Hospitals are places we go to get well, and we don't expect to get sick or sicker there. But a study from researchers at the Cleveland Clinic, Case Western Reserve University School of Medicine, and Cleveland VA Medical Center in Ohio found that hospital floors in patient rooms were frequently contaminated with healthcare-associated pathogens—often dangerous multi-drug resistant bacteria.
The study, published in the American Journal of Infection Control (AJIC), reported that samples from the floors of 159 patient rooms showed the presence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile, a highly infectious and hard-to-treat gastrointestinal pathogen.
Floor contamination was common in rooms used for any patients, and those used only to isolate patients with C. difficile infections, but MRSA and VRE organisms were found more often on the floors of the patients with C. difficile infections. Interestingly, C. difficile was found as frequently in the general patient rooms as in those used just to isolate patients with the infection—meaning it was transported there by some means.
Forty-one percent of the rooms had one or more objects in contact with the floor that was also highly likely to be touched by human hands.
Objects that came in frequent contact with the floor, like cell phones, phone chargers, personal items of clothing, canes, medical devices or supplies (pulse oximeters, call buttons, heating pads, urinals, blood pressure cuffs, wash basins, heel protectors, etc.), and bed linen or towels, were touched by the researchers with either bare or gloved hands. Then they tested the gloves and their hands to see what bacteria may have been transferred simply by handling objects that came in contact with the floor.
Of 31 glove cultures, 18% were contaminated with MRSA, 6% with VRE, and 3% with C. difficile. Six percent of hands were contaminated with MRSA, 2% with VRE, and 1% with C. difficile. It's not clear why bare hands carried fewer organisms.
Rooms that were cleaned after a patient's stay had less MRSA and VRE contamination on the floor, but the same amount of C. difficile contamination. Clearly, standard floor cleaning wasn't adequate to remove pathogenic bacteria contaminating the surfaces. And objects in contact with those floors easily passed those pathogens onto hands or gloves that touched them.
"Although healthcare facility floors are often heavily contaminated, limited attention has been paid to disinfection of floors because they are not frequently touched," said Dr. Abhishek Deshpande, researcher in the study, in a press release from Elsevier Health Sciences. "The results of our study suggest that floors in hospital rooms could be an under-appreciated source for dissemination of pathogens and are an important area for additional research."
Every year, 722,000 people in the US get an infection from their hospital visit. There are a lot of reasons behind that statistic—and they aren't all due to cleanliness of the facilities.
Increases in the number of people seeking outpatient treatment means hospital inpatients are the sickest patients. Many of those have weakened immune systems due to their disease or treatment, which makes them more susceptible to infections.
As the AJIC report showed, those sick inpatients bring their infections with them to the hospital and leave it on their surroundings and on those who treat them. Medical equipment and sophisticated procedural equipment that is reused for other patients, and medical staff moving from patient to patient, all contribute to the spread of infection.
Then, there is the problem of antibiotic resistance. In a 2015 study in Mexico, 23% of people with hospital-acquired infections died, and 88% of them were infected with a multi-drug resistant organism. Another study in North Carolina found that two of those multi-drug resistant organisms, MRSA and VRE, frequently contaminated nonslip socks worn by hospitalized patients—meaning they were transported wherever the patients walked.
The use of antibiotics encourages multi-drug resistance in hospital settings for a couple reasons: There are many different organisms present due to the sickness of the patients there, and the fact that many of them are prescribed antibiotics.
Some bacteria die from antibiotic treatment, but those that survive because they are resistant to the treatment rapidly take over as tough-to-kill superbugs. These resistant superbugs are scary sources of hospital-acquired infections.
To help reduce hospital-acquired infections, the Healthcare Infection Control Practices Advisory Committee sets strict and extensive guidelines for cleaning healthcare facilities and infection control.
However, as the new research pointed out, floors in healthcare facilities can be heavily contaminated, and may be kept clean, but they aren't part of programs aimed at effectively accomplishing disinfection. The study authors suggested two ways their results can be used to improve transmission of pathogens on floors.
First, because floors are frequently contaminated, it would be reasonable to educate health care personnel and patients that they should avoid placing high-touch objects on the floor when possible. Second, studies are needed to examine the efficacy of current floor cleaning and disinfecting strategies in removing potential pathogens from floors.
By raising the awareness of this neglected surface, its potential infection source can be nipped in the bud. Any and every opportunity to decrease hospital-acquired infections, especially with multi-drug resistant bacteria, should be aggressively pursued.