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Unsanitary Behavior

More than 80,000 patients die each year from hospital-borne infections. Faulty disinfectants could be a major factor.

  • Also a part of this story: Cross Purposes -- the Red Cross promotes questionable products to hospitals.

Prospective patients often choose a hospital after considering the reputation of its medical staff, the sophistication of its technology, perhaps even the comfort of its wards. But one invariably overlooked category -- the hospital's disinfectant -- could determine whether their stays turn deadly.

More and more, hospitals are becoming sources of infection. Dr. William Jarvis, chief of investigation and prevention for the Centers for Disease Control and Prevention's Hospital Infections Program, estimates that at least 80,000 patients die each year from infections they acquire after entering the hospital. That makes hospital infections the nation's fourth most common cause of death, accounting for more mortalities than car accidents and homicides combined. Jarvis believes that about 5 to 10 percent of patients -- from 1.75 million to 3.5 million people annually -- contract infections while hospitalized, a rate experts estimate has probably increased at least 50 percent in the last decade.

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But despite the rise in infections, the Environmental Protection Agency has failed to monitor the disinfectant industry effectively. In 1990, the government's General Accounting Office (GAO) reported that the EPA had acknowledged that "as many as 20 percent of marketed disinfectants may be ineffective" -- and the EPA has done little to put a dent in that figure. Although the EPA is supposed to examine all disinfectants and keep unregistered products off the market, many manufacturers don't register their products, gambling that the EPA will not use its authority to halt product distribution. This places responsible manufacturers at a substantial disadvantage, since they pay lab and consulting fees that usually range from $50,000 to $100,000 and wait six to 18 months to gain registration for their products, while their competitors flout the law.

Meanwhile, according to Jarvis, the role of disinfectants in preventing the spread of hospital infections has become "increasingly important." Most disease-causing pathogens cannot survive outside the human body -- on the bed railings and doorknobs, for example, that are typically cleaned with disinfectants. In the last few years, however, lethal antibiotic-resistant organisms that can survive outside the body have become endemic in many U.S. hospitals. As a result, ineffective disinfectants are "absolutely" a cause for concern, Jarvis says. And hospitals aren't the only place where disinfectants prevent the spread of infection: They are routinely used in medical and dental offices, school nurse stations, daycare centers, and veterinary clinics.

The EPA has repeatedly acknowledged the importance of disinfectants. In March 1996, Steven A. Herman, the EPA's assistant administrator in the Office of Enforcement and Compliance Assurance, said that a primary focus of his Toxics and Pesticides Enforcement Division would be "continued efforts to remove from the marketplace ineffective and/or unregistered disinfectants used in hospitals and other critical care facilities." Nevertheless, Jesse Baskerville, the director of that division, has conceded that between October 1, 1995, and mid-December 1996, his office did not enforce a single case against a disinfectant manufacturer. (While the EPA says its regional offices also investigate manufacturers, officials cited only one case in which distribution of an unregistered product was halted during this period.)

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