Hospitals Bring Janitors to the Front Lines of Infection Control

Hospitals have reached this realization while trying to cope with an alarming trend. Over the past decade the organisms that cause most infections in hospitalized patients have become more difficult to treat. One reason is increasing drug resistance; some infections now respond to only one or two drugs in the vast armamentarium of antibiotics. But the problem also arises because the cast of organisms has changed.

Just a few years ago the poster bug for nasty bacteria that attack patients in hospitals was MRSA, or methicillin-resistant Staphylococcus aureus. Because MRSA clings to the skin, the chief strategy for limiting its spread was thorough hand washing. Now, however, the most dangerous bacteria are the ones that survive on inorganic surfaces such as keyboards, bed rails and privacy curtains. To get rid of these germs, hospitals must rely on the staff members who know every nook and cranny in each room, as well as which cleaning products contain which chemical compounds.

The infectious organisms that require all this extra effort became a serious problem around 10 years ago. The first outbreaks were caused by vancomycin-resistant Enterococcus, or VRE, and Clostridium difficile, known as C. diff, followed by a group of bacteria collectively referred to as highly resistant gram-negative organisms: Escherichia coli, Klebsiella, Pseudomonas and Acinetobacter.

Recently hospital cleanliness has become a matter of reputation, especially since the federal government's Hospital Compare Web site started posting institutions' rates of health care–associated infections. Cleanliness is also becoming a bottom-line issue: in 2008 the federal Centers for Medicare and Medicaid Services ceased reimbursing hospitals for the treatment of any infections that those hospitals caused—a controversial carrot-and-stick venture that, according to new research, has successfully begun to lower infection rates.

Institutions also employ infection-control specialists, who track infections and investigate their causes. Yet when the problem is bacteria on surfaces, eliminating them depends on the building-services crews. “This is the level in the hospital hierarchy where you have the least investment, the least status and the least respect,” says Jan Patterson, president of the Society for Healthcare Epidemiology of America. Traditionally, medical centers regard janitors as disposable workers—hard to train because their first language may not be English and not worth training because they may not stay long in their jobs.

At N.Y.U. Langone in 2010, Phillips and his co-workers launched a pilot project that redefined those formerly disposable workers as critical partners in patient protection. Janitors, they realized, know better than anyone else which rails are touched most frequently and which handles are hardest to clean. The Langone “clean team” paired janitors with infection-control specialists and nurses in five acute care units to ensure that all high-touch surfaces were thoroughly sanitized. In its first six months the project scored so high on key measures—reducing the occurrence of C. diff infections and the consumption of last-resort antibiotics—that the hospital's administration agreed to make the experiment routine procedure throughout the facility. It now employs enough clean teams to assign them to every acute care bed in the hospital.

Read the article Clean Sweep: Hospitals Bring Janitors to the Front Lines of Infection Control in it's entirety from Scientific American.