Last week our Plexus call had a dynamic discussion representing different lenses focusing on the concern of preventing infections in healthcare environments. Ecologist Jessica Green, a researcher at the University of Oregon, has studied the role of facility design, particularly sealed/mechanical ventilation versus a green system that imports air from outside the facility, on the microbial environment of the air in the facility. Jessica has found that mechanical ventilation is associated with a less diverse and more pathogenic population of bacteria colonizing the environment compared with more "natural” ventilation systems (open windows, for instance).
Clearly the interplay of microbes, sterility, immune function, and healthcare facility design and maintenance is an excellent example of complexity. Mary Uhl-Bien, researcher and Plexus Board member, states that the clearest characteristic of complexity is "rich interconnectedness.” Imagine the network of connections that link bacteria with patients, their immune systems, the healthcare facility itself, and everyone working in and passing through that facility. What a complex array of relationships and interdependencies!
Now superimpose on this complexity our desire and need to impose order; this could be by keeping portions of the environment sterile, as in operating rooms; or it could be more general, as in cleaning processes after patients depart for home, or how to design the ventilation system of units or the entire facility. These actions are necessary to protect the most fragile of patients from harm-- whether the fragility is caused by an immune system impaired from illness or treatment, or from breaches in our own barriers to infection because of the need for surgery. What struck me as I began to think of this complexity was the realization that our infection prevention actions have consequences, as all efforts to impose order on complex adaptive systems do. I’m not advocating discarding these practices, which clearly save lives and prevent harm. What I’m wondering, however, is how we can hold the complexity and need for order together in a wicked question way, to even further help those most fragile among us remain free from harm as they receive care. How can we maintain strict sterility and allow favorable microbial adaptation and emergence to minimize the risk of healthcare-acquired infections? As always, I'm interested in your reactions and ideas.