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Friday, October 14, 2016

The quest for the silver bullet

Monty Python’s The Quest for the Holy Grail was the first Monty Python movie I watched, but from that point on I was hooked!  If you’ve not had the pleasure of watching, one of my favorite scenes is when King Arthur and his squire, Patsy, who travel throughout England in search of men to join the Knights of the Round Table, encounter the Black Knight.  The Black Knight, however, will not let them pass without a fight. A sword fight ensues with Arthur gaining the upper hand, but the Black Knight continues fighting despite having his arms and legs severed.  The Black Knight assures King Arthur that the injuries are nothing but a scratch and after losing both his legs explains that he’ll bite King Arthur’s legs off.   Somehow, in the end the battle is declared a draw…..  The movie continues with Arthur and his Knights of the Round Table going in search of the Holy Grail.

What does Monty Python have in common with infection prevention?  Well, until I read an article on a new invention that claims to kill MRSA on surfaces in 5 minutes I did not realize how far we have gone in the quest for the elusive silver bullet in our fight against germs.   If we look back in history, routine disinfection of frequently touched environmental surfaces and floors has been a controversial issue due to the fact that the exact extent of the impact of contaminated surfaces on the rate of infections is difficult to establish.  As the prevalence of antimicrobial resistant organisms continues to rise, more attention has been paid to environmental disinfection and its importance in an effective infection prevention program. We would now agree that there is sufficient evidence for the possibility of cross-contamination from surfaces to patients and staff, and vice-versa, to make surface disinfection essential.   However, effective disinfection is dependent on the choice of products, on suitable application methods, on staff training and lastly, on evaluation and monitoring of processes to ensure that disinfection is in fact occurring.  Effective cleaning and disinfection is also dependent on having the appropriate amount of time to ensure that ALL surfaces are addressed.

Back to King Arthur and the Black Knight - in our quest to stop the spread of diseases are we King Arthur who is willing to travel wherever he must to find the grail – even if it means fighting a killer rabbit?  In our quest to kill germs are we willing to try anything and everything in the hopes that something will safeguard us against our apathy of following methods we know work?  Cleaning and disinfection works.  We know this. But because of the human factor, we cannot trust people to do their jobs correctly.  Have we inadvertently made cleaning staff out to be the Black Knight in a futile fight due to the fact that staffing has been cut and we expect more with less?  Cutting staff and not allowing for an appropriate time to clean a room leads to cutting corners.  Have we effectively cut their arms and legs off?

Don’t get me wrong, I am all for innovation.  I am all for looking at ways we can improve patient safety.  I am all for looking at the use of newer products that are safer for the environment and those who have to use them.  What I am against, is the use of Silver Bullets like doorknobs, handrails or what have you made out of salt when we have not addressed the fact that hand hygiene rates continue to be dismal and are linked to transmission of pathogens.  What I am against is the amount of money we are willing to invest in the search of the Silver Bullet when if we added staff to our housekeeping and nursing departments that we would not have people struggling with too many rooms to clean or too many patients to care, encouraging the mindset that we need to cut corners and skip cleaning of all surfaces in a patient’s room or all shared patient equipment in order to get to them all.

Bugging Off!


PS – Salt dissolves in a liquid does it not?  How the heck are these surfaces going to be cleaned?  

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