by Hank Rahe
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“The Man Who Knew Too Much” is the title of a movie that I was reminded of by a recent real life experience. I just knew that my appendix had been removed more than 20 years ago and could not possibly be the source of my health problems. However, a CT scan revealed that I did, in fact, still have an appendix, which by this time was ruptured. I was rushed from the ER to surgery and received a first-hand view of the United States healthcare system in action.
The level of care that I received from the surgeon and nursing services during my inpatient stay was great. The hospital staff attended to my needs and thankfully, I am on the road to recovery. I could tell that I was feeling better when I started to notice the details of facility and medication delivery systems around me. Because of the increased risk of infection, due to the ruptured appendix, I was receiving extensive IV therapy.
As you may be aware from reading some of my previous columns, hospital secondary infections have been the focus of reports by the Center for Disease Control and several articles that I have authored in CleanRooms. Because I was sort of 'the man who knew too much,' my concerns prompted me to ask the hospital staff some strange questions concerning my treatment and surroundings.
The room was designed to create as pleasant an environment as practical but brought home what may be a major fault in facility design. Beyond the bed, the environment simply was not cleanable. For those who are not as acclimated to looking for potential problems, the difficult-to-clean surfaces might seem to be only the pictures hanging on the wall.
As roommates changed during my stay, cleaning procedures were followed and the bed was washed and decontaminated. I thought it would be interesting to take swab samples of the walls and ceiling surfaces to see what strange things are lurking! It is a prime example of aiming at the wrong target, in terms of design. I am sure the architect had as a primary concern to create the most pleasant environment possible for the patient, and possibly had little understanding of the potential hiding places for bacteria and viruses that the un-cleanable surfaces in the room had created. Pleasant environments can be attained with cleanable surfaces.
Delivery of the IVs was done in a professional manner and followed procedures, including wiping the administration site with alcohol before changing out the numerous bags of fluids. I received some strange looks though from the staff when I started talking about contact times for sanitizing solutions, such as alcohol, to actually “kill” microorganisms. I knew better than to ask if the alcohol had been sterile filtered!
In the United States we have access to the best overall healthcare services in the world but we need to work hard to make it better. The work starts with educating the professionals involved in the design of the facilities. Rather than receiving awards for aesthetics, architecture should focus on delivering facilities that incorporate contamination-control essentials into their design. Understanding the basics of creating spaces that can be cleaned and decontaminated and incorporating these concepts should be their primary objective. If this were accomplished then the job of those who operate and maintain the facilities would be made much easier. These steps, combined with the continuing education of those who prepare and administer sterile products, will go a long way to ease the concerns of those of us who know too much.
Hank Rahe is director of technology at Contain-Tech in Indianapolis. He has over 30 years' experience in the healthcare industry, as well as four years in academia. He is an expert in the areas of conventional and advanced aseptic processing. He is the past chairman of the board of the International Society of Pharmaceutical Engineers, and is a member of the CleanRooms Editorial Advisory Board.