When you go to the hospital, whether it’s caring for a loved one or as an actual patient, you inevitably increase your risk of contracting certain infections. Any type of exposure to harmful bacteria can lead to illnesses as minor as the common cold to as serious as sepsis.
Many hospitals are looking to better the overall patient experience by keeping hospital rooms, ORs and waiting areas as bacteria free as possible. This starts by cleaning the air in which employees and inhabitants breathe.
Dr. Dennis Deruelle is a physician and National Medical Director of Acute Services for IPC Healthcare/TeamHealth, one of the largest suppliers of healthcare professional staff and integrated care providers in the country. Dr. Deruelle helps hospitals and hospital systems across the country improve their quality, safety, and efficiency. He is a national speaker and consultant with expertise in how the Affordable Care Act affects the new value-based world of healthcare.
Dr. Deruelle completed a fellowship in Hospitalist Medicine Leadership at the University of California at San Francisco. Dr. Deruelle was Chief Resident and did his internal medicine training at the University of North Carolina at Chapel Hill after earning his M.D. from Albany Medical College. He recently published a book, ‘Your Healthcare Playbook: Winning the Game of Modern Medicine.’
We sat down with Dr. Deruelle to discuss more about hospital acquired infections, air filtration, and infections.
- How has awareness of hospital infections — and the need for improvement in this area — changed over the past 5 – 10 years?
DD: It’s changed dramatically. I think that there are many reasons, the biggest being that there is just a lot more awareness about this particular issue. It’s an interesting dichotomy: As much as awareness has increased, budgets in this area have decreased. I see so many hospitals dealing with budget reductions that leads to important staff getting cut. So, the awareness has increased, but due to the pressure on hospitals budgets, I see less infectious control staff.
The reason why an increase in overall awareness exists is due mainly to the news headlines that the subject garners, including news on super bugs, super infections and deaths in ICU’s from bugs that we cannot kill with any antibiotic. Ebola also had a little to do with it as a flashpoint in terms of understanding infectious control procedures in hospitals where we saw an obvious breakdown. I think that the pressure from the federal government and the Affordable Care Act, along with pay-for-performance has heightened the awareness from hospitals.
Finally, the staggering number of deaths that occur in hospitals every year plays a huge role in raised awareness. There have been many studies that have pointed this out, from the first one, To Err is Human in 1999, to a recent study that said deaths in hospitals from medical errors are the third leading cause of death in the U.S.
Buried in those numbers are the amount of people that die in hospitals from infections they’ve gotten in hospitals, which is about 100,000 per year. These numbers are leaking out on a macro level, which leads to reporting in the newspapers that an emergency room or operating room has been shut down due to MRSA. The combination of all of these factors has really raised awareness.
- How big a role does air quality play in improving the patient experience, reducing infections and ultimately lessening readmissions?
DD: The patient experience is huge nowadays. Patient-centric care is the future of healthcare. Through the Affordable Care Act, the federal government placed hospitals in a position of losing money or winning money based on performance against other hospitals… or themselves. Readmissions is one performance area that’s reviewed. Another is hospital-acquired conditions, and the third is patient experience using the HCAHPS survey. The HCAHPS includes a question about the cleanliness of the hospital, and I do think air quality can play into that component. If you’re in the top 25 percent of the country in the spreading of infections, then you’re losing 1 percent of Medicare, and next year C.diff and MRSA are going to be added to those infections that are dinging hospitals. This is certainly one area where having organisms in the air is playing directly into an area that’s important to hospitals and patients.
Readmissions now come with a 3 percent Medicare penalty on certain diagnoses: Acute myocardial infarction, pneumonia, congestive heart failure, hips and knee joints (infections/complications) and COPD. So it’s not that we have specific readmission penalties for infections, but some patients that go in and have those diagnoses will leave the hospital and get readmitted with an infection gotten when they were in the hospital.
Hospital stay length is also affected by patients that have existing respiratory diseases, and are affected by particulate matter in the air, dust or mold.
For all of these reasons, air quality (the odor, particulate matter, bacteria or viruses that are floating in the air) can have a huge impact on patients and hospitals.
- What role can AtmosAir play in dealing with these important issues?
DD: AtmosAir can certainly improve the patient experience, and if [patients] knew that the air they were breathing was being filtered, ionized and deodorized, it would be information they’d certainly enjoy being made aware of. Having the sensation that the air is cleaner, and that it’s being cleaned by AtmosAir, would be a very good thing for a hospital. It’s been shown in the lab that AtmosAir’s technology kills certain viruses and bacteria, and because of that, it’s believed that it will reduce bacteria on surfaces and in the air. If that takes place, I believe that it will provide a decrease in overall infections. It’s also true that certain patients with respiratory disorders will do better in rooms that use AtmosAir products.
- What kind of advantages can hospitals/medical centers take advantage of by promoting the use of clean-air systems in their institutions?
DD: The overarching point is that these products are energy efficient, so it’s important to anyone interested in having a green building. Secondly, indoor air quality is important for the people who work long hours in these buildings. You don’t want to have any version of a sick building. We want to make sure that the ventilation is good and efficient. Just having AtmosAir alone — forgetting the healthcare aspect of it being in the building — should be seen as a positive.
In general, when discussing patient health, reducing the chance of getting an infection — and 100,000 people die from these infections annually — or of patients having a prolonged hospital stay, or of them getting an infection in a joint that might need to be replaced —which is a major operation — would be positive results of using AtmosAir. These are just a few reasons why it would bode well for a hospital to let people know that they’re using these modalities to help reduce infections. You’re not going to get infections down to zero without using many, many modalities, and I think that’s where AtmosAir fits in. They attack the problem from a unique spot [airborne and surface organisms], which is a different angle than the hospital staff attacks from.
- What has been the primary cause of infections like MRSA and Staph becoming so rampant?
DD: When people come in the hospital, we don’t have as many people checking them to see if they have some of these infections. We’re not screening as well and not picking up infections soon enough. Because of those things, they’re having a bigger impact on the actual hospitals. That’s where I think the budget decreases are really hurting us. In terms of the numbers of infections, what happens inside the hospitals doesn’t affect what happens outside of the hospitals. Most of the infections with MRSA occur outside the hospitals within the community, and that’s a byproduct of the organism. We have a lot more of it. It’s resistant to the penicillins, which is why it’s called MRSA [Methicillin-Resistant Staphylococcus Aurea]. The more you have of it, the more it’s going to spread. I also think the inappropriate overuse of antibiotics is creating organisms that are resistant, and that is driving more cases.