Danger in the Hospital

The scene in the operating theater of Boston's Peter Bent Brigham Hospital was typical of the best in U.S. medicine. Carefully scrubbed surgeons and nurses in sterile caps, masks, gowns and gloves glided around the table with smooth efficiency. The senior scrub nurse knew the senior surgeon's methods so well that he rarely had to ask for an instrument. A laconic New Englander, he uttered hardly a word. One thing that set this operation apart: in the theater, also sterile-garbed, was Microbiologist Ruth B. Kundsin, who took air samples every few minutes to test for harmful bacteria floating over the patient's widely opened abdomen. For more than an hour the bacteria count stayed reassuringly low.

The senior surgeon removed a diseased ovary and appendix. Then he was called out of the theater and turned over the job of closing the wound to an assistant. This man was, as Dr. Kundsin told the American College of Surgeons last week, "a loquacious type." Though he wore the conventional double-thickness, sterilized gauze mask, he breathed heavily through it. The bacteria count in the air increased fivefold. After the operation, Dr. Kundsin took smears from the young resident's nose and throat. The cultures proved him to be a fertile carrier of Staphylococcus aureus--and some strains of staph are the deadliest bacteria now plaguing hospitals in the U.S. and all other countries where modern, miracle-drug medicine is practiced.

Doctors & Menaces. Spread of infection within hospitals appeared to be under control a generation ago, thanks to universal use of Listerian antiseptic and aseptic techniques. In those days, 90% or more of potentially fatal infections were picked up on the outside, and the hospital was the place to go to be cured. Today, even in the best hospitals, more than half of all fatal infections are acquired inside the hospital, where they attack patients already weakened by other diseases or by operations.

With the wholesale, often haphazard use of antimicrobial drugs (sulfas and antibiotics), easy-to-kill bacteria are becoming rarer, while resistant strains, especially of Staph. aureus, are rampant. As Boston's Dr. Carl Waldemar Walter told the surgeons: "These drugs kill the sissies among the bacteria and leave the toughs." Philadelphia's Dr. Robert I. Wise reported a nationwide eruption of "hot" staph strains since 1950. Doctors and nurses are the greatest menace: in some areas, 67% of them are healthy carriers of hot staph, as against 30% of their patients. By contrast, the rate among people who have had what Dr. Walter called "no close contact with the health industry" is trifling.

Booties for All. Surgeons rated hospital infection as the most pressing problem aired at Atlantic City: 2,000 of them jammed a morning-long session to discuss it. and among the scientific exhibits the biggest crowds were around a booth where the Huggins Hospital of Wolfeboro, N.H. demonstrated its exacting anti-infection routines. Here Administrator Stanley Read and Boston University's Surgeon Ralph Adams (who operates at Huggins) spelled out the steps on the road to safety:

P: Floors, walls and furniture in operating rooms and corridors must be scrubbed often with fresh disinfectant-detergent solution.

P: Inside the operating room, before and between operations, the floor must be swilled with this solution, the excess being removed by a wet-pickup vacuum cleaner. Ultraviolet lamp tubes girdle the operating room, high enough to offer no risk of skin burns.

P: Between corridor and operating suite is an "exchange area." Everybody who passes this must first put on conductive booties over his shoes. Inside, he dons sterile cap and gown and scrubs (with antiseptic) for ten minutes. Patients, even on stretchers, get fresh sterile coverings and masks at the door.

Perhaps most important is the final masking of surgeons and nurses. Despite double-thickness or deflector masks (TIME, March 2), Dr. Adams insisted that the fitted filter mask is the only sure preventive of bacterial infection spreading from doctor to patient. The model he favors comprises two layers of copper wire cloth (mosquito screening) with a layer of Fiberglas (in the form of Filter-down) in between. This filter, developed for the Atomic Energy Commission, contains no holes more than half as big as staphylococci, thus blocks their passage completely. Since the mask is molded snugly to the face, many surgeons fear that it will hinder their breathing. Not so, said Dr. Adams: it is as easy to breathe through as properly placed gauze, and it keeps spectacles from steaming. The filter costs $3, can be used and sterilized daily for six months or more.

Proof of the Huggins program's value was in its-figures for infections after operations. In U.S. hospitals generally, the rate ranges up to 5%, and 2% is acceptable in the best. At Huggins it used to be 1.4%; in 15 months since the Adams-Read routine was enforced, it has dropped to .25%--two cases in 800 patients. Cracked a visiting college member: "The thinking surgeon's filter!''

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