Blog | Friday, February 15, 2013

Rosie reincarnated

As a child I never liked cartoons much, with one exception--The Jetsons. The Jetsons were a family that lived in Orbit City in 2062. The parents were George and Jane, and the kids were Judy and Elroy. But there was also the family dog, Astro, and their cleaning lady, Rosie the Robot.

I couldn't help but think of Rosie as I read an article on the use of disinfecting robots at Johns Hopkins Hospital in a recent issue of The Baltimore Sun. These robots seem to be all the rage. If you want to dig a little deeper, Clinical Infectious Diseases has the full account of the study done by Trish Perl's group.

In the study, rooms that had previous occupants with MDROs were subjected to standard cleaning in three hospital units. In three other units, rooms were disinfected by hydrogen peroxoide vapor producing robots. Subsequent room occupants were assessed for MDROs to determine whether transmission to the new occupant had occurred. The investigators demonstrated a significant reduction for VRE in subsequent occupants, but no significant decrease for MRSA, C. difficile, or MDR-gram negative rods. Of note, the study was partially funded via in-kind services by the robot maker. An excellent editorial by Cliff McDonald and Matt Arduino accompanies the paper.

The bottom line is that the authors demonstrated an absolute 6% reduction in VRE acquisition with use of robotic disinfection. Does that result warrant jumping on the robot band wagon? I don't think so, for several reasons.

First, with the exception of a few special patient populations (e.g., oncology and transplant patients), VRE has little pathogenic potential. Second, only a fraction of newly colonized VRE patients will develop infection. Third, a big problem with the study is that molecular typing was not performed.

A few years ago, one of my IPs noted that 4 consecutive patients housed in the same room in our medical ICU all developed VRE bloodstream infections. I was certain that we had a problem with suboptimal cleaning between patients. Fortunately, we had all the isolates, and when molecular testing was performed, we surprisingly found that the isolates were all genetically very distinct. It seems that VRE is an organism that while transmissible is also one for which antibiotic pressure is always creating new strains in individual patients.

Lastly, even if this technology were perfect and rendered a room absolutely sterile, within seconds of the robot leaving and the humans returning, the room will once again be contaminated. It reminds me of the hysterical response by grade schools several years ago of shutting down a school and bleaching it after a child was found to have MRSA.

So to any hospital thinking about hiring Rosie, ponder long and hard, and consider taking all that money and using it to drive hand hygiene compliance to a new level. Remember, in health care, the hands remain the final common pathway.

Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.