“I’d be the worst patient,” laughs researcher Dr. Michelle Alfa. “I’d be grilling them about how they cleaned their instruments.”
Dr. Alfa’s concern is legitimate as hospitals around the world struggle with how to fight medical-device-related infection.
Broadly speaking, there are two types of infection that affect patients while in hospital, explains Dr. Alfa, Principal Investigator, Infectious Diseases, Canadian Centre for Agri-food Research in Health and Medicine (CCARM).
“Endogenous” infections are caused by bacteria in the patient’s own body – a post-surgery wound infection due to bacteria found on the skin, for example.
Dr. Alfa focuses on the prevention of “exogenous” infections that start outside the patient’s body. These are infections from bacteria in the patient’s environment or from contaminated medical devices.
“Infections due to Clostridium difficile could be the result of something as simple as touching an unclean surface in the bathroom,” says Dr. Alfa. “For older patients, C.difficile infections make hospital stays longer and could even be fatal.”
There is renewed global interest in hospital acquired infections, due in part to an outbreak of NDM E.coli in the United States earlier in 2014. This particular bacterium is resistant to most antibiotics and like other bacteria, can be spread by flexible endoscopes that have not been properly cleaned.
“Scopes require proper cleaning and high-level disinfection between uses,” says Dr. Alfa. “Cleaning them is a complex, manual process that involves many steps. Sometimes the cleaning isn’t perfect. It’s a challenge faced by hospitals everywhere.”
Dr. Alfa and her team are looking at the issue to learn whether parts of the cleaning process can be automated. This includes conducting clinical studies for private companies, including major players like Johnson & Johnson, while still looking for ways to improve the manual processes.
“We are not only working toward learning more about keeping the hospital environment and medical equipment clean,” she says, “we are trying to integrate our research findings and determine best practices, and implement these practices in a realistic manner.”
On a local level, Dr. Alfa is observing and influencing practice at St-Boniface Hospital, and she likes what she sees.
“Housekeeping personnel and the people who clean medical equipment are on the front lines in the battle against infection,” says Dr. Alfa. “We do a very good job here, but every hospital needs to be constantly diligent and strive to improve.”