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What a hospital bed could teach about patient safety

So it stands to reason that thoroughly cleaning and disinfecting beds between each use is critical to preventing the spread of dangerous micro-organisms from patient to patient.

In fact, Healthcare-Associated Infections (HAI) are a dangerous source of complications in hospitals across the United States. These so-called "nosocomial" infections not only expose patients to morbidity and mortality risks, they are also a serious drain on health budgets.

The Centers for Disease Control and Prevention (CDC) and other federal and state regulatory agencies carefully monitor the incidence of HAI. Almost all hospitals have internal task forces to identify sources and vectors of these so-called nosocomical microbes.

But, could it be that the very hospital bed in which millions of patients are placed to recuperate is an overlooked vector for nosocomial infections?

A recent paper in JAMA Internal Medicine showed that patients using a hospital bed previously occupied by other patients who were given antibiotics are more likely to contract Clostridium difficile, which can cause severe and sometimes deadly diarrhea and colitis.

Recently, my wife underwent a major operation at the Hospital of the University of Pennsylvania. Following the operation, she was recovering in a Hill-Rom TotalCare ICU bed – being cared for by a world-class group of physicians and nurses.

The day following the operation, however, she noted something very disturbing:  The side rails of the hospital bed have a total of four alcoves where the joint mechanisms are located.  These alcoves, which are partly obscured by bedding,  were full of dirt and debris. For all we knew, they could contain biohazardous material from prior patients.

We immediately informed the hospital administration and the ICU staff of this problem. They responded with appropriate concern and initiated an internal investigation of this problem.

Fortunately, my wife has not shown any signs of having contracted an infection, and is at home recovering from surgery. But the potential for harm from those filthy alcoves still disturbs us deeply.

So we were shocked, to hear the Executive VP for Public Affairs at the hospital stating to the Inquirer reporter, Tom Avril, that the debris poses "no risk" and is "harmless" to patients.

There is no way to definitively clean, much less disinfect, these alcoves - no matter how dedicated and careful the hospital's cleaning staff.  By virtue of their design, their position and their inaccessibility, these joint alcoves will collect debris which could touch the vulnerable patient.

How this joint alcove design poses "no risk" and is "harmless" defies logic, no matter how hard the corporate side of medicine seeks to downplay it.

The FDA is not really up to snuff when it comes to  safe regulation of medical devices - as multiple examples of disaster over the past 5 years have repeatedly demonstrated.

Hill-Rom's Vice-President for Medical Affairs, Dr. Carlos Urrea, responded to media inquiries almost immediately after I reported the problem to the company. He indicated the company's commitment to "ensuring safe and effective products" and as the head of Medical Affairs for the company, he promised to "be personally involved in understanding this issue and determining the appropriate steps moving forward."

But we've heard no more about effective action.

The hospital and the company should issue an immediate warning to all user facilities via the FDA, and move quickly to correct this design flaw so there's no chance of patients encountering this contamination source.

If eliminating the dangerous risk of hospital-acquired infections is a national priority, hospitals, manufacturers, the FDA and the CDC ought to look at this vector with a very serious eye. It makes no sense to spend billions of dollars a year in private, federal and state resources combating nosocomial infections using antibiotics and novel technologies, and then expose patients to the potential for contamination in the beds where they spend all of their time.

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