Over a century ago, Florence Nightingale saw the link between dirt and health, and prioritised the scrubbing of hospital floors. Indeed, at a time when the significance of micro-organisms was yet to be uncovered, she had already predicted a link between hospital cleaning and patient outcomes.

Today, researchers contend that hospital floors may be an overlooked source of infection and a new study by the Association of Professionals in Infection Control and Epidemiology (APIC) found that hospital floors can pose significant health risks.

Floors are said to provide a huge reservoir of bacteria, and since items in the patient’s room are often in contact with the floor, the pathogens on the floors can spread rapidly from these items to the hands and high-touch surfaces throughout a hospital room.

"Understanding gaps in infection prevention is critically important for institutions seeking to improve the quality of care offered to patients," said Linda Greene, the APIC President.

CDC: “Hospitals can be hot spots for infections”

Hospital-acquired infections (HAIs) are a major threat to patient safety, and the Agency for Health Research and Quality reports more than a million of these infections happen in the U.S. every year which took the lives of tens of thousands of Americans.

According to the Centre for Disease Control and Prevention (CDC), about one in 25 hospital patients have at least one healthcare-associated infection. “Hospitals can be hot spots for infections and can sometimes amplify spread,” says Tom Frieden, director of the CDC.

“Patients with serious infections are near sick and vulnerable patients—all cared for by the same health care workers sometimes using shared equipment.”

Overseeing CDC’s work at preventing HAI, Dr Arjun Srinivasan feels that with the indiscriminate use of antibiotics in hospitals which encourages the growth of “superbugs” that become immune to the drugs and kills off patients’ protective bacteria, it’s the “perfect storm” for infections to develop and spread. “We’ve reached the point where patients are dying of infections in hospitals that we have no antibiotics to treat.”

Research shows floors could disseminate pathogens

In the APIC study, Dr Abhishek Deshpande and his team cultured 318 floor sites from 159 patient rooms in five Cleveland hospitals, including C. difficile infection (CDI) isolation rooms and non-CDI rooms. They also cultured gloved and bare hands as well as other high-touch surfaces such as clothing, call buttons, medical devices, linens, and medical supplies.

In the study, the floors in patient rooms showed evidence of contamination with Methicillin-resistant Staphylococcus aureus (MRSA), VRE, and C. difficile, the most frequently recovered pathogen found in both CDI isolation and non-CDI rooms.

The researchers noted that most efforts aimed at disinfecting the hospital environment usually focus on surfaces that have the most contact with the hands of healthcare workers or patients, and limited attention has been given to disinfecting the floor though they are often heavily contaminated.

“Even though most facilities believe they are taking the proper precautions, this study points out the importance of ensuring cleanliness of the hospital environment and the need for education of both staff and patients on this issue,” said Linda Greene.

Unlike the nurses in Florence Nightingale’s era, nurses today perform specialised cleaning, and the cleanliness of floors is not a priority in some hospitals. Perhaps, Nightingale had it right when she said, “Very few people, be they of what class they may, have any idea of the exquisite cleanliness required in a sick room.” MIMS

Read more:
Cleaning techniques for endoscopes may be insufficient, study finds
How hospital design can make patients sicker
Antibiotics can turn hospital beds into hotbeds for spread of C. difficile infection
Hospital sinks: Could the core of many hospitals’ infectious control policies actually be a problem in itself?