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THE HOSPITAL OF THE FUTURE
Introduction
The news media has been inundated with information reminding us of the dangers of Anthrax, Staphylococcus, Sepsis, Ricin, SARS, AIDS, Eboli, Small Pox and a whole list of other bio/medical hazards impacting the human population. The current problems are that 1) viruses are difficult to identify, 2) bacteria have developed more resistant strains and 3) fungi are not the primary focus of attention, since they are often confined to areas that are out of sight – such as janitorial closets – and are therefore out of mind.
In contrast, the pharmaceutical industry has made great strides in combating contamination in its research and production areas. How was that accomplished? Do they communicate among themselves?…a lot. Does the FDA challenge them to prove the areas are clean enough for specific tasks?…you bet. Does the FDA also inspect the records to show the areas are consistently clean?…of course. And if the data does not reflect the required protocol limits, what action is taken? The entire operation is shut down until standards come up to par and remedial steps are in place. Thus the Pharmaceuticals tailor areas to meet specific strict CGMP, Current Good Manufacturing Practices, needs and maintain the cleanliness with routine challenges.
In comparison, hospitals tend to be self-regulating, with lots of government controls in discreet areas. The Joint Commission for Accreditation of Healthcare Organizations is one of the monitoring bodies. However, the focus of inspection is different from the FDA because health care is not considered an “exact science” as is the case in the pharmaceutical industry. Hospitals are rated and their deficiencies listed with few hospitals receiving high marks. Conditions that would result in a shutdown at a pharmaceutical site do not render the same consequence in a hospital setting.
The question remains, can hospitals rise to the occasion and compete with the standards in place for industry?…Most definitely. Patients will insist on improved care. Hospital designs and operations must be improved to combat many of these common contaminants? Currently many precautions are in place in hospitals but the approach to a “fully controlled environment” is more difficult to achieve with the present thinking.
Hospitals and their staff need to be equipped with a new front line attack action plan. Some of the issues requiring more intense action are: cross contamination, contact sources (doorknobs), visitor routing, indoor air quality and disinfection of surfaces. The “contamination control gap” between hospitals and industry needs to be narrowed.
Past concerns
Research indicates that hospital officials have been hesitant to discuss many of the consequences of contamination because of the threat of lawsuits. However, some of the
issues raised in various reports express concerns over these very problems. Among the items cited is staph contamination and resulting illnesses being an all too common event.
Other reports cite a breakdown in preventing cross contamination. Incidences of contamination have increased despite efforts to control or eliminate the problems. Nosocomial infection is the single most adverse event outside of the immediate medical issues facing hospitals and is a troublesome complication of in-patient hospital treatment. Hospitals do not have a good track record at policing themselves. And the list goes on and on. Given similar problems in a pharmaceutical setting, the FDA would have issued an absolute edict to shut down and develop a corrective action plan.
While many hospital facilities have made improvements in their approaches to prevention and control, much remains to be done to enhance infection control. Some hospitals have reduced surface contamination with cleanable surfaces. They have installed automated doors and systems with room pressure control. They have improved filtering capabilities as well as air handling systems in the ER and OR suites. To some extent, janitorial cleaning cycles have also been upgraded. All of these improvements are commendable but are too sporadic and inconsistent within the hospital community as a whole, particularly in light of the fact that the CDC weighs in on the side of prevention being a plausible goal.
The vision for the future is to integrate all of the revisions necessary into a central uniform approach for hospital design and operation. Specific areas need to be capable of being germ free so as to reduce the risk to the