[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.