In response, The Chief Public Health Officer’s Report on the State of Public Health in Canada (2013), recommends that we re-focus our efforts on prevention strategies; namely, better hand hygiene and improved hospital cleaning.
Obviously the more bugs we kill the safer we’ll be: that’s just common sense — right?
Not so fast, say researchers at the Hospital Microbiome [i.e. bug] Project, whose mandate is to reduce hospital-acquired infections. They say that not only is this approach not fixing the problem, it’s actually making it worse. In other words, that insane rise from 189 MRSA cases a year to over 7,000 – that’s on us.
The thinking is this. Bad bugs don’t exist in isolation. Rather, they exist as a huge minority among hundreds of millions or even trillions of other bugs. Our weapons of destruction – things like antibiotics, bleach, or hand sanitizers – are not laser-guided missiles, they’re like atomic bombs that wipe out almost everything around. Who doesn’t get slaughtered? The bad guys mostly; specifically, the bugs who have already developed resistance to our drugs, etc. – that’s what resistance means, the ability to survive it all.
So once you have a hospital battlefield with a ton of dead harmless and even helpful bugs, guess what happens next? The resistant guys that remain standing reproduce like crazy. That’s because there’s no one left to compete with them for living space and food – as our antibiotics, etc., have killed-off the competition.
Jack Gilbert, PhD, who‘s in charge of the Hospital Microbiome Project puts it this way:
“For the past 150 years, we’ve been literally trying to just kill bacteria. There is now a multitude of evidence to suggest that this kill-all approach isn’t working.” (For example, here and here; and in this popular New York Times essay, “We Are Our Bacteria.”)
Thus, hospital-acquired infections are being driven not by the existence of harmful microbes but by the absence of helpful species.
So the idea is to replace search and destroy with “growing a garden.” You do that by manipulating such things as hospital air temperature, humidity, light intensity, room air and CO2 concentrations, ventilation, and so on, thus cultivating an ecosystem of bugs beneficial to the patient. It’s just like tending a garden: by manipulating light, water, and soil conditions you influence the health of the plant; here, you influence the health of the patient by “weeding out” the bad bugs by, especially, growing and nurturing the good ones.
“In watching disease … the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable … are very often not symptoms of the disease at all, but of something quite different – of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these.” - Florence Nightingale, “Notes on Nursing,” 1860.
It seems we may finally be catching up with her.