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When Outsourcing Turns Deadly

Hospitals should keep their cleaning teams in-house if they want to prevent unnecessary infection.

By Tom Jacobs


(Illustration: Elias Stein)

Hospitals have taken steps in recent years to reduce the number of patients who get infections during their stay, including a renewed emphasis on hand washing. Research points to another, less-obvious remedy: Hospitals could stop outsourcing their cleaning staffs.

A research team led by Adam Seth Litwin of Cornell University examined rates of a particularly nasty hospital-acquired infection, Clostridium difficile, in general acute-care hospitals in California. They found that the number of such cases “increases with the amount of outsourcing,” with hospitals that outsource half their cleaning staff experiencing double the number of cases of those that have all such employees on their own payroll.

Cleaners employed by a contractor are more likely to be “under-rewarded, undertrained, and detached from the organization, and the rest of the care team,” the researchers write in the Industrial and Labor Relations Review. An unmotivated custodian is a superbug’s best friend.