The last time you were in a hospital room, how clean was it? And really, could you tell if it was clean? After all, bacteria aren’t exactly visible. Unfortunately, though, in most hospitals you don’t need a microscope to determine how dirty they are.

I remember an infamous photograph that one of our UT residents took outside of one of our patient’s rooms. He had assured us that he was being compliant and not bearing weight on his post-operative limb. But leading in and out of his room there was a winding trail of blood-stained tracks. Oy vey…..

If memory serves me right, this patient had Hepatitis C as well. A catastrophic situation. Thus this recent research caught my eye:

A 12-week British study in London compared standard cleaning methods done with mops, chlorine, and water, and alternative cleaning methods with ultramicrofiber mops and cloths with water or the third method - with a copper biocide. Sampling for bacteria was done 1 hour before and 1 hour after cleaning at 10 different sites on 4 different hospital wards. After cleaning, each location was cleaned using each of the three methods. The most effective cleaning method was that performed with the ultramicrofiber mops and cloth along with copper biocide. This method was shown to remove 80-85% of the existing bacteria. The effect came from both components but the effect realized from the copper biocide actually continued beyond the initial effect.

Researchers discovered its effects persisted for 23 hours.

A more expensive answer to overcoming bacteria present in hospitals is the automated UV radiation device (the Tru-D^® device, manufactured by Lumalier), a study undertaken at the Cleveland Veterans Affairs (VA) Medical Center in Ohio.  It uses UVC radiation which can even kill C. difficile spores, a notoriously difficult species that usually requires soaking in bleach for 8-10 minutes for disinfection purposes.

Results of the study showed a reduction of MRSA and vancomycin-resistant Enterococcus by 89% and C. difficile spores by 83%.  A key outcome of the study was the fact that difficult-to-clean surfaces (such as the bottoms of tables) were decontaminated as well.

The radiation machine can’t hold a candle to the less effective ultramicrofiber mop, of course, when it comes to price. The machines run from $75,000 to $100,000 each.

Yet another system, a vaporized hydrogen peroxide disinfection unit, is believed to reduce contamination to virtually zero, said one researcher. The downside to it is its running time of four to six hours to clean a room plus the special training required for its operators.

Overall, the UV unit, in spite of the initial cost, is the best agent for disinfecting hospital rooms.

This research was presented at the 49^th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in September 2009.

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Authors and Disclosures

Barbara Boughton

Barbara Boughton is a freelance writer for Medscape.

I cannot give you a reference , but I was told a study showed that doctors' neck ties were as contaminated as a clinic floor.   In the Clinic I wear scrubs with a short  sleeved jacket.   That  is clean    and  comfortable.

I would ask Dr. Lee Rogers for the references. I think he told me the reason he wears a bow-tie is because of the infectious disease study. I also wear scrubs for work at all times, and wear Crocs (plastic clogs) that I hose off frequently since I get blood on them all the time. 

Just my 2 cents... 

I'm familiar with a few of those studies myself, having done a paper on the subject. It has always fascinated me.

In one early study in the British Medical Journal in 1991 in an article Microbial flora on doctors' white coats, that was authored by physicians at the Public Health Laboratory in East Birmingham Hospital, they reported on a study done to determine the type and level of “microbial contamination present on the white coats of doctors in order to assess the risk of transmission of pathogenic micro-organisms by this route in a hospital setting.”

They studied coats of 100 doctors of different grades and specialties.  The results showed that the were the most highly contaminated areas. Staphylococcus aureus was isolated from a quarter of the coats, most often from those of surgeons.  Pathogenic Gram negative bacilli and other pathogens were not isolated in this 1991 study. With the increase in MRSA I would definitely wonder if this study would have a different result today.

In a 2004, a study in New York Hospital Medical Center of Queens, a study was done on the neckties of 42 medical professions at the hospital.  The result showed that 20 of the ties showed pathogens known to cause pneumonia,  blood infections and MRSA. The control group in this study were ties collected from the security personnel from the same office.

Another outcome was that the medical personnel’s ties were shown to have 8X more contamination .

When I was in Family Medicine at UTSW/Parkland  all male  attendings and residents were required to wear a neck tie with the exception of Podiatry.   I refused for the reasons sited above. 

I wonder in a "perfect healthcare world" what measures should be used in cross-contamination. However, my feelings are that the recommendations I would site would not pass financing even with the current combined healthcare bill.. (or should it?) Again, my thoughts are initial "costs" that save higher future expenditures are worthly for at least consideration. It comes down to prevention!

Imagine this!....you get to plan a hospital with unlimited space and an adequate budget (rarely ever happens) !

1. Should each patient be in their own room? I have always thought so for two main reasons. Cross-contamination of bacterial flora between patients themselves and common use of one bathroom. Another reason, less likelihood of medication errors. It is less likely to give the patient in room a wrong medication than a room filled with usually 2-4 patients designated as bed A, B, C or D.

2. A patient's visiting friends and family influence bacterial intake to a room where a patient may be even mildly compromised from a post-surgical healing process and susceptible to infection. They walk into the room and despite many hospital policies that bathroom are for patient use only...they could walk down the hall but instead tend to ignore these signs that place their own loved ones at risk (AMAZING!!!!)

3. Proper cleaning and appropriate use of disinfectants are needless to say a "no brainer."

4. Use of gloves by physicians, nurses and other healthcare providers. Use of hand sanitizers. I cannot site the reference but use of a sanitizer with rings on precludes proper disinfection of skin flora from hands.

5. Ties are problematic if they are not dry cleaned. Here is a more important point to me that I wonder about...infrequent /inappropriate changes of scrubs by health providers? What do I mean by this? Let us say you performed a "dirty case" (ie, resection of osteomyelitic bone, incision/drainage abscess, etc.)...does or should one change their scrubs/lab coat to make rounds on other patients in their rooms prior to discharge. How about frequent changes of shoe covers prior to enter and leaving an OR?

6. How about wash stations for physicians outside all rooms for doctors and health staff instead of patients' restrooms? Some hospitals have these stations, but some older hospitals have not refitted themselves.