[rsync]

"You can't treat a hospital room with an autoclave"

Hmmm... that sounds like an awfully good idea, actually...

Build the hospital room with the ability to be airtight, make sure all materials can withstand 134 C (or remove things that can't for their own cleaning) ... and autoclave the room ...

[joe_the_user]

There are simpler things.

Like not having mega-hospitals that are impossible to keep entirely clean.

Growing up near the UCLA Medical Center, a vast, vast complex, I heard tales that there were diseases that existed there and nowhere else in the world. Most patients derive little benefit from the scale of the hospital and the fact that in a huge hospital getting all rooms clean at once is logistically very difficult means that scale can be very dangerous.

[Fomite]

I'm...not sure I agree with most of this.

First of all, the size and scope of the hospital has very little to do with whether or not any particular room can be cleaned. The things that are "hard" to clean in rooms are features of the rooms themselves, not the number of them. For example, even small hospitals have TV remotes, soft and absorbent surfaces like mattresses, toilets, etc.

For that matter, small hospitals can't benefit from the economies of scale that allow large hospitals to have dedicated specialist cleaning teams for high risk rooms, or for that matter dedicated infection prevention staff.

[joe_the_user]

First of all, the size and scope of the hospital has very little to do with whether or not any particular room can be cleaned.

Uh, you're right but you're missing the implication. Scale influences whether every room can be clean simultaneously. A given room being dirty and infected with a bug adapted to surviving in a hospital lets said bug be tracked or blown to a different room before the bug is eliminated from the first room.

As for dedicated teams, I don't see why such things couldn't exist on a city-wide basis if they were useful.

The question whether healthcare benefits economies of scale at all is open to question. It clearly doesn't benefit too much given the lack of price differentials. The lousy and getting-lousier quality of American healthcare just generally indicates that hospitals don't put profits from economies of scale or whatever else back to real improvements in safety - though they apparent put a lot of money into meals to entice returning patients (fancy meals - visible, real safety - invisible).

[Fomite]

I'm not missing the implication, because rooms don't have to be clean simultaneously. Bacteria aren't actually all that mobile - most transmission is from touch contact with surfaces (or patients, who are themselves surfaces). Major disinfection takes place when a room is vacated, and it gets done - there's no reason to suggest that a cleaning staff doesn't scale with hospital size.

What's far more important is the quality of the room disinfection, which again, is a property of the room, not the number of them.

As for dedicated teams, I don't see why such things couldn't exist on a city-wide basis if they were useful.

Because now all you've done is taken the same workload, and said "Now you need to deal with 5 different smaller hospitals, five administration schemes (two of which don't like you), travel time, etc. Smaller hospitals do do this, sharing their burden between them, but a dedicated team has been shown to perform better.

And for specialized high risk disinfection teams, you've now suggested both that rooms need to be cleaned simultaneously, and that having a team across town is A-OK. Pick one, you really can't have both.

The lousy and getting-lousier quality of American healthcare just generally indicates that hospitals don't put profits from economies of scale or whatever else back to real improvements in safety - though they apparent put a lot of money into meals to entice returning patients (fancy meals - visible, real safety - invisible).

This really isn't true at all. Because hospitals aren't reimbursed for hospital-acquired infections, it costs them real money, and there is intense interest in improving patient safety. MRSA rates have been dropping, antibiotic stewardship programs are better, hand-washing rates are much improved, etc.

Fancy meals might be visible, but a bad case of C. difficile will cost a hospital many, many thousands of dollars. They're interested in preventing those types of infections.

I know because I work with them doing exactly that.

[malandrew]

I'm honestly surprised we don't take a quarantine approach in hospitals. i.e The first sign of an infection gets you shipped out to a specialized hospital building (air gap) designed specifically to be able to keep patients in "solitary confinement" and able to be completely disinfected afterwards.

[joe_the_user]

Most infectious diseases are not so dangerous that this is necessary. The ones that are, they do something like that as the other poster mentioned.

The fact of the matter though, is that a hospital for those with whatever condition is a somewhat ideal breeding ground for germs, not all of which will be deadly of course. That's not something is likely to be completely eliminated but it's something we can mitigate in a variety of ways.

[Fomite]

...this is what many infectious disease and isolation wards effectively do.

[jlgreco]

Hospital rooms with built-in autoclaves would give horror movies a lot more material to work with...