National Nurses United

that finds its way into "rivers and streams and water tables that affect downstream consumers," says Prolman. All of these antibiotic misuses conspire to distribute resistant bacteria into the community. Over the past decade, researchers have found a dramatic increase in antibiotic-resistant germs in places like gymnasiums, sports facilities, and day care cen- ters as CAFO workers, their families, consumers, patients, and healthcare workers spread the pathogens. According to the Tribune study, such organisms have increased a thousand fold in Illinois. For hospitals, a community's ground zero for germs, the profit motive has encouraged a number of practices that make it easier to infect others. In the 1970s, the average hospital stay was seven days, enough for doctors to identify and treat infections. But new hospital procedures aimed at generating a rapid turnover of beds (the average stay now is three days) means many patients go home before they can be properly diagnosed. "If you spend five minutes in a room with someone with MRSA, you are going to get colonized," says Dr. Neil Fishman, director of epi- demiology and infection control at the University of Pennsylvania's School of Medicine. Jill Furillo, RN and Southern California Director for the Califor- nia Nurses Association and National Nurses Organizing Committee, points out that healthcare workers are particularly vulnerable "because they are exposed and can potentially bring those germs home to their families." From there, the bacteria can spread to the wider community. In addition to bed turnover, the Harvard School of Public Health found there was a direct link between hospital-acquired infec- tions and nurse staffing levels. "The national study of 799 hospitals found that patients were more likely to contract urinary tract infections and hospital-acquired pneumonia if nurse staffing was inadequate," reported the Tribune. Another part of the hospital equation is poor housekeeping. A survey by the Auditor General of Scotland found that cleaning services "play a key role in minimizing the risk of hospital acquired infections." The Tribune study found, however, that many hospital cleaning staffs receive inade- quate training, are overextended, and have fewer personnel than a decade ago. Cleaning staffs have been cut by 25 percent since 1995. One East Coast nurse who spoke on con- dition of anonymity said, "Hospitals are filthy. It is really incredible. The housekeep- ing staff at my hospital was cut by one-third several years ago." The nurse says that to reduce staff, many hospital workers are "cross trained." But this means they may end up "touching the patient's bed, and at times the patient, after doing housekeeping work." Many hospitals have contracted out cleaning services to work- forces that may not be adequately trained, and where turnover rates are almost twice as high as in-house cleaning services. "We have report after report showing that rooms are not cleaned every day," Pia Davis, president of a Chicago healthcare chapter of the Service Employees International Union (SEIU), told the Tribune. "Hospitals hire people and just say go in there and clean. They don't show them what chemicals to use or not to use." When infections do occur, hospitals are less prepared to handle the outbreaks because, to cut costs, they have stopped investing in infection-tracking personnel and resources. "Once, when I was working as an intensive care nurse, we began to be alarmed by the number of infections on our ward," says Kay McVay, a 45-year RN and former president of CNA. "We checked everything we were doing, including hand washing and sterilizing instruments, but still couldn't find the source." McVay says an infec- tion nurse came in, watched everything, and finally figured it out. "She noticed the doctors were not wiping down their stethoscopes as they moved from patient to patient. With that discovery, we were able to deal with the problem." But according to the Tribune study, infection-tracking units have been cut 20 percent since 1995. "One of the effects of the cutbacks in nursing carried out by hospitals in the '90s," says CNA's Furillo, "was a sidelining of procedures for infection detection and control. Many facilities eliminated the position of infection nurse." Some experts on infections say there is, in fact, pressure for hospi- tals not to be particularly aggressive in ferreting out infections. "Repairs to equipment or extensive cleaning can mean shutting A U G U S T 2 0 0 6 W W W . C A L N U R S E S . O R G R E G I S T E R E D N U R S E 13 Close-ups of Staphylococcus (opposite) and E. coli bacteria get colonized." —DR. NEIL FISHMAN

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