Hospital Floors Linked to Pathogen Transmission

Years ago, when faced with an MDR-Acinetobacter baumannii outbreak, I recommended that our hospital implement shoe covers in the outbreak unit (along with other measures) since the floors were covered with Acinetobacter. Since then, I've been almost surprised by the continued lack of attention that floors (and even contaminated shoes) have received from my infection prevention colleagues. Fortunately, it seems, some folks are finally noticing and estimating the role that contaminated floors play in pathogen transmission in hospital settings. And by "some folks", I mean Curtis Donskey's group at the Cleveland VA.

In a study, just published in ICHE, Sreelatha Koganti and colleagues used non-pathogenic bacteriophage MS2 to measure the speed of spread from isolation room floors to patients' hands and high-touch surfaces inside (and outside!) their rooms.

First, I would like to quote from their background:

"Notably, hospital floors are often heavily contaminated but are not considered an important source for pathogen dissemination because they are rarely touched. However, floors are frequently contacted by objects that are subsequently touched by hands (eg, shoes, socks, slippers). In addition, it is not uncommon for high-touch objects such as call buttons and blood pressure cuffs to be in contact with the floor (authors’ unpublished observations). Therefore, we hypothesized that floors might be an underappreciated reservoir for pathogen transmission."

And now their results:

"MS2 was detected on multiple surfaces of all patient rooms by 1 day after inoculation... Contamination was common on high-touch surfaces in adjacent rooms, in the nursing station, and on portable equipment. Portable equipment included wheelchairs, medication carts, vital signs equipment, and pulse oximeters."

What was most surprising was that MS2 was detected on 40% of patients's hands on Day 1, 63% on Day 2 and 43% on Day 3 after the floors were inoculated. Wow.

Now, after years watching our non-responses to epidemiological data such as these, I can already foresee the responses. Most will continue to do nothing waiting for some mythical/magical cluster-randomized trial, which can't be done for economic reasons (try powering such a study). Others will ignore these results completely. And a few brave souls will soldier on with more excellent epidemiological investigations, like this study from Cleveland, hoping that people will eventually notice. Oh, and some will install copper floors.

Maybe we could start with cleaning patient-room floors daily?

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  1. From a patient standpoint it has always been a concern of mine. To my horror I have noted a majority of patients in waiting rooms and hospitals who wear flip flops and sandals.(Houston is a special type of cesspool of bacteria in too many of our hospitals) I frequently see parents allowing their children to sit on the floors and "touch everything!" Of note as well are women who set their purses on the ground. Probably my greatest horror was watching a family with their toddler in a hospital who's toddler kept tossing his pacifier on the ground and the parents casually picking it up and putting it back in his mouth. For some reason in the past 25 years patients have become convinced that Medical offices and hospitals are sterile, clean, germ free. To patients out there, wear closed toed shoes. Remember that your parents when they took you shopping or the hospital taught you " don't touch!" they did that not just to keep you from breaking things but to reduce transmission of disease. Wash your hands! I am horrified by the dismal rate of hand washing in Medical professionals, but even more horrifying is the lack of hand washing by the consumer/patient. Don't set your purse or diaper bag on the ground, and if you do? Disinfect it. Change your clothes when you get home. It would surely help if hospitals would at least mop daily, and hopefully learn to properly clean their cleaning tools as well. A couple years ago I saw a janitor in the hospital mopping with clearly brown filthy water... room to room with the same filthy water all morning long. You could smell it was sour. That likely did more damage then good. If we cannot trust the hospitals to at least do the basics, as patients we need to step it up. Obviously we are limited, but jeez people, at least skip the flip flops and pacifiers dropped on the floors!

  2. Yes it would be good if floors were cleaned daily, but after my husband had a recent stint in a hospital with a very good infection prevention infrastructure I can state that in my humble single shot case study observations the floors in ICU were not cleaned once in 3 days. It would also be very good if they cleaned daily with products that have been shown to be effective against a wide range of pathogens, using compatible products (quats and cotton or microfiber anyone? Stick all those rags or mops in the bucket and let them soak for a good long time!!!). Might as well be using microfiber and water. And carpet!!! Don't get me started. I'm so glad this study was published!!

  3. I've also been concerned about newer hospitals moving towards carpeted hallways in an attempt to make the hospital look more like a hotel. I was told by head ID that there was no good data opposing carpets. Surprising...


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