Designing a Hospital to Better Fight Infection

A research project is mapping where hospital germs linger and what causes them
to take root

Enterococcus faecium bacteria that are resistant to multiple antibiotics, including penicillin and
vancomycin, have become increasingly common in hospitals. It can cause surgical wound
infections, endocarditis and urinary tract infections. PHOTO:DENNIS KUNKEL/CORBIS

By
ROBERT LEE HOTZ
April 27, 2015 6:06 p.m. ET

4 COMMENTS

In a new approach to reducing the scourge of hospital-acquired infections, a team of

scientists has been testing thousands of microbe samples from a Chicago hospital to
learn how a medical building might make patients sicker.
Data from the three-year Hospital Microbiome Project are still being analyzed. So far
the team has found factors including ventilation and humidity, and design features such
as furnishings and fixtures, affect the kinds of bacteria people encounter inside a
hospital in ways that impact their health. The scientists aim one day toslow the rise
of antibiotic-resistant bacteria in hospital settings by manipulating conditions from
room to room to keep pathogens in check.
They also hope eventually to make the hospital building itself a curative probiotic
perhaps by infusing walls or furnishings with bacteria that enhance patient health and
recovery.
I see a future far off where we use bacteria to protect us from the bacteria that harm
us, said infection-control epidemiologist Emily Landon at the University of Chicagos
new Center for Care and Discovery, the facility under study. We could make the
hospital itself into a treatment for the patient.
Hospitals have done much to reduce infections contracted after patients are admitted,
according to an annual survey of 14,500 U.S. hospitals by the Centers for Disease
Control and Prevention. They have tightened sterilization standards, made more careful
use of antimicrobials and enforced more attentive hygiene.

Still, on any given day, about 1 in 25 patients is fighting an infection contracted during
hospital care, at an estimated cost of more than $36 billion a year. Hospital-acquired
infections kill 75,000 people in the U.S. each year.
More than half of hospital infections are caused by bacteria that make themselves at
home in hospital settings. Some infectious microbes cling to catheters despite rigorous
hygiene efforts. Others contaminate improperly sterilized surgical areas. More than a
third of hospital infections are caused by nurses and doctors who dont wash their hands
properly after a patient examination.
Some of the hospital pathogens live both in the humans and in very expensive pieces
of medical equipment that are hard to clean, saidDr. Julie Segre, a senior scientist at the
National Human Genome Research Institute in Bethesda, Md., who uses genetic
analysis to track bacteria responsible for hospital infections. That is why we worry.

Gut bacteria, such as the Enterobacteriaceae shown in this electron micrograph, can cause
urinary tract infections, respiratory tract infections and bacteremia. It is a leading cause of
hospital-acquired infections. PHOTO: SCIENCE PHOTO LIBRARY/CORBIS

Staphylococcus bacteria, shown in this electron micrograph, cause a variety of hospital

infections. They usually spread by direct contact with an infected person, by using a
contaminated object or by inhaling infected droplets dispersed by sneezing or
coughing.PHOTO: SCIENCE PHOTO LIBRARY/CORBIS

Candida albicans commonly causes yeast infections such as thrush or diaper rash. A common
cause of the infection in hospitals may be the use of antibiotics that destroy microorganisms in
the body, both beneficial and harmful ones, permitting Candida to multiply in their
place. PHOTO: CORBIS

The $856,000 hospital-research project, funded by the Alfred P. Sloan Foundation in

New York, stems from growing awareness that we each harbor a unique collection of a
hundred trillion or so microbes in and around our bodies. This community of bacteria,
called the microbiome, influences our health, mood, eating habits and sleep patterns in
waysscientists are only beginning to understand.
A person typically sheds some 37 million bacteria every hour into the surrounding air or
onto surfaces touched. We leave our microbes all over the place, said researcher
James Meadow at the University of Oregons Biology and the Built Environment
Center, who last year analyzed the microbes inhabiting a 155-room building in Eugene.
Every building appears to have its own unique microbiome, depending on how it is built
and operated, who uses it and what they do there, said University of Oregon
microbiologist Jessica Green, who helped pioneer the field. We know microbes in
buildings are relevant to human health, she said.
In hospitals, for example, the air that many patients breathe, recycled through heating
and air-conditioning systems, concentrates human-related bacteria and potential
pathogens, compared with patient rooms with open windows where outdoor air can
circulate, according to Dr. Greens 2012 study of Providence Milwaukie Hospital in
Portland.
Other recent studies discovered that moisture-loving bacteria living in showerheads
include distinct populations of potential pathogens quite different from microbes on
shower curtains a few feet away. Drug-resistant staph germs can live for up to a week
on some common furniture fabrics. Strep germs can survive for months on a dry
surface.
Experts say the Chicago hospital project is the most comprehensive effort so far to study
the hidden life of a large medical facility.

About half of U.S. hospital patients take an antimicrobial drug during their stay. Half of
them take two or more. The drugs kill all but the hardiest microbes, leading to
generations of bacteria better able to withstand efforts to eradicate them. As broadspectrum antibiotics decimate normal bacteria in a patients body, it is open for
pathogens already in the room, medical experts said.
Patients get multidrug-resistant bacteria when their bacteria are wiped out, said Dr.
Landon. Once the hospital-microbiome data are analyzed, maybe we will find out that
when a person is on antibiotics, their room needs a probiotic so that their room does not
get colonized by antibiotic-resistant bacteria.
The two dozen microbiologists and infection-control experts working on the Chicago
project started collecting DNA data while the building was under construction,
cataloging bacteria likely brought there by dirt, wind, water, construction materials or
workers.

A researcher taking DNA samples of microbes from different rooms and people around a new
University of Chicago hospital for the Hospital Microbiome Project. PHOTO: MATTHEW
WOOD/UNIVERSITY OF CHICAGO

When the hospital officially opened on Feb. 23, 2013, the researchers documented a
change in the buildings microscopic life.

Overnight, the building became alive with all these human bacteria, said
environmental microbiologist Jack Gilbert at the U.S. Department of Energys Argonne
National Laboratory in Lemont, Ill., who is directing the project. The microbiome
suddenly increased in diversity. It increased in complexity. There was greater variation
between the spaces in the building.

In the following year, researchers focused on a suite of five patient rooms on the
hospitals ninth floor and five rooms on the 10th floor. They installed sensors to collect
information about a dozen different environmental measures that affect how bacteria
grow. Every day, they collected DNA samples from beds, bed rails, water, air, room
phones and other surfaces, as well as from patients, nurses and other staff.
Typically, people came in and out of each room 100 times a day, trailing invisible
plumes of bacteria, the researchers found. Some room surfaces had thousands of types
of bacteria; others had only a few hundred.

Within hours of arrival of a new patient, however, his or her personal collection of
microbes spread throughout the room, mingling with microbes already present and
making the microbiome of each room unique, Dr. Gilbert said.

Researchers hope the project will inspire a new generation of infection-control

practices. Dr. Green, of the University of Oregon, believes the technology will begin
showing up in hospitals within five years.

Write to Robert Lee Hotz at sciencejournal@wsj.com

Corrections & Amplifications
An earlier version referred incorrectly to University of Oregon researcher James
Meadow and a Eugene, Ore., building that he studied. His name isnt James Wood and
the building isnt in Portland. (April 28, 2015)