Death at the Bedside

The hospital patient who complains that the water in his bedside carafe is not fit to drink is usually right, reports the New England Journal of Medicine. In fact, the stuff could kill him. It was patients' complaints that set a team of Harvard University physicians and Peter Bent Brigham Hospital bacteriologists to checking bedside water in 24 of Boston's nongovernment hospitals. What they found was far worse than they had feared.

Two-thirds of the carafes examined were "grossly unhygienic"--meaning that in many there were the partly decomposed bodies of insects, or "islands" of algae and fungi. Often, the walls were slimy. Most had a stale odor, and "a few were literally foul." When the bacteriologists went to work, they found that in 22% of the carafes the water contained colon bacilli, and no fewer than 69% held Staphylococcus aureus--including at least one of the deadly, penicillin-resistant strains that have caused wholesale epidemics and killed babies in some hospital nurseries (TIME, March 24 et seq.).

The microbes do not come from Boston city water, the researchers established: that contains enough chlorine to kill them off. And ice made from this water under proper conditions is equally safe. The trouble originates right in the hospitals. Most of them have carafes with narrow necks, so they cannot be properly cleaned without a brush--and not a single bottle brush was found. Most carafes are made of materials that will not stand sterilization by heat, and no hospital specified disinfection as part of the cleaning routine. In one-third of the hospitals the carafes were "cleaned" in the utility room --along with basins, bedpans and urinals. In many cases, ice was prepared without adequate safeguards, then juggled into the carafes by employees' unwashed fingers. In one hospital a nurse emptied (but made no effort to clean) the carafe of a patient who had just died, and left it at the bedside for the next patient.

The investigators' recommendations for eliminating these bedside cesspools are formidable: put ice-cube makers in microbe-free areas, bag the ice mechanically and store it at 20DEG F.; dispense ice with tongs; use wide-mouthed carafes, of types that can be sterilized with heat, and have skilled help do this job daily in the diet kitchen. The researchers note wryly that hospital personnel spend hours figuring out just what quantity of fluids a patient gets--so why" not pay a little attention to the quality?

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