Meeting your hospital roommates, one q-tip at a time

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I dropped something on the floor at the hospital.

My parents were visiting me and my one-day-old son, and I dropped something behind the bassinet, something disposable. A diaper, perhaps. My dad, who had spent all his adult life working in hospitals, stopped me from picking it up.

“I know they clean,” he said, “but I never touch anything that’s been on a hospital floor.”

I was, after all, in what comedian Jim Gaffigan calls “the germ-infested building where people go to die.”

Some very scary microbes live in hospitals. They’re the place to be if you’re a nasty germ – convince your host to bring you to a hospital, and you may get a chance to hop a ride on a piece of equipment, or somebody’s unwashed hands, and then – bonus! – have access to a ton of people with compromised immune systems. Hospitals are also a sort of professional conference for the aspiring superbug, exposing germs to antimicrobials and introducing them to buddies who may be willing to share a resistance gene or two.

Aseptic technique and hand washing are standard practice, but drug-resistant superbugs are still a crisis in health care. If we knew more about how microbes live and travel in hospitals, could we prevent infections?

Trillions of roommates

You know by now that your body carries more bacteria than it does human cells. If you are a parent, you know (because all the ads tell you) that everything your child touches is covered in germs. Everyone from high school biology students to Lysol-funded research institutes can swab the surfaces all around you – your toothbrush, your keyboard, the bathroom at the hotel you stayed in – and tell you how many gazillions of microbes there are. Microbes live in antarctica, in nuclear reactors, at the bottom of the ocean and (thanks to us) in space.

Within a year, my son was crawling on the floor of our home, among traces of dust and dog fur and the accumulated microbial communities that sixty years of foot traffic had brought into the house. Some of the germs came from us; we shed more than a billion of our own cells each day, and bacterial cells come with them. Some were from previous occupants. Some were from the factories in distant lands where our things were made.

A microbial community has to come from somewhere, and unless you could autoclave a whole building, there’s no such thing as a blank slate. Your house or apartment begins to take on your personal microbial fingerprint after a few days. What about your hospital room?

The hospital as a body, and a world
Later this month the doors will open on a new hospital in Chicago. It will be already colonized with microbes from its building materials, from the contractors that worked there and the people who toured it during construction; from the dirt and airborne particles that make their way in to all buildings; and other sources besides (like the tap water that flows in every day).

What’s unique about this hospital is that some of those microbes have already been collected and analyzed, and for the next year, an enthusiastic team with a lot of Q-tips is going to swab surfaces in the hospital with an eye to how the bacterial communities change from place to place, and patient to patient. It’s called the Hospital Microbiome Project.

The PI on this endeavor, Jack Gilbert, also works on the Home Microbiome Project and the Earth Microbiome Project. He started out studying microbial communities in moving water; despite strong currents, the same types of microbes could always be sampled from the same spot. Now he’s turned his interest to a different type of current: the motion of people into and out of a place.

A building is a bit like a body – complex, with lots of parts that interact. We have respiratory systems, buildings have ventilation systems. We have digestive tracts, they have plumbing. At the same time, a building (or body) is a world where populations live and interact. It has a climate and seasons; when you turn up the thermostat, it’s a sort of global warming for the microbes in your house.

Could we manipulate the conditions in a hospital to encourage the good microbes to flourish? Are there good microbes in a hospital, or are they only neutral? Opening windows may be a start, says Gilbert, who told the Guardian that surgeons are “constantly sterilising the bejeebers out of their operating room[s]” and that may be a mistake: as in the human body, microbes in a building can be part of its defenses.

After all, we can never totally get away from germs, but maybe we can try to spend our time in the company of good ones.

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