Hospitals, even those that are 50 years old, can be properly restored by removing a layer of masonry or plaster and replacing them with materials that have bactericidal solutions, Minister Alexandru Rafila said on Saturday. The statement caused a lot of resonance, especially since it was made on the weekend, when it was 7 years since the fire in the Kolectiv club. Can hospitals be properly restored, as explained by the Minister of Health? Do bacteria penetrate the walls or not?

I spoke with epidemiologist Sergiu Tasinski to find out whether the problem of nosocomial infections can really be solved with rehabilitation, even in a 50-year-old hospital.

Rehabilitation can be done, but it is more expensive than rebuilding the hospital from scratch. In addition, if the current schemes and standards are followed, the number of beds is reduced

“Yes, the minister is right,” epidemiologist Sergiu Tasinski explains to HotNews.ro.

“Bacteria do not penetrate through the walls, they remain there. Again, hospitals are buildings. No matter how old they are, they undergo rehabilitation. The big problem, from my point of view, is that if in an old, unrenovated hospital, you have a certain number of beds, say 500 beds, but you don’t have functional contours, you don’t have surfaces, etc. , once rehabilitated to current standards, you may find that once rehabilitated and the hospital no longer has 500 beds, it will only have, say, 200-300. There is a problem of what to do with the rest of the beds, where to put the rest of the patients who came to that hospital. But, of course, from a technical point of view, any building can be restored and properly equipped. The main problem, from my point of view, is the number of beds, which will be significantly reduced as a result of these works,” epidemiologist Sergiu Tasinski explained to HotNews.ro.

Another big problem with hospital renovations, aside from the reduction in beds under the new rules, is that “I’m not a technical expert, but as far as I know, rehabilitation costs a lot more than a new building . It’s probably a lot cheaper and even more economical to build a building from scratch, with everything you need in terms of layouts, space, etc., than to do a remodel.”

Serhii Tasinskyi, medical epidemiologist

“I don’t know where the custom that bacteria live in walls came from. Germs can really stay on surfaces in a hospital, including wall surfaces.”

Epidemiologist Serhii Tasinskyi says that he does not understand where the custom that “bacteria penetrate the walls” came from: “Of course, masonry and plaster are not sterile, something is growing. But it’s a long way from here to dismantling everything to bricks, burning everything.”

However, he explains that surfaces frequently touched by medical staff, including walls, can be contaminated. However, it is about the surface of the walls, the epidemiologist emphasizes, and not about the plaster inside: “The surface of the walls, not the plaster, gets dirty if certain rules are not followed in the hospital. These are surfaces that, in turn, when touched with a clean hand, germs from that surface reach the clean hand, and if the doctor or nurse does not wash their hands before touching the patient, they are transferred to the patient. This is a chain of transmission of nosocomial infections.”

Some of these bacteria that live on hospital surfaces do not live long, but others can exist for months or even years. Clostridium difficile, for example, can live on surfaces for a year, says epidemiologist Sergiu Tasinski.

“So basically, even if you don’t take it, take the patient, they’re still living on a contaminated surface. If you touched this surface with your hand, you did not wash your hands, then you ate an apple and this growth got into the body, you have every chance of getting enterocolitis, or if the medical staff removed this growth from the surface and touches the patient, this growth reaches the patient”.

Intensive therapy open space or isolated rooms?

We asked epidemiologist Sergiu Tasinski what intensive care units should look like in Romania, where hospitalized patients are in critical condition and a possible nosocomial infection can be fatal for patients: “We did not reinvent the wheel, and there is no point in doing so. we are trying to reinvent the wheel. And in the Romanian legislation, which is old, from 2014 or 2006, if I’m not mistaken, order 914 stipulates that any section, any compartment must have isolators. Of course, intensive care units are where patients are admitted in critical condition, undergoing various invasive procedures and where the risk of hospital-acquired infections is much higher. In my books, I say that it is better that these patients sit in separate rooms. But this is a salon with a much larger area than a salon in an ordinary ward, a salon with completely different amenities than in an ordinary ward. In theory, an open space is also acceptable, but in that open space you are housing patients who are not infected.”

Any intensive care unit should have at least 2-3-4-5 rooms for patients with sepsis or colonized patients who must be isolated, emphasizes Serhiy Tasinskyi: “No matter how the intensive care unit is designed, it should have isolators for these patients, and I don’t just mean the intensive care of a major burn, which is completely different.”

In Romania, the vast majority of hospitals do not have such isolation units in intensive care units, says epidemiologist Sergio Tasinski: “Look at what’s happening with Clostridium difficile here in Romania. Of course, there are two reasons: the antibiotics, then the lack of isolation options. You can’t pretend you’re trying to control, I don’t know, a Clostridium difficile event when you have a ward with a hall that has lounges on one side and two toilets at the end. First of all, there should be a sanitary group in every salon, even if it is not an isolator, because it is still civilized. It is mandatory to have a sanitary facility in the isolation ward. Of course, I do not mean resuscitation, where the patient is immobilized. But the lack of isolation facilities is a big problem in our hospitals.”

We “definitely” need an infusion of medical infrastructure

Do doctors have hopes that we will have new hospital buildings, given that there is also money for this in the PNRR?

“Of course, I and all my colleagues hope to have modern and properly equipped hospitals,” says Serhii Tasinskyi.

“Think about it, the biggest hospital in the country, if I’m not mistaken, about 1,700 beds. If you take the legislative acts in one hand and walk around the hospital, then probably many wards, departments, if not closed, at least reduce their number in order to breathe in them. We definitely need an infusion of healthcare infrastructure. How will this be done? I do not know. We are trying to absorb this money from PNRR.”

Photo: Dreamstime.com.

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• How can hospital-acquired infections be reduced in a 50-year-old hospital? Answer of the Minister of Health Alexander Rafila