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Can Facility Design Reduce Hospital-Acquired Infections?

Research project maps where hospital germs linger

In a new approach to reducing hospital-acquired infections, a team of scientists has been testing thousands of microbe samples from a Chicago hospital to learn how a medical building might make patients sicker, according to a report in the Wall Street Journal.

Data from the 3-year Hospital Microbiome Project are still being analyzed, the article says. So far the team has found that factors including ventilation and humidity, and design features such as furnishings and fixtures, affect the kinds of bacteria people encounter inside a hospital in ways that affect their health. The scientists aim one day to slow the rise of antibiotic-resistant bacteria in hospital settings by manipulating conditions from room to room to keep pathogens in check.

They also hope eventually to make the hospital building itself a curative probiotic —perhaps by infusing walls or furnishings with bacteria that enhance patient health and recovery.

“I see a future far off where we use bacteria to protect us from the bacteria that harm us,” said infection-control epidemiologist Dr. Emily Landon at the University of Chicago’s new Center for Care and Discovery, the facility under study. “We could make the hospital itself into a treatment for the patient.”

The $856,000 hospital research project, funded by the Alfred P. Sloan Foundation in New York, stems from a growing awareness that we each harbor a unique collection of about a hundred trillion microbes in and around our bodies. This community of bacteria is known as the microbiome.

Every building appears to have its own unique microbiome, depending on how it is built and operated, who uses it, and what they do there, said University of Oregon microbiologist Dr. Jessica Green, who helped pioneer the field. “We know microbes in buildings are relevant to human health,” she said.

In hospitals, for example, the air that many patients breathe, recycled through heating and air-conditioning systems, concentrates human-related bacteria and potential pathogens, compared with patient rooms with open windows where outdoor air can circulate, according to Dr. Green’s 2012 study of Providence Milwaukie Hospital in Portland.

Other recent studies discovered that moisture-loving bacteria living in showerheads include distinct populations of potential pathogens different from microbes on shower curtains a few feet away. Drug-resistant staph germs can live for up to a week on some common furniture fabrics. Strep germs can survive for months on a dry surface.

The two dozen microbiologists and infection-control experts working on the Chicago project started collecting DNA data while the building was under construction, cataloging bacteria likely brought there by dirt, wind, water, construction materials, or workers. When the hospital officially opened in February 2013, the researchers documented a change in the building’s microscopic life.

“Overnight, the building became alive with all these human bacteria,” said environmental microbiologist Dr. Jack Gilbert at the U.S. Department of Energy’s Argonne National Laboratory in Lemont, Illinois, who is directing the project. “The microbiome suddenly increased in diversity. It increased in complexity. There was greater variation between the spaces in the building.”

The following year, researchers focused on a suite of five patient rooms on the hospital’s ninth floor and five rooms on the 10th floor. They installed sensors to collect information about a dozen different environmental measures that affect how bacteria grow. Every day, they collected DNA samples from beds, bed rails, water, air, room phones, and other surfaces, as well as from patients, nurses, and other staff.

Typically, people came in and out of each room 100 times a day, trailing invisible plumes of bacteria, the researchers found. Some room surfaces had thousands of types of bacteria; others had only a few hundred.

Within hours of the arrival of a new patient, however, his or her personal collection of microbes spread throughout the room, mingling with microbes already present and making the microbiome of each room unique, Gilbert said.

Researchers hope the project will inspire a new generation of infection-control practices. Green believes the technology will begin showing up in hospitals within 5 years.

Sources: Wall Street Journal; April 27, 2015; and Hospital Microbiome Project; 2015.

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