buttonIn 19th century Europe (and probably in America, too) women were less likely to die in childbirth if their babies were born at home or even on the street rather than in hospitals. The reason was simple: street and home births almost always involved the doctor or midwife washing their hands, thus minimizing the risk of infection. Doctors of the time rarely bothered to wash between hospital patients. Yum. Ignaz Semmelweiss first noticed this in Austria before 1850. Then Louis Pasteur came up with his germ theory of disease in 1864. Finally Joseph Lister in England (he of Listerine fame) pioneered the use of carbolic acid (phenol) antiseptics and the fight against germs took off in earnest.

Or did it? Each year in the USA the Centers for Disease Control estimates that there are approximately 1.7 million so-called Hospital Acquired Infections (infections that wouldn’t have happened had the victim not been in the hospital) leading to approximately 100,000 deaths.

One hundred thousand deaths is a lot of deaths, especially if every one was avoidable. If you look at morbidity and mortality statistics for the USA you’ll see that very few causes of death have greater than 100,000 annual victims. Heart disease, cancer, accidents, and strokes are all over 100,000 annual deaths, as are chronic respiratory infections, but many of those latter are actually hospital acquired.

Hospitals are not a very good place to be sick, it seems.

We spend a lot of time bitching about the cost of medical care in this country but not enough time, it seems, demanding that our hospitals be cleaner.

Wait a minute! What about the semiconductor industry, couldn’t their clean room technology help make hospitals less dangerous? Maybe… if anyone would bother to try.

This topic came up in a discussion I had recently with an old friend who designs (actually, used to design) clean rooms for high tech companies. He was calling to talk about my stinky Jeep I wrote about last week:

Ozone is interesting stuff.  We used it as a biocide in our ultra pure RO-DI water.  We’d inject Ozone, then run the water through UV-C light.  Between the Ozone and the UV we’d zap every bug in the water.  Ozone is a good biocide.  UV-C is a good biocide.  Combine them and you have an awesome biocide.

I’ve been appalled by the rampant infections in hospitals.  Using UV-C it is easy to disinfect the air in the HVAC system and make it bug free.  With the right tools a hospital room can be sterilized between patients.  Using something like the tool professional carpet cleaners use one can soak, clean, and dry every surface of the room with Ozonated water.  I’d then roll in a UV-C light, seal the room, and zap it for an hour or so. 

As you know I used to design electronic clean rooms.  One of my last projects was to design a pharmaceutical clean room.  The differences between the two were interesting and the influence of government was obvious.  In the pharmaceutical industry they didn’t care about particles in the air, they wanted the room to be able to be sterilized.  Some of those particles are bugs.  Electronic filtration was so good it could remove the bugs in the air.  Bugs will accumulate in your filters.  If you zap the air before it gets to the final filters it will greatly reduce the number of bugs and finding colonies of them in your filters will be rare.  The pharmaceutical industry doesn’t worry about eliminating the bugs.  Their plan is to be able to kill them when there is a problem.

Hospitals follow the same mindset and have generally believed they can deal with most problems by cleaning and sterilizing after the fact.  The circulating air and every person that enters a patient’s room is introducing contamination.  Once you understand the full implications of this, you can make hospitals MUCH cleaner and safer.

Many years ago my mother-in-law had surgery and wound up with a nasty infection that kept her in the hospital for months.  It was a nightmare.  As you entered the ward the smell would hit you.  The rooms were not clean.  The patients were not clean.  The HVAC was not very good and the odors would linger.  If the odors can linger, so can the germs. 

The hospital building was designed and built in the 1960’s.  Back then HVAC designs had low air circulation.  In office buildings this led to what was known as “sick office syndrome.”  It is easy to imagine what can happen in a hospital setting.

I came up with some innovations in the clean room.  The first was to isolate the people (the dirty stuff) from the product (the things you were trying to keep clean).  With good layouts and by isolating the airspace I could turn a low grade clean room into a top performer.  (I could get better than class 10 conditions around the product in a class 10,000 clean room!)  I found ways to take the people out of the clean room and make it a much smaller product only room.  I reduced the size of one room by 90%.  (A 90% reduction in clean room space is a huge savings in money!)

Given this, one could improve on the design of a patient’s room and make it a lot cleaner.  How much room does the patient really need?  He/she needs space for a bed and toilet.  Given that, one could design a super clean zone for the patient.  Does all the equipment and the hospital staff that tends to the equipment need to be in the same air space as the patient?  When you start going through the process of re-examining old assumptions and practices, very obvious design improvements present themselves.  

Okay, it’s Bob again: you thought I had left, didn’t you?

What astounds me about all this are the 1.7 million Hospital Acquired Infections and 100,000 deaths that could have been avoided. We all have to die sometime, but not this week.

Think of the cost to society. Those 1.7 million infections surely add $10,000 each to the hospital bill. That’s $17 billion. What’s the economic value of those 100,000 deaths, say $1 million apiece? That’s another $100 billion for a total of $117 billion per year, every year.

Why don’t we learn from Intel and AMD and make our hospitals safer for patients?