Back to the future in fighting VRE

Dateline: 12.08.2009
Author: Nick Miller

The Melbourne Age newspaper’s Nick Miller has reported (12 August) that Melbourne’s Austin Hospital “is about to go back to the future in a move to rid itself of a growing superbug colony”.

The report noted that, “From this week, the Austin Hospital will abandon world disinfection standards, which it believes are failing in the fight against superbugs, in favour of a regime using old-fashioned methods, including a daily bleach clean of all clinical areas.

“Senior staff say the universal use of bleach instead of modern disinfectants means the hospital ‘will smell like hospitals did 20 years ago’.”

The Austin Hospital’s initiative is in response to a rapidly growing problem with the superbug vancomycin-resistant enterococcus, or VRE. Apparently blood-borne VRE infections at the Austin have doubled every year since 2006 - there were 11 last year but 13 already this year. For one blood-borne infection, there are estimated to be 20 more carrying, but not infected by, the bacteria.

DNA analysis had confirmed the problem was due to a large ‘colony’ or strain of the superbug that was causing similar problems at most of Melbourne's, and many of Australia's, hospitals, said Professor Lindsay Grayson, director of the Austin's infectious diseases department.

The standard response to a VRE breakout is a ‘terminal clean’, using high strength bleach, of every square inch of a room down to the curtains. Other times, cleaners use detergent and disinfectant.

“We have been following these guidelines and the [VRE] rates kept going up,” Professor Grayson said. “So we thought, why don't we treat the whole hospital like a VRE ward? Get rid of all the disinfectant that the germs have learned to avoid?”

The strategy now being used involves all clinical and common areas cleaned with bleach daily; new cleaning supervisors to educate cleaners in scientifically proven techniques; no ties (unless tucked in or clipped); no lanyards; no sleeves below the elbows; and no rings or false nails.

A trial in the hospital's transplant unit ‘worked brilliantly’, Professor Grayson said, cutting VRE rates tenfold, and he expects improvement once the whole hospital is covered. “It's about paying more attention to the basics, he noted.

There will also be less use of gloves and long-sleeved gowns, which were suspected of being a ‘vector’ for transmitting the bugs. Instead, staff will use alcohol rub to disinfect between every patient visit.

Professor Grayson said other Melbourne hospitals were watching the Austin and would likely copy the program if it was successful - just as the Austin's hand hygiene program has been picked up nationally.

Peter Judge, who co-ordinates the Austin Hospital's patient services assistants, said the changes had delivered an unexpected bonus: returning respect and science to the job of hospital cleaning staff. “They are an important part of the hospital - it is making the people feel good about themselves and the job they are doing,” he said.

www.theage.com.au

Back to the future in fighting VRE