The Fight Against the Unseen: Small Organisms Can Mean Big Trouble

Ever wonder if your hotel bed sheets are really clean? Have you heard that your desk at work is filled with bacteria and is the dirtiest place to eat your lunch? Are you fearful to use the bathroom on airplanes due to the confined space of germs and the re-circulated air? Do you wash your hands frequently to prevent colds and flu? Or are you one of those people who flushes the toilet in public restrooms with your foot so you don't have to touch the handle?

Worrying about what you can't see makes sense when you consider that bacteria are everywhere. But the good news is that most bacteria are harmless and some even help us. Organisms made up of just one cell, bacteria are capable of dividing and multiplying by themselves and they even exist inside and on our bodies. Bacteria become harmful when they end up in the wrong place in the body.

Most people who worry about bacteria take preventative steps to avoid these invisible germs whenever possible. But it is most important for people who are sick or susceptible to infection because of a compromised immune system. That is why the Centers for Disease Control (CDC) recommends that seniors and people with compromised immune systems receive flu shots.

Deaths due to MRSA and VRE have been increasing year after year for decades. Antibiotic-resistant infections like MRSA and VRE are important not just because they are spreading out of control from patient to patient in U.S. hospitals, but also because they are more deadly and more costly than infections due to antibiotic susceptible strains of the same species.

For anyone who just wants to avoid germs or possible infection, something your mother probably told you is still the most effective solution: wash your hands frequently. While there has been some controversy regarding the effectiveness of anti-bacterial hand soaps by some who argue that it's no more effective than regular soap, the importance of washing hands often, shouldn't get lost in the debate. The CDC recommends using soap with an alcohol base for the most effective protection. Currently the CDC is studying if anti-bacterial soaps are more effective than regular soap, while the FDA is looking into whether the synthetic chemicals in some soaps (not alcohol-based soaps) pose a hazard in the environment after they wash down the drain.

Many manufacturers offer hand washing cleansers, skin rubs and anti-bacterial lotions that you can offer to your clients. To truly understand the significance of hand washing, consider the bacterial problems that play out in hospitals across the country.

One out of every 20 patients gets an infection in the hospital and almost all of these cases are preventable. A CDC report indicates that hospital infections add $30 billion each year to the nation's hospital costs. According to Betsy McCaughey, health policy expert and chairman of the Committee to Reduce Infection Deaths, many of these deaths occur due to poor hygiene: unclean hands, lax procedures, contaminated equipment and doctors failing to clean their hands before treating a patient about half of the time.

According to Dr. Brian Farr, professor of internal medicine at the University of Virginia, the CDC has made some progress in reducing certain types of infections, but has a way to go to address antibiotic-resistant infections like methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE). MRSA, a type of bacterium commonly found on the skin and the noses of healthy people, is harmless unless it gets into the body through breaks in the skin, wounds and indwelling catheters. The result can be serious, such as infections of the blood stream, bones or joints, or mild, including pimples or boils.

"Deaths due to MRSA and VRE have been increasing year after year for decades. Antibiotic- resistant infections like MRSA and VRE are important not just because they are spreading out of control from patient to patient in U.S. hospitals, but also because they are more deadly and more costly than infections due to antibiotic susceptible strains of the same species."

The Society for Healthcare Epidemiology of America published a guideline in 2003 recommending that all hospitals look for MRSA and VRE colonized patients using surveillance cultures among patients with risk factors for colonization and care for these patients using contact precautions such as private rooms and health care workers wearing gowns and gloves. "This approach has been used to control MRSA to very low levels in multiple nations in Northern Europe and in Western Australia for decades," Farr says.

Almost all infections are preventable through relatively simple procedures: washing hands with an alcohol-based product and keeping equipment clean. The practice of keeping hands clean can be the single most important factor in preventing nosocomial (those that originate or occur in a hospital or hospital-like setting) infections, according to the CDC. Poor hygiene and contaminated equipment often spread infections throughout hospitals. For example, when physicians fail to wash their hands or a blood pressure monitor is used repeatedly from one patient to the next without being adequately cleaned, infection can spread.

In the Home

People at home "can also be at increased risk of MRSA infection if visited by home health workers; they have been shown to carry the microbes to such patients presumably on contaminated hands, clothes or equipment carried into the home. This is a risk in the United States because MRSA and VRE have been allowed to spread out of control throughout the health care system," Farr says. "By contrast, this would not be a risk in Denmark, the Netherlands or Finland where the health care systems have very low rates of antibiotic-resistant infections and ongoing control programs."

In addition to keeping hands clean, it is important to keep surfaces and products clean, especially in rooms in the house that are prone to the growth of bacteria like the kitchen and bathroom. Hard surface disinfectants can help.

Moisture often fosters the growth of bacteria, so the kitchen and the bathroom are favorite spots for bacteria to reside. The kitchen, often the most frequented room in homes, can be the gathering place for bacteria. Bacteria often multiply on surfaces such as countertops, sinks and sponges, but the bathroom environment is the microbes' ultimate paradise because of the constant moisture, which produces bacteria, mold and mildew growth.

Bacteria and mold can use products such as pillows, sheets, comforters, carpeting and clothing as a food source; products in the home that are infrequently cleaned are most vulnerable to attack.

Invacare, Elyria, Ohio, uses Microban® antimicrobial product protection "engineered to protect products from bacteria, mold and in some cases algae that can cause stains, odor and product deterioration. Microban protection is not designed to protect people from disease-causing micro-organisms, but products with Microban protection help protect the product from microbes that can cause stains, odor and product degradation.

Microban technology which is built-in to a product during the manufacturing process, works by penetrating the cell wall of the microbe and disrupting key cell functions so that the microbe cannot function, grow or reproduce.

Living cells that are too small to be seen without a microscope, microbes can double in number every 15 to 20 minutes under the right conditions, according to Microban International. There are four different types of microbes including bacteria, fungi, algae and mold.

Invacare offers an entire bath safety line with Microban antimicrobial protection including commodes, transfer benches, folding shower chairs and toilet seats.

CDC Facts About Antibiotic Resistance for Clients

Skin and Wound Care

Another area where infection control plays an important role is the home medical equipment industry is skin and wound care. Moist anti-bacterial wipes can help prevent infection for an incontinent client. In addition, the excess moisture from wounds increases the risk of possible infection. Johnathon Primer, president of Medline's, Dermal Management Systems division Mundelein, Ill., said that antimicrobial silver wound dressings can reduce the risk of infection where there are breaches in the skin. "Silver has long been known for its antimicrobial ability," Primer says. "What makes these wound dressings unique is their controlled release allowing ongoing and safe release of the silver. These wound dressings protect patients by significantly reducing the risk for infection," Primer says.

Hand Hygiene Guidelines: CDC Fact Sheet

Air Quality

Many people worry about the air quality inside their homes as it can sometimes be a source of microbial contamination, where molds and bacteria multiply. Lack of ventilation and high moisture levels or water damage can cause the proliferation of molds and bacteria, both visible and invisible. If you really want to get scientific, you can even have the dust in your house tested to get a read on the microbial history of your home.

For people with a compromised immune system or respiratory problems, Airsonett, Charlotte, N.C., offers the Airsonett Airshower, which creates and maintains a halo of clean room quality air. The Airshower acts as a personal air purifier; however, it also can filter the air in a bedroom, living room or other space in the home with its pre-ionizing and HEPA-type filtration system. People who suffer from severe allergies, asthma, COPD, or a compromised immune system are protected from airborne infection with this device.

Some experts even argue that growing up in too clean of an environment might cause a person to develop allergies or asthma later in life because exposure to bacteria can help create a strong immune system—good news for people who only clean once in a blue moon. Most experts however, recommend keeping a balance of clean products, clean surfaces and clean hands to prevent otherwise avoidable infections.

Check out Infection Control Products.

CDC Facts About Antibiotic Resistance for Clients

Hand Hygiene Guidelines: CDC Fact Sheet

Infection Control Products

Infection Control

SilvaSorb® Site Dressing from Medline is designed to prevent infection by wrapping around catheters, CV lines, feeding tubes and other medical devices inserted under the skin.

Antimicrobial Protection

Invacare's bath safety products feature Microban International's antimicrobial technology designed to provide added resistance to mold, mildew, stains and odors by preventing bacteria from lingering. The technology is intended to make surfaces easier to maintain and keep clean.

Personal Care Products

No Rinse personal care products are designed to provide convenient, effective bathing alternatives when traditional bathing is unavailable or difficult. The line includes No Rinse Shampoo, No Rinse Body Bath and No Rinse Bathing Wipes for clean hair and bodies.

Selfwipe® Bathroom Toilet Aid

Maddak's easy-to-use hygiene aid makes post-toilet cleaning possible for people with a myriad of physical disabilities and mobility challenges, such as difficultly bending or limited use of the hands or arms. The rotating handle allows the desired amount of toilet tissue to be rolled. The tissue is then placed around the angled clamp on the lower portion of the device. After use, the tissue is discarded by pressing a release button on the end of the handle.

Premium Guard Cushion

Drive's Premium Guard Visco Foam Cushion is fire-retardant with a sheer cover that is a non-sheer, fluid-resistant, antimicrobial/bacterial stretch nylon.

Compression Stockings

S.A.I's TruSoft Therapeutic Compression Stockings are designed for anyone with sensitive feet, including those with special needs brought on by diabetes or arthritis. The combination of moisture-wicking yarns, an antibacterial/antifungal finish, gentle support and a low-profile seam provides all-day protection and comfort.


Coloplast's Contreet® is a family of antimicrobial foam and hydrocolloid dressings that incorporate advanced moist wound healing technologies with silver as the active component. The easy-to-use wound dressings keep wounds moist, while allowing them to breathe.

Hygea® Flushable Wipes

Hygea® Flushable Wipes from PDI are soft for sensitive skin and provide fresher cleansing than dry bathroom tissue alone. The wipes are biodegradable and alcohol- and latex-free. Hygea Flushable Wipes are available in 48-count wipe tubs. The wipes are safe for sewer and septic systems.

This article originally appeared in the February 2006 issue of HME Business.

The Key to Patient Engagement