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Sterile wards may be wiping out 'friendly' microbes

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Lessons learned from Florence Nightingale could prevent the spread of harmful bugs by allowing “friendly” bacteria into hospitals, an expert has claimed.

Sterile conditions in wards and operating theatres may be doing more harm than good by wiping out organisms that keep dangerous microbes at bay, Dr Jack Gilbert believes.

Florence Nightingale, the 19th-century “mother” of modern nursing, advocated cleanliness, but also plentiful fresh air for patients.

Dr Gilbert, who heads an international project to construct a bacterial “field guide” of all the world’s known bugs, thinks she was right, despite knowing nothing about microbial diversity.

He points to emerging evidence that what happens in buildings mirrors what occurs in the gut. It is well known that beneficial bacteria, or “flora” in the intestinal tract help to ward off infection by out-competing potentially harmful organisms.

Dr Gilbert, who is British-born but based at the Argonne National Laboratory near Chicago, said: “There’s a good bacterial community living in hospitals and if you try to wipe out that good bacterial community with sterilisation agents and excessive antibiotic use you actually lay waste to this green field of protective layer. Then these bad bacteria can just jump in and start causing hospital borne infections.

“This is going back to Florence Nightingale. Florence Nightingale said if you have an open window where air from the environment is coming in.. you’ll have less illness.

“You open up these windows, you keep it nice and airy, and you’ll see less sick soldiers in this hospital theatre.

“You let in all these bacteria from outside, and you will either dilute out the pathogens (harmful infectious agents) or you don’t allow the pathogens to establish themselves, because there is too much competition for the nutrients and energy that the bacteria need to survive.”

He cited a study published just last month conducted by Dr Jessica Green, from the University of Oregon.

She carried out an experiment in which bacterial samples were taken from clinic rooms that either had their windows open or closed.

The rooms with open windows had a more diverse range of microbial types. The sealed and artificially ventilated rooms had less variety of bugs, and more of the kinds of bacteria that could potentially be harmful.

Dr Gilbert delivered his message at the annual meeting of the American Association for the Advancement of Science (AAAS) in Vancouver, Canada.

 

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Readers' comments (4)

  • I work in a hospital with hundreds of beautiful big windows that everyone is desperate to open, especially in the Summer. However, they are all locked shut because of the suicide risk. Fresh air would be nice.

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  • perhaps part of the problem is that too many commensals are being killed off as well as harmful bacteria leaving patients with seriously compromised resistance to disease

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  • The aim of cleaning in hospital is to remove potentially harmful organisms and spores. Using the word 'sterile' is misleading, because we could never achieve the complete removal of organisms in a ward environment. In fact, as soon as you put patients back in the clinical environment after it has been cleaned, the area quickly becomes re-contaminated. The author is right that we do need to limit the use of antibiotics. I don't know whether the intervention of opening the windows is evidence based - but from a common sense point of view it would probably be beneficial!

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  • a lesson we learned on the ward which still impresses me 35 years later:

    we took swabs of materials and equipment on the wards anywhere we chose and sent them to the path lab to grow cultures on agar plates. the largest colonies were first , pseudomonas from soap and a face flannel and staph aureus from telephone receivers and earpieces of communal stethoscopes. The smallest colonies were found on the insides
    of folded bed cotton or linen sheets which were almost sterile and at had been washed at 90 degrees. This was at a time jut before the general strike and the introduction of general management when they had different bedding materials and different laundering processes and sheets were changed every day, or even several times a day, according to need.

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