Beyond the White Gloves

Maureen Larkin, for HealthLeaders Media , May 8, 2008

Clostridium difficile, or C. diff, isn't a new name to those who work in a hospital. But CMS' recent proposal to include the infection on its list of "never events" and figures released recently by the federal government have brought increased media attention to the hospital-acquired infection. And with a new, more drug-resistant strain making its way through our facilities, maybe it's time that we start paying more attention, too.

The last time a patient was discharged from your hospital, you probably made sure that a cleaning crew quickly readied the room for the next patient. They changed the linens, mopped floors, and wiped down counter surfaces. But do you know what kind of cleaning solution they used? Did they thoroughly wipe the phones, the call buttons, the bed rails, and other commonly-touched items?

If you can't confidently say "yes" to all of these questions, it may be time to start paying attention to how well your hospital is cleaned. Two weeks ago, my colleague Gienna Shaw wrote about how important clean facilities are to the image of a hospital, but cleanliness is more than image. With drug-resistant strains of C. diff and MRSA invading our facilities, cleanliness is a matter of life and death. To combat these infections, we have to make sure that our hospitals are not just spotless, but infection-less. Passing the white glove test is no longer an acceptable standard.

Curtis Donskey, MD, director of infection control at the Louis Stokes Veterans Affairs Medical Center in Cleveland, says that this newer, tougher strain of C. diff is why we're seeing so many more cases of the infection—both inside and outside of the hospital. While regular cleaning solutions used to be effective in wiping away C. diff spores, this new strain is tougher to eradicate and is more likely to be transferred from person to person through spores left on surfaces.

"You can go into a room and it looks clean, but it's not until you look closely that you can appreciate the contamination," Donskey says.

That's why at the VA Medical Center, cleaning crews are now using a solution that is 10% bleach to disinfect rooms between patients—but they're not just wiping down the tray tables, call buttons, and doorknobs. They're spraying the solution directly on the surfaces and allowing it to dry there.

"There is evidence that C. difficile is not killed by regular hospital disinfectants that are used to kill other pathogens," he says. A solution with 10% bleach, however, has shown to be effective in killing C. diff spores. "The major issue is not whether it kills, but how well you apply it. Spray it on and let it air dry. It takes contact time to kill the spores."

At Pacific Hospital in Long Beach, CA, controlling infection is a matter of simple hygiene for both the facility and its patients, says Alfonso Torress-Cook, MD, hospital epidemiologist. Over the last eight years, the rehabilitation hospital has completely reevaluated how its hospital rooms are cleaned and instituted a policy that all incoming patients are bathed with a special solution that eliminates C. diff pathogens from skin, he says. The result has been a 90% reduction of C. diff infections at the hospital.

"We made a commitment two years ago to make everything possible for our patients not to develop infections," says Torress-Cook. "We can prevent a lot, and we're trying our best. Am I going to say that I just want to prevent 30% of infections? No. I want to get to zero. Some say I'm crazy, but at least it's a goal and we are seeing results."

"Superbugs" like MRSA and C. diff aren't going away unless we collectively send them packing. Thanks to CMS and the media, there's now increased pressure for hospitals and healthcare organizations to do everything they can to make sure that facilities are not just clean, but super clean. If you haven't paid much attention to the cleaning of your facility lately, it's time to take interest, before the "superbugs" take control.

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at


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