AIDS Cured?

[K9]

You know what one of the biggest sources of infection in hospitals is?  Cellphones, particularly the ones the floor nurses carry around with them.  You hit on another great point-  until we can get our hospitals cleaner we're really pissing up a rope with nosocomial infections. 

Infection control is a curious business, it ends up being the least obvious stuff that is often the problem. I don't know about the US, but in the UK doctors no longer wear ties or watches (how often do you wash ties compared to how often you touch them). I'm not sure about mobile phones, but I do know there were a slew of papers a few years back where some curious chaps went and swabbed pretty much everything they could reach on a bunch of wards and came back with some pretty scary results.

[ghost]

I've spent a lot of time in hospitals, operating rooms and emergency rooms.  One important thing that I learned from all this is that a hospital is not a healthy place to be.  The infection control is just a part of the equation.

[K9]

Here's the paper for those who are interested. (might be paywall, I'm accessing this from work).

It's an interesting case, but as a single data point it remains pretty anecdotal. given the complexity of the immune system I'll maintain my view that this guy got lucky in more senses than just getting the transplant until we get to see some more results. Sadly there's no fucking way this is going to help anything in sub-saharan Africa where AIDS is the biggest problem.

I've spent a lot of time in hospitals, operating rooms and emergency rooms.  One important thing that I learned from all this is that a hospital is not a healthy place to be.  The infection control is just a part of the equation.

No doubt, but it's reassuring to think that the hospital you're going into probably won't end up giving you a dose of C.diff or MRSA or VRE or something equally lovely 

[Morat20]

I've spent a lot of time in hospitals, operating rooms and emergency rooms.  One important thing that I learned from all this is that a hospital is not a healthy place to be.  The infection control is just a part of the equation.

It's like they took a lot of sick people and shoved them all into the same place...:P

There's an infamous study that got shit-canned by the FDA (for what, IIRC, was understandable rules about patient confidentiality and protection that led to a ridiculous result) where a hospital posted a bunch of reminders and checklists and watched their infection rates plummet.

Then the project got yoinked and the study cancelled because, well, the hospital was using all the patients as guinea pigs for a study without consent. (I *think* that was the issue. The FDA or whomever oversees that sort of thing had rules that basically said "Thou Shalt Not Experiment on Patients without Informed Consent" and, well, the hospital hadn't thought to bother for a study that was aimed at making doctors, nurses, and orderlies wash their damn hands).

[ghost]

It's like they took a lot of sick people and shoved them all into the same place...:P

Who would have thought, right?   

I'm not surprised that the FDA would ding something like that.  Research rules are extremely important but can be confining at times.

[Morat20]

It's like they took a lot of sick people and shoved them all into the same place...:P

Who would have thought, right?   

I'm not surprised that the FDA would ding something like that.  Research rules are extremely important but can be confining at times.

I'm not sure if that was the actual rationale used, but there was a big stink about it because the hospital had seen a giant drop in oppurtunistic infections and spread of those really nasty super-bugs, and had to call it off entirely and go back to the status quo.

People immediately started developing FDA-compliant setups for it, of course.

It's just one of those cases where a really good and important rule runs into a bad outcome.

[ghost]

There had to be something else involved with it.  Even as a pilot study that they had to call off because of ethical concerns they should have had some good data to put into a publication.  I believe that there are other studies out now that point to poor infection control as the root cause of the increase in nasty nosocomial infections, but I can't remember where I've seen them and am too lazy to look them up. 

[Xuri]

IIRC, the general process was this: ...

I've turned your process into an episode of House:

1) A guy with HIV gets leukemia.
2) House sends his team to the patient's workplace/home/gym/secret basement where he tortures kittens - and Taub finds a container with paint-thinner at the location. Ahh, of course. Paint thinner. That explains everything.
3) House tells Chase to inject him with .... growth hormones and asparagus-seeds to <something or other that will make it easier/more fun to treat>. Foreman objects to the injection-strategy for 5 seconds then agrees and joins in on the fun.
4) Patient has a near-death experience, but is saved just in time by 13 and Chase, who happen to be strolling past the room where he lies just as the alarm goes off
5) Cuddy is angry with House
6) The team is stuck, so we diverge to a scene with House and Wilson arm-wrestling over whether or not <random fact> is true or false. House cheats and wins.
7) House pops some Vicodin before heading out of the hospital to go home on his bike. Just before he drives off, a ball bounces off a garbage bin right outside the hospital and into the front of a car, which swerves and hits a bus - 5 passengers are brought into the hospital on stretchers. He drives off anyway.
8) 13 discovers, through luck and social engineering, that one of the new patients is immune to HIV.
9) The team collectively calls House to inform him, but says Cuddy refuses to let them to do a bone-marrow transplant because it's too risky to the new patient, who suffers from a broken appendix or some such.
10) House tells them to steal some bone-marrow from him under the rouse of checking him for scuff-marks/some other made-up excuse. Foreman objects, for about 5 seconds, then agrees and goes to do it along with Taub.
11) They eventually get around to doing the bone-marrow transplant, and then sit back to see what his white blood cells will do
12) Cuddy is angry with House
11) Guy is cured of HIV
12) Guy dies from leukemia not long after, but House is happy because he cured him of HIV. Celebrates by spending money on a hooker to wash his bike.

[Samwise]

Celebrates by spending money on a hooker to wash his bike.

I LOLed.

[Morat20]

There had to be something else involved with it.  Even as a pilot study that they had to call off because of ethical concerns they should have had some good data to put into a publication.  I believe that there are other studies out now that point to poor infection control as the root cause of the increase in nasty nosocomial infections, but I can't remember where I've seen them and am too lazy to look them up. 

I can't remember the specifics of it. Maybe it was because they'd developed an actual protocol? They had a very specific and regimented approach, and it sounded for all the world like a company adopting a new safety program.

You know, where suddenly there's tons of signs, training classes, and new procedures?

It could have been the problem was adopting operating procedures for the hospital that hadn't been cleared, which is an understandable rule.

[angry.bob]

Still, what's ironic/sad is you can STILL massively cut hospital infections by posting stuff like handwashing instructions everywhere -- not for visitors, for staff because they either miss, forget, or just skip sanitizing steps. (Probably because they think "Hell, I've got gloves on" and don't really pay too much attention unless there's going to be blood or sharps around)

After a year of Clinicals at two of the area's largest hospitals I can say it's not handwashing or lack of it that's the big problem, at least anymore. every room has a no-touch purrel dispenser at the door and and gloves. The routine is purrel on the way in, glove up, do whatever, deglove, wash hands, purrel on the way out. Next room starts the process over again. The problem is housekeeping. The housekeeping staff in both places was almost universally shitty and bad at cleaning. using the same rag to wipe stuff for the whole floor, poor wiping, etc. Rooms used for isolation would change almost daily based on admittance and discharges and the housekeeping staff could barely be bothered to come clean the room a second time in one day, let alone properly sterilize the beds, table, and nightstands. So the bed that a stroke victim with c. diff shit all over ever couple hours for a week gets a half hearted couple of swipes with a semi-damp rag after a quick spray of disinfectant, then a new cover. There were a couple times where a new patient had been admitted into a bed that hadn't even had the linen changed yet. Luckily as students we had the time and focus to catch stuff like that, but if we hadn't been there the nursing staff is always stretched way too thin to know.


Also, Hospital floors. Holy fucking god do they everything that you don't want on you covering them. Never, ever set anything you want to ever touch again down on the floor of a hospital. In any part of the hospital. Hands get washed a jillion times a day. The bottom of shoes? Not once.

[NowhereMan]

Yeah staff in hospitals in the UK now regularly disinfect their hands. Medical students in fact get told off for not doing this obviously enough (if the patient doesn't know you've disinfected your hands it's treated as pretty much the same as you not doing it at all). A student nurse I know got a bad comment on her performance thing because she washed her hands with soap rather than using the disinfectant (which apparently dried her skin pretty bad and led to lots of flaking/cracking) since she couldn't do that so obviously in front of patients. Of course like bob said the problem is that this stuff gets shoved in everyone's faces (and it is a good thing they're doing it) but then floors don't get properly cleaned as often as they would need to be, cleaners don't properly disinfect stuff and nurses have so much more shit to deal with now that there's no way they're going to be devoting serious time to making sure the cleaning staff are doing their jobs to the ridiculously high standard they need to.

[MahrinSkel]

Cleaning things to a really aseptic standard is labor-intensive and takes both special training and the time to do it right.  Hospitals don't bother outside the operating rooms, they generally just contract it out to the lowest bidder.  If they paid for both the quantity and quality of work it would take, probably 3/4 of the infections would go away.

When you consider the amount charged these days for just a bed, the fact that they aren't should be a scandal in and of itself.  And it does seem to have gotten worse, I remember going to hospitals in the 80's and there always being the smell of Lysol everywhere.  You don't smell that anymore, and I don't think it's because they use odorless disinfectants.

--Dave

[ghost]

If they paid for both the quantity and quality of work it would take, probably 3/4 of the infections would go away.

This wouldn't fix the real problem which is MRSA, et al.  They would have to eliminate almost all nosocomial infections to be effective.  Even if 1% of the bacteria live, that is an infective source and, if they have been selected out as resistant by killing off all the non-resistant bacteria you are in essence compounding the problem.  At this stage they need to figure out a way to be 100% effective which probably isn't going to happen. 

[Nebu]

We could go back to spraying aerosolized phenol everywhere like they did at the turn of the 20th century! 

Purel is shit for killing most things.  So is soap unless you're VERY thorough (triclosan as an additive is about worthless).  Iodine and bleach are necessary for killing really infectious agents and most custodial workers will bitch profusely about being in prolonged contact with either.   

[ghost]

I suspect they will have to go to something akin to a "disposable" room, or something they could completely immerse in a bleach solution to be completely effective.  Another option would be to have much of the current "in house" treatment done actually in home settings, that way there is less contamination actually passed from one person to the next.  Obviously this would only work with more mild illnesses that didn't need a SICU/MICU situation. 

[Morat20]

I suspect they will have to go to something akin to a "disposable" room, or something they could completely immerse in a bleach solution to be completely effective.  Another option would be to have much of the current "in house" treatment done actually in home settings, that way there is less contamination actually passed from one person to the next.  Obviously this would only work with more mild illnesses that didn't need a SICU/MICU situation. 

Autoclave the room. :)

Seriously, build a giant autoclave. Make all the furniture steel. Remove the linens/covers/mattresses to sterilize elsewhere and just bake the damn room. If you design the room to make everything either stainless steel or designed to be removed and easily sterilized elsewhere, you can probably get it done for only a small fortune. :)

[Lantyssa]

When I was on home care that was one thing the nurse mentioned.  It's not that my home is going to be more sterile than a hospital, because it's certainly not, however all the germs there I am already adapted to.  My chance of an infection actually decreases.

[Threash]

So can i start raw dogging crack whores yet or not?

[Simond]

That depends. Do you have leukaemia?

[ghost]

When I was on home care that was one thing the nurse mentioned.  It's not that my home is going to be more sterile than a hospital, because it's certainly not, however all the germs there I am already adapted to.  My chance of an infection actually decreases.

And your chances of getting an infection with something really nasty decreases a lot.  MRSA/VRE are going to be much less likely in this scenario, even though some people still carry those bugs as asymptomatic carriers.

[K9]

I don't know about enterococci, but carriage rates for Staph are pretty high.

I suspect they will have to go to something akin to a "disposable" room, or something they could completely immerse in a bleach solution to be completely effective.  Another option would be to have much of the current "in house" treatment done actually in home settings, that way there is less contamination actually passed from one person to the next.  Obviously this would only work with more mild illnesses that didn't need a SICU/MICU situation. 

Autoclave the room. :)

Seriously, build a giant autoclave. Make all the furniture steel. Remove the linens/covers/mattresses to sterilize elsewhere and just bake the damn room. If you design the room to make everything either stainless steel or designed to be removed and easily sterilized elsewhere, you can probably get it done for only a small fortune. :)

In all likelihood this wouldn't reduce rates significantly. While it is important for surfaces and furniture to be clean, bacteria don't thrive very well on those. The major issues are things which get touched with high frequency (and hands of course). So phones, taps, lines, handles, monitoring equipment etc are the real problem. The issue is that a lot of these things aren't the easiest objects to clean regularly.

The UK Design Council actually tackled this problem and came up with a bunch of clever solutions.

[ghost]

That's why I'm thinking almost everything is going to have to be disposable. They may have to develop cheap interface units for some of the monitoring equipment or have a more centralized unit with disposable in-room monitoring probes/guages, etc.  Of course this is going to create a lot of waste...

[Mrbloodworth]

So can i start raw dogging crack whores yet or not?

Yes.


Report back.




No.

[Morat20]

That's why I'm thinking almost everything is going to have to be disposable. They may have to develop cheap interface units for some of the monitoring equipment or have a more centralized unit with disposable in-room monitoring probes/guages, etc.  Of course this is going to create a lot of waste...

Massive bug-bombs filled with quickly decaying nerve gas and totally sealed environments......

*grin*. Expose the room to total vaccuum! Run everything through a transporter! Reverse the polarity!

[ghost]

Expose the room to total vaccuum! Run everything through a transporter! Reverse the polarity!

Ludicrous speed........?

[Morat20]

Expose the room to total vaccuum! Run everything through a transporter! Reverse the polarity!

Ludicrous speed........?

Bacteria and viruses die when accelerated into plaid.

[Sheepherder]

Seriously, build a giant autoclave. Make all the furniture steel. Remove the linens/covers/mattresses to sterilize elsewhere and just bake the damn room.

Build the hospital out of brass.

[ezrast]

Autoclave the patients upon entry. If no bacteria can get in, you don't need to sanitize!

[Morat20]

Autoclave the patients upon entry. If no bacteria can get in, you don't need to sanitize!

Better yet kill then and raise them as the undead, who will feast upon the living bacteria and viruses to grow stronger and healthier.

Or we can take a page from introducing 'useful wildlife' into new ecosystems. Let's find a really predatory bacteria or virus that eats others of it's kind and flood hospitals with that! It'll work out great, just like rabbits and goats.

[01101010]

Autoclave the patients upon entry. If no bacteria can get in, you don't need to sanitize!

Better yet kill then and raise them as the undead, who will feast upon the living bacteria and viruses to grow stronger and healthier.

Or we can take a page from introducing 'useful wildlife' into new ecosystems. Let's find a really predatory bacteria or virus that eats others of it's kind and flood hospitals with that! It'll work out great, just like rabbits and goats.

Great... a biological skynet. 

[angry.bob]

Or we can take a page from introducing 'useful wildlife' into new ecosystems. Let's find a really predatory bacteria or virus that eats others of it's kind and flood hospitals with that! It'll work out great, just like rabbits and goats.

Bitches don't know bout my T4.

[MahrinSkel]

Something like this is almost enough to make me believe in Intelligent Design (or alternatively, Alien Panspermia).  That thing just does not *look* "organic" or naturally evolved.

--Dave

[NowhereMan]

That's why I'm thinking almost everything is going to have to be disposable. They may have to develop cheap interface units for some of the monitoring equipment or have a more centralized unit with disposable in-room monitoring probes/guages, etc.  Of course this is going to create a lot of waste...

I don't think it necessitates making everything disposable as having parts that can be detachable and easily cleaned, so having monitors and whatnot that can be detached and replaced easily with the original being sent off for cleaning. I imagine that part of the design brief for a lot of this stuff involves minimising waste and providing it's designed to be easily sterilised that shouldn't be too much of a drawback.

[ghost]

Hospitals are already going to a lot of disposable stuff for several reasons.  First, there is a significant cost involved with cleaning/sterilization because you have to pay for man hours to do this stuff.  Staff overhead is usually very high with medical facilities anyway.  It is often cheaper and easier to just buy throw away supplies.  Second, there is much less chance of having a breakdown in the sterilization/cleaning chain leading to unwanted contamination.  Third, regulations involved with sterilization procedures can be a pain, therefore you can possibly cut a lot of red tape by going disposable.