are full of sick people, many of whom have respiratory impairments. You don’t want to make it harder for them to breathe if you can help it. Which is why ozone isn’t used as a disinfectant treatment in hospitals.
There is a problem with infection control in hospitals, but the correct way to tackle it is to recognize that cleaning and disinfection, like nutrition, is a core function and not something that should be out-sourced to the lowest bidder. Antibiotics trained us to assume that we were safe from disease; unfortunately the age of working antibiotics may be ending, due to massive abuse by the agrobusiness sector. Time for a re-think.
It appears most if not all posters on this thread are going under the assumption that there are enough staff employees (who actually care) to clean a room to standard between patients. This is often not the case. Another point is that it’s not so much that the patient rooms are the leading environments of where nosocomial infections are being acquired, but more so at centralized points of care – such as the ED or medical imaging departments, physical therapy suites, and yes even the hospital’s cafeteria. The root cause of this issue is most, if not all hospital’s dependence on federal and state spending under it’s various guises. And since that spending is continuously being reigned in, the first thing to be scrutinized and eliminated is the biggest operational expenditure – staffing. (sorry for the double post).
Here’s something else to consider…maybe we shouldn’t always be looking to _modern_ technology to solve medical or heatlhcare problems.
Look a little deeper and you’ll see that the idea that high tech solutions are the answer to health and healthcare related problems is a modern concept. It’s also largely B*llshit. It’s really just an extension of the high tech capitalist myth that all new technology is by definition superior.
I am not saying we shouldn’t use UV or ozone. I have actually have personal experience with both.
I’m just saying maybe we ought to also put some emphasis on improving peoples’ immune strength through other routes, such as nutrition, exercise, emotional support, meditation, acupuncture, exercise, natural supplementation, at least for those who are capable of using those tools.
There are herbs out there that fight tons of microbes but we choose not to use them. Read beyond the corporate and government worlds’ lies and you’ll see many of those substances are highly effective, at a fraction of the cost of big pharma’s drugs. Do your own research. These facts are substantiated in the science. It’s just not a big moneymaker compared with pharmaceuticals.
BTW Cringe….in a PBS documentary a while back, I think it was Frontline, they discussed a new hospital, I think in California, that was supposed to be the most technologically advanced in the country. Guess what they were using for disinfecting rooms…yep…little R2D2-like machines which blasted the room with UV light.
Oh, and if you want to learn the true “future” of successful medicine…listen to what natural medicine specialists are saying. UV light was in use as early as the 1930s. It still is, but I believe it’s mostly illegal in the North America.
Bob:
When I ran across this CDC report (https://www.cdc.gov/drugresistance/threat-report-2013/) on drug resistant viruses, I immediately thought of this article. It seems we may be in trouble earlier than expected. The report is worth a read, but don’t do it at night in a dark room!