The New Year started out on a very bad — if not deadly — note for one Chicago-area hospital.
On January 6, 2014, the U.S. Centers for Disease Control and Prevention (CDC) discovered 44 cases of a strain of bacteria called carbapenem-resistant enterobacteriaceae, or CRE, in northeast Illinois.
Thirty-eight confirmed cases involved patients treated at a Park Ridge, Illinois, hospital who had undergone an endoscopic procedure of the pancreas or bile ducts in 2013.
This bacterium was first reported in 2009; since then, there have only been 96 outbreaks reported in the entire country, making this high number of new cases quite significant.
“It’s the largest outbreak that we’ve seen in the U.S. of this bacteria ever,” said Alex Kallen, a doctor of infectious diseases who served as the supervisor of the CDC investigation.
The infection that results from this bacterium is highly resistant to most antibiotics, and patients who contract the infection have, at most, a 50 percent chance of survival.
To be clear, this bacterium is not transferred by touching a contaminated surface or other common sources of cross-contamination.
Rather, it is contracted by coming into contact with a medical instrument or scope used to view the stomach and intestines for medical issues such as pancreatic cancer and gallstones.
But what is of concern to the CDC, as well as medical facilities and cleaning professionals everywhere, is that the hospital was using accepted and recommended methods to clean the scopes that are seemingly responsible for the outbreak.
Could this bacterium have become resistant to traditional methods of cleaning and disinfecting?
Unsure of what is causing this serious issue, the hospital has “moved to gas sterilization for these particular scopes, which exceeds the manufacturer’s recommended cleaning and disinfectant guidelines,” said Kallen.
Gas sterilization is the cleaning method used in operating rooms.
Losing The Battle Against Bacterium
While we are not sure if the bacterium causing this outbreak has become resistant to the usual disinfectants and procedures used to clean and disinfect the scopes in question, what we do know is that many types of bacteria are in fact becoming resistant.
This means that many hospital administrators and cleaning professionals now believe they need to use ever-more-powerful disinfectants in greater quantity to kill germs and bacteria, especially in settings such as medical facilities, nursing homes, and special care facilities.
A study published in the January 2009 issue of the journal Microbiology described this phenomenon in more detail.
The study was based on a test performed by researchers at the National University of Ireland, who slowly introduced higher levels of disinfectants to kill lab cultures of the bacteria Pseudomonas aerunginosa.
This particular pathogen is rarely harmful to healthy people but can cause very serious illness and even death among people with compromised immune systems.
After gradually increasing the pathogen’s exposure to the disinfectant benzalkonium chloride, which is used in a variety of products, including hand sanitizers, some floor cleaners and spray disinfectants, researchers found that they had what is termed a “Frankensteinian pathogen” on their hands that showed a 12-fold resistance to the disinfectant.
To make matters worse, as the bacteria becomes resistant to disinfectants, it can also become resistant to the antibiotics typically used to treat people infected by the pathogen.
This means that such diseases can eventually become immune to treatment — a very worrisome trend that has already been observed in medical facilities around the world.
According to Dr. Gerard Fleming, one of the key researchers behind the Irish study mentioned earlier, when this happens, “We’ve lost the first line of defense [disinfectants], as well as the second line of defense [antibiotics].”
What Cleaning Professionals Should Know
Northwestern Hospital is the largest medical care provider in Chicago, with medical facilities throughout the city.
In virtually all of its locations, patients will notice this sign in waiting rooms: “You should thank your doctor for not prescribing antibiotics.”
Only 20 years ago, doctors prescribed antibiotics for just about everything from serious infections to minor colds.
Now doctors only prescribe antibiotics when all other treatments fail.
The reasoning behind this: Antibiotics have been misused and overused for decades, with the result being that treating infections requires considerably more antibiotics.
In fact, in some cases the organisms that cause infection have become immune to antibiotics altogether.
The same appears to be happening with disinfectants.
“The message, for heaven’s sake, is to use disinfectants properly,” says Fleming. “There is a tendency toward using disinfectants as a ‘clean-all,’ when there are other proven remedies available.”
Fleming suggests that instead of using disinfectants and sanitizers, we should put more emphasis on “soap and water. I am not messing with you. Why don’t surgeons . . . just use a hand sanitizer [to clean their hands before surgery]? Why do they go to the sink and scrub? Because [when they scrub] they are physically removing the bacteria.”*
This analogy can also apply to cleaning surfaces.
Instead of using stronger and stronger disinfectants, a better way to clean many surfaces may simply be more effective cleaning with conventional cleaning chemicals and water.
However, while conventional cleaning products may work well, what may not be as effective is the traditional way in which surfaces are cleaned.
According to a white paper published in 2009 by Kaivac (manufacturers of the No-Touch Cleaning® systems), what is necessary is a “new model” for cleaning.
According to the paper, “This means moving away from the old models of cleaning [sprayer and cleaning cloths; mops and buckets] to adopting new science-based cleaning procedures.”
The paper came to this conclusion based on studies conducted by an independent NELAP-certified** laboratory.
According to the study, using what ISSA calls “spray-and-vac” or no-touch cleaning systems and flat-surface cleaning systems removes more than 99.9 percent of the targeted bacteria.
Making this all the more impressive, this was accomplished using plain tap water.
Should We Thank Our Janitors For Not Using Disinfectants?
While the jury is still out regarding the causes of the disease outbreak at the Chicago-area hospital mentioned earlier, the overuse of disinfectants is already creating a serious problem for the health care industry.
Just as many doctors and healthcare organizations are rethinking their use of antibiotics, the time may have come for the professional cleaning industry to rethink its use of disinfectants.
According to Stephen Ashkin, a leading green cleaning advocate, the use, overuse and misuse of some disinfectants is a very serious issue in our industry.
Not only does it have negative environmental implications, it may also be contributing to the problem of disinfectant-resistant pathogens — something that we must rectify.
* In many medical settings, cleaning professionals are currently legally required to use certain types of cleaners and disinfectants. In these cases, the “soap and water” suggestion made in this article would not be feasible.
** National Environmental Laboratory Accreditation Program (NELAP)
Robert Kravitz is a frequent writer for the professional cleaning and building industries.