Healthcare Hygiene magazine August 2020 | Page 32

A Better Way
to Understand
Your Microbial
Jungle: What’s
In There and
How to Know
When It’s Gone
By Paul Pearce, PhD; and John Scherberger, FAHE
Editor’s note
This article is
the seventh in a
year-long series
describing
an industry
journey led by
environmental
services and
infection
prevention
toward
better patient
outcomes,
quality and cost
savings.
Introduction: The Complexity of the
Healthcare-Associated Microbial Jungle
How often is the comment “I know clean
when I see it” made? How often have the
people who said it given any thought to
how inane and uninformed the comment
is? Indeed, everyone reading this article
has never said it, for the pure ignorance it
conveys, or have they?
Surely healthcare professionals, even
those on the purely business side of
healthcare, know that “clean” is a subjective
state. Not only do healthcare professionals
struggle with defining “clean,” dictionaries
struggle to define “clean.” Dictionary.com
may come closest when it describes it as
“being free from dirt; unsoiled; unstained;
free from foreign or extraneous matter; free
from pollution; unadulterated; pure.”
But science cannot rest on a general definition. Scientists,
particularly microbiologists, know the dangers that disease-causing
bacteria, yeasts, fungi, protozoa, prions, viruses, and other
microorganisms– commonly referred to as pathogens – may be
present. They are on surfaces, in water, and the atmosphere,
even when the eyes see something that appears to be pristine,
pure, untainted, and welcoming.
A recent report issued by the Centers for
Disease Control and Prevention (CDC), Antibiotic
Resistance Threats in the United States, 2019
(2019 AR Threats Report) provides a detailed
2019 AR
Threats Report
and problematical list of dangerous infections
and potential disease-causing pathogens. Why
potential? Because what is a pathogen to one
person may not be a pathogen to another person. The challenges
faced by microbiologists, epidemiologists, infectious disease
doctors, and medical staff are endless.
The causes of healthcare-associated infections (HAIs), while
similar in their association to a disease condition, are frequently
different in their resistance to antimicrobials and disinfectants.
They have varying habitat requirements, environmental requirements
for existence, growth, and reproduction. The means,
skills, capabilities, and competencies needed to detect them in
a healthcare setting accurately are varied and unique.
The 2019 AR Threats Report provides the latest 2019 U.S.
death and infection estimates. The report underscores the
continued threat of antibiotic resistance in the United States
and offers extensive and helpful profiles of each of the six
ESKAPE pathogens. The name comes from the first letter of
each pathogen: Enterococcus faecium, Staphylococcus aureus,
Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas
aeruginosa, and Enterobacter spp.
It is essential to know the report is pre-COVID-19; it presents
a dilemma facing healthcare in 2019 and beyond, even during the
COVID-19 pandemic. Healthcare is not only facing the SARS-CoV-2
virion and the COVID-19 it causes; it must remain engaged in
the battles presented by the 2019 AR Threats. Microbiologists,
Iantibiotic resistance threats present in the future.
According to the 2019 AR Threats Report, “more than 2.8
million antibiotic-resistant infections occur in the U.S. each year,
and more than 35,000 people die as a result.” Also, 223,900
cases of Clostridioides difficile occurred in 2017, and at least
12,800 people died.
Those are staggering numbers, but nowhere near the
COVID-19 death toll in the U.S. As of July 28, 2020, the U.S.
has confirmed more than 4.3 million cases of coronavirus, which
has resulted in at least 148,298 deaths. During the period of July
24-28, 2020, the U.S. was averaging more than 1,000 per day.
But these are not just numbers; they are people. They are
people who loved and were loved; people who had families; and
people who impacted hundreds of thousands of other people
during their lives. Science must never ignore nor grow old of
the personal human aspect of infections. EvSOP© is dedicated
to helping environmental services (EVS) professionals save lives
and maintain everyone’s dignity, because everyone is important.
Deaths are not just numbers; they are people who meant
something, people that mean something. It is for those people
who are saved and return to their families and lead productive
lives that microbiologists work so hard – to save lives. Too often
in their haste to accomplish their tasks, nurses and others ask
for assistance with “the COVID in room 219” or the “Code
Brown (C. difficile) patient in room 505.” Patients must never
be relegated to disease status.
This article proposes to describe the microbial jungle
found in healthcare environments and review the recognized
evidence-based practice guidance for detecting microbial
contaminants that may be present before and after cleaning
and disinfection.
32 august 2020 • www.healthcarehygienemagazine.com