Sick It to Me!

Everyone knows that lots of people go into a hospital and pick up germs that eventually kill them or make them very sick. Yet when we have a serious medical problem, or there is an accident necessitating an ambulance, those who know they have healthcare coverage – any many who don’t – find themselves in such a major medical facility. It’s a matter of necessity.

We watch as disinfectant dispensers are everywhere. Surgical instruments are boiled, and operating theaters are scrubbed down. Doctors, nurses and support staff are constantly cleaning, wearing protective masks and clothing. But with all that care, people still pick up the bacteria and viruses lurking almost anywhere you can imagine in a hospital – it is so easy to miss “something.”

But what would be particularly shocking to hospital workers, doctors and patients alike is how these “germs” fester in massive numbers throughout virtually every room or facility in the hospital linked in any way to the plumbing system. From operating theaters to intensive care units to patients’ rooms, the “germs” just sit and wait for a chance to infect and perhaps kill, particularly where antibiotic-resistant bacteria grow stronger and more virulent. Some recent research into this obvious, and almost never addressed, issue might make a difference to you own health and safety the next time the medical care you need is only available at a hospital.

Melissa Healy, writing for the February 9^th Los Angeles Times, fills in the troubling details based on a newly-released study: Even when the sinks, faucets, bedrails and countertops of patients’ rooms are largely free of germs that resist modern medicines, the genetic building blocks for antibiotic resistance intermingle freely in the pipes connected to those rooms, according to a published this week [2^nd week of February] in the journal mBio. That DNA can give superbugs the power to defeat modern medicines and threaten the lives of patients…

The new study involves some of the same NIH [National Institutes of Health] investigators. Over five years, they used ever-improving genome sequencing techniques to hunt down and track antibiotic-resistant germs… In all, they gathered and sequenced the genomes of 700 different samples from the same NIH hospital, looking specifically for carbapenem-resistant Enterobacteriaceae. [Those pretty little purple critters pictured above]

The problem of antibiotic resistance is a growing worldwide threat. The Centers for Disease Control and Prevention estimate that each year, more than 2 million patients in the U.S. are infected with a bacterium that’s become resistant to one or more antibiotic medications, and that at least 23,000 of them die as a result…

Carbapenem-resistant Enterobacteriaceae — including strains of the commonplace gut bacteria Klebsiella and Escherichia coli (E. coli) — most often infect hospital and nursing-home patients who take long courses of antibiotic medicines, and whose care requires devices such as ventilators, urinary catheters or intravenous lines.

And they’re deadly: One report suggests that they contribute to death in as much as 50% of patients who become infected… In addition to swabbing patients and testing the usual suspects — sinks, computers, doorknobs, counters — the team collected samples from pipes beneath the ICU of the NIH’s Clinical Care Center, and from outside manholes draining hospital wastewater.

Then they conducted whole-genome analyses on the samples to study the bacterial plasmids, the readily transferable rings of DNA that can confer antibiotic resistance from one bacterium to another… In samples taken from places patients and their caregivers touched most, the results were largely reassuring — only 3 of 217 (1.4%) tested positive for the antibiotic-resistant organisms that most threaten patients… In addition, out of 340 samples collected from drains, only 11 (3.2%) were positive.

When those samples were compared with others taken from patients, they were not the same. In short, the infection-control efforts of one of the nation’s most elite hospitals seemed to be working pretty well… But the story was quite different for the samples from pipes and sewers — all of the samples drawn from the piping system leading from the ICU tested positive for bacterial plasmids that confer resistance to carbapenems. And so did all seven samples drawn from wastewater samples taken from two external manholes associated with the NIH Clinical Center.

Two wastewater samples collected from a non-ICU floor of the hospital came up negative for carbepanem-resistant bacteria… Scientists long believed that antibiotic resistance develops mainly when a bacterium comes into repeated contact with an antibiotic — say, in a patient’s intestinal tract — and eventually evolves a defense against it. Lax personal hygiene or hospital cleaning practices could then scatter those fortified germs to places where they could infect additional patients and spread their antibiotic-resistant superpowers.

That’s why efforts to curb the growing problem of antibiotic resistance have focused both on reducing the unnecessary use of antibiotic medicines and, in hospitals, deploying armies of workers to locate and shut down germ breeding grounds.

But far from view, in the hospital’s fecund wastewater pipes, a bacterium that can still be vanquished with available antibiotics need only meet up with another that’s antibiotic-resistant. In the resulting exchange, the first bacterium acquires a plasmid from the second that will make it impervious to workhorse medicines.

That lateral gene transfer means bacteria can gain resistance without even being exposed to an antibiotic medicine. And, the study authors said, it’s probably happening just inches from where even the most vigilant hospital infection-control teams are taking samples and directing cleaning crews to scrub: on the other side of sink drains, of housekeeping floor drains and in the pipes leading from toilets.

It’s pretty clear that addressing this rampant problem requires a ground-up set of revised standards, uniformly applied to every licensed medical facility in the United States. This seems an almost unsurmountable problem given a regulation-averse federal government, quite willing to sacrifice clean water and air – particularly exceptionally toxic industrial effluents that used to be banned until the Environmental Protection Agency retracted the regulations that had banned releasing such waste into public waterways and atmosphere. But even under a harsh and purely economic analysis, it would seem more than obvious that the cost of treating patients infected with these antibiotic-resistant bacteria would well exceed the cost of prudent prevention. The time to deal with this is absolutely now.

I’m Peter Dekom, and if this issue matters to you, please let your elected representatives know exactly how you feel.