Special Advertising Section: Infection Control from Top to Bottom
Improvement in hospital infection prevention and control can occur in many places. Not all of them are obvious, but they are all in sight.
By Tom Inglesby
Infection control comes in many different packages these days. Critical care facilities have long noted the importance of hand hygiene and so have the various health standards and safety organizations. Indeed, “hand hygiene continues to be identified by the U.S. Centers for Disease Control and Prevention (CDC) as the single most important and basic intervention to reduce the incidence of healthcare-associated infections (HAIs),” explains J. Hudson Garrett, PhD, vice president of clinical affairs at PDI Healthcare. “Healthcare providers can serve as sources of transmission due to contamination of their hands from patients, environmental surfaces, medical devices, or each other, and then can transmit deadly pathogens to other patients.”
PDI focuses on the three most common sources of infection transmission: the contaminated hands of the healthcare providers and patients, the contaminated skin of the patient, and the contaminated environment of care. On this last point, Garrett notes, “There are two major issues that need additional work to better implement infection prevention and control recommendations. The first is the operating room, particularly the anesthesia practices regarding safe injection practices. The second is the outpatient environment, particularly ambulatory surgery centers. These environments are high-volume, quick-turnover settings that require attention to detail for critical processes such as scope reprocessing and terminal disinfection of operating room suites.”
PDI delivers a comprehensive portfolio of evidence-based solutions that target the evolving infection prevention needs of the healthcare environment. In addition to safe and efficacious product solutions, PDI offers a robust platform of clinical education on a variety of relevant and timely infection prevention and control topics. Garrett says, “The PDI Clinical Affairs team maintains extensive partnerships with relevant infection prevention and control associations such as the CDC, the Association for Professionals in Infection Control and Epidemiology, the Association for Vascular Access, the Society for Healthcare Epidemiology of America, and the Association for the Healthcare Environment.”
Innovations Address a Complex Problem
Hospitals are constantly searching for innovative approaches to the complexities of infection prevention. PDI provides a more holistic approach, which has been proven and documented in several publications and abstracts presented at important conferences. Garrett remarks, “Infection prevention, as a science, has evolved to a multi-faceted approach that includes patient safety, the medical laboratory, healthcare quality, environmental services, regulatory accreditation, public reporting, and much more. As such, the patient must be at the center of each and every intervention in infection prevention and control programs. This approach will contribute to compliance with the Institute for Healthcare Improvement Triple Aim and improve outcomes. HAIs are a patient safety concern, and as such we must target zero and work diligently towards this goal.”
How can a hospital prevent infections by “superbugs” that have proven to be antibiotic-resistant? Garrett says, “Superbugs are a growing problem as identified in a recent report from the CDC. Superbugs are not only a healthcare problem but also have a growing impact on the community as well. These infections can be dramatically reduced by the simple intervention of more appropriately managing our antibiotic formularies and ensuring that not only are antibiotics indicated for the patient, but that the specific narrow spectrum medication is prescribed as soon as possible. Broad spectrum agents can contribute to resistance and patient harm. PDI closely monitors the reports and concerns of the CDC and has a robust process in place to ensure that all of our products incorporate the most clinically relevant pathogens but also will not contribute to potential resistance if used according to the manufacturer’s instructions for use.”
Hand Hygiene
Dave Mackay, vice president of healthcare sales and marketing for GOJO Industries, Inc., acknowledges the concerns hospitals have about hand hygiene. “In healthcare, hand hygiene is considered the single most important means of preventing the spread of infection. This is why its role in reducing infection rates has taken center stage. Earlier this year, the CDC released its Healthcare-associated Infections Progress Report, which stated that hospitals and health systems are making progress in reducing the number of HAIs. Yet, the report also indicates that more work needs to be done. This demonstrates the need to have strong infection control programs, which include hand hygiene, in place to reduce HAIs.”
Yet, hospitals and healthcare facilities face challenges to hand hygiene compliance. In January 2015, The Joint Commission Journal on Quality and Patient Safety listed more than 20 issues that caused healthcare workers in eight hospitals to miss a hand hygiene opportunity. “There are two main insights to hand hygiene compliance,” Mackay says. “Hand sanitizer dispensers need to be placed in the right location, convenient and at the point of care, and formulation matters when it comes to hand hygiene products. These products must be effective, gentle on skin, and have good aesthetics.”
GOJO offers a variety of hand hygiene solutions to the healthcare market including high-efficacy formulations, advanced technology dispensing systems, and the SMARTLINK Hand Hygiene Solution that is built upon a state-of-the-art electronic compliance-monitoring platform.
GOJO continues to launch new innovations such as new products that allow for integration with leading real-time location systems. GOJO also continues to develop and improve its clinician-based services to provide the added coaching, support, and expertise necessary to help build and sustain hand hygiene improvement.
“Hand hygiene products themselves are often overlooked in importance but are highly formulated to deliver on multiple attributes,” Mackay states. “Two new GOJO product formulations help address these needs; Provon Ultra Mild Foam Handwash and Purell Advanced Hand Sanitizer Ultra Nourishing Foam. Both products are formulated with a unique blend of ingredients to help maintain or improve the skin’s natural moisture barrier even under high-frequency use.”
HAIs remain a patient safety concern, and there is a significant body of evidence that demonstrates a correlation between hand hygiene rates and infection rates; as hand hygiene goes up, infection rates go down. This is why the CDC and WHO consistently state that hand hygiene is the best way to prevent the spread of infection. But Mackay warns, “The current state of hand hygiene compliance is far lower compared to what many originally thought. This is why objective hand hygiene compliance and tracking is imperative. At GOJO, we work with hospital infection control experts to help them find a system and the hand hygiene products that best fit their needs.”
According to the CDC Threat Report, each year in the United States alone, approximately two million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these types of infections. Plus, many more people die from other conditions that were complicated by an antibiotic-resistant infection. Antibiotic resistant infections have been estimated to cost of the U.S. healthcare system more than $20 billion annually. Mackay explains, “Hand hygiene is one of the best measures for preventing the spread of illness-causing germs. Staying healthy and preventing infections from happening is a very effective way to reduce the use of antibiotics. If illness is unavoidable, it is important to use antibiotics wisely. Unneeded antibiotics can lead to future antibiotic resistant infections. It is important for all of us—healthcare workers and the public—to learn when and how it is appropriate to use antibiotics.”
Environmental Surface Cleaning
Accumulation of dust, soil, and microbial contaminants on environmental surfaces in healthcare facilities is not only aesthetically displeasing, but the transfer of microorganisms from environmental surfaces to patients can occur via hand contact with the surface. The hands of healthcare workers become contaminated while providing care to patients. They then touch and contaminate the inanimate environment surrounding the patient. Patients can also spread their germs on surfaces they contact. It is critical, therefore, that healthcare facilities develop and implement evidence-based cleaning and disinfection policies for the environment. It is especially important to pay attention to “high-touch surfaces,” or those surfaces with frequent hand contact. These can include bedrails, IV pumps, over-the-bed tables, monitors, and various other equipment and surfaces. High-touch surfaces may require more frequent cleaning and/or disinfection than surfaces with minimal hand contact.
Because the environment can play a role in transmission of microorganisms, it is important to remember that performing hand hygiene upon room entry and exit is not always adequate. The World Health Organization’s My Five Moments for Hand Hygiene outlines key moments when hand hygiene should be performed. They are:
- Before patient contact
- Before an aseptic task
- After a body fluid exposure risk
- After patient contact
- After contact with the patient’s surroundings.
“The healthcare environment and its high-touch surfaces are known to transmit pathogens,” acknowledges Chuck Dunn, president and CEO of Tru-D SmartUVC LLC, an ultra-violet disinfection system that uses UVC light. UVC utilizes short-wavelength ultraviolet radiation (shorter than UVB and UVA which are NOT germicidal) that is harmful to microorganisms.
Short for Total Room Ultraviolet Disinfection, Tru-D “finishes the job” by bolstering the traditional disinfecting efforts of hospital staff members and reducing the risk of dangerous infections being transmitted through surface contact. The remotely operated robot works from a single position within the room by delivering an automated, accurately delivered dose of UVC light that modifies the DNA
structure of an infectious cell, rendering it harmless.
The robot’s ultra-efficient low-pressure mercury vapor UVC lamps, endorsed by the Environmental Protection Agency and the U.S. Department of Energy for use in healthcare environments, provide three times the germicidal dose for every minute of operation in side-by-side comparisons with competing xenon strobe lights that claim to disinfect healthcare spaces. Tru-D’s combined automated dose measuring capabilities and real-time usage-tracking features make Tru-D the device of choice for discerning hospitals that are looking to implement evidence-based, best-in-class technology.
“Hospitals have to be proactive in their efforts to reduce the risk of the transmission of infection and focus on delivering the safest environment possible for their patients to heal and their staff to operate in,” says Dunn. “Using this best-in-class UV disinfection technology gives hospitals confidence in protecting their patients and staff, as well as the ability to track and optimize their infection prevention efforts.”
With recent epidemic scares and an initiative from President Barack Obama to prevent the spread of antibiotic-resistant bacteria, the need for infection control and prevention heightens as hospitals look for new ways to ensure optimized and evidence-based patient safety. “Studies show that manual terminal cleaning of patient areas typically is only 50 percent effective. That data in itself is troubling news for patients and staff. Tru-D SmartUVC has been the device of choice in more than a dozen third-party research studies, of which all demonstrated the effectiveness of Tru-D in delivering a consistent disinfection outcome regardless of the room configuration. Tru-D has been proven 99.99 percent effective in these studies at destroying methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and C. diff in a single cycle that disinfects an entire room in minutes.”
Highly trafficked areas are of most concern because surface contamination is such a huge factor in how infection is spread. For example, busy operating suites and triage areas in the emergency department see a large volume of patients come through at a rapid speed that can lead to infection prevention measures being overlooked in some cases to account for the patient load.
“Studies show that the risk of acquiring an infection goes up when a patient is admitted to the room previously occupied by a patient infected with a multi-drug resistant organism,” notes Dunn. “In 2007, Tru-D Smart-UVC brought to market the first automated UVC disinfection system with the ability to overcome room variables and deliver a precise measured dose of UVC light to effectively eliminate
99.99 percent of pathogens—an asset infection control teams had never had access to before.”
While Tru-D was created to be a solution in the battle against environmental infection in healthcare settings, with its many functional advantages, such as its Sensor360 analytical technology and myTru-D’s real-time reporting capability, along with its ease of use and single placement, housekeeping teams are able to easily add Tru-D into their infection prevention protocols with minimal disruption to the existing workflow processes, providing an added layer of protection against the spread of infections.
It is clear that traditional cleaning methods are not enough to combat the threat posed by hospital-acquired infections to patients and staff. Healthcare leaders must enlist innovative technology to bolster infection prevention practices, and they must be deliberate in their selection. Dunn reports, “ECRI Institute recently listed automated disinfection technologies as number one on its Top 10 C-Suite Watch List. Selecting Tru-D SmartUVC, which offers a programmatic approach to training, implementation and ongoing support, ensures that hospitals can validate return on investment, resulting in a value-based purchasing decision. Over the long term, infection prevention specialists will incorporate automated disinfection technologies for best practice in delivering a standard of care related to patient safety.
“Every day we receive testimonials,” Dunn says, “Such as from Nancy Osborn, RN, manager of infection prevention control and epidemiology at Navicent Health in Macon, Georgia, who shares, ‘We have experienced major savings due to the reduction in overall infections. We attribute the reduction in infections to evidenced-based practice changes. High on the list of interventions is the judicial use of Tru-D on rooms that bed patients and a nightly rotation in the surgical suites.’”
St. Vincent Healthcare in Billings, Montana, is also using the Tru-D SmartUVC to eliminate harmful germs, such as Ebola, MRSA, CRE, influenza, and norovirus, that can infect patients during their hospital stay. “The acquisition of this technology is simply another way that we’re working to safeguard the well-being of every single patient who walks through our doors and protect the integrity of our healthcare environment,” said Dr. Michael Bush, St. Vincent Healthcare chief medical officer.
While antibiotic stewardship is a top concern for all infection preventionists, hospitals need to consider tracking infection rate data and protocol compliance in their fight against “superbugs.” “Functionally, Tru-D’s real-time cloud-based reporting feature, iTru-D, allows hospitals to track usage data for report consolidation and analysis alongside their infection rates,” says Dunn. “Additionally, hospitals must make sure that traditional cleaning procedures are being strictly followed and bolstered with innovative technology. Tru-D is awaiting the publication of our latest CDC-funded study, The Benefits of Enhanced Terminal Room (BETR) Disinfection, by the Duke Prevention Epicenter Program. This will be the only epidemiologically correct research assessing automated UVC disinfection. This study will present outcomes related to disinfection of 10 hospitals and 25,000 disinfection cycles for more than 100,000 patient days. The purpose of the study is to determine how a UVC-emitting device capable of measuring a specific UVC dose lowers infection rates and improves patient outcomes and quality of care. Tru-D Smart-UVC’s patented, analytical Sensor360 technology made it the UV disinfection device of choice for the team of researchers and was the sole device used during the study conducted at an academic teaching hospital, tertiary care centers, community hospitals and a Veterans Affairs medical center.”
Flooring
The hospital environment can adopt many products to help control and prevent the spread of infection. Often overlooked is the surface right below people’s feet. In its 60 years of operation, Parkland Memorial Hospital has had a tremendous impact on the surrounding community of Dallas County, Texas. The facility became world famous on a tragic day in November 1963 when President John Kennedy was rushed there with a fatal gunshot wound. But that was a special day; on any given day in 2015, the hospital completes nearly 1,000 radiology exams, performs more than 40 surgeries, and delivers approximately 45 babies.
Regularly providing this volume of patient services established a need for additional space that the hospital could not provide. As a result, a new $1.3 billion facility will soon open across the street, welcoming patients and staff with an abundance of space in a building that is defining the future of healthcare environments.
Looking to best support patient recovery and staff comfort, the hospital selected Noraplan Environcare from Nora Systems, Inc., a German company with U.S. offices in Salem, N.H. They installed more than 750,000 square feet of the rubber flooring in corridors, labs, pharmacies, staff areas, radiology and nurseries. “Rubber is a great fit for healthcare, as it doesn’t require the same kind of maintenance that you have for some of the vinyl products; it is wax-free,” says Robyn Roleofs, senior interior designer, HDR + Corgan. “The flooring won’t have to be replaced for decades, supporting a sustainable facility. It is also naturally antimicrobial and is quieter than a lot of our other floors. Acoustic control and sound transmission are hugely important to help patients heal faster.”
“When we looked at the hospital design overall, we wanted to make sure we were creating the best center for healing,” says Gena English, senior program manager for New Parkland Hospital. “As we considered flooring options, we knew we needed something that was going to last—something that was extremely durable, even in a busy healthcare environment. We tested that a lot in mock-up rooms.”
The hospital conducted its own tests on the flooring, measuring its resistance to common chemicals, such as methylene blue, iodine, and betadine, and bringing heavy foot traffic through the mock-up spaces. The results pointed to one clear winner. “It was really interesting to see how much better Nora performed over some of the other floors,” says Roleofs. “Even looking at it with scrutiny, we couldn’t find fault with the way it was maintained and the way it looked over time.”
Ergonomics also contributed to Parkland’s decision to use Nora. “From a nursing perspective, flooring is important, because our nurses work 12-hour shifts,” says Gay Chabot, program director, Parkland Hospital. “Nurses are almost always walking. While you can have orthotics and real fancy expensive shoes, the softness of the actual floor plays a large part. Nora is a huge difference from what they’re used to walking on in the old facility.”
Additionally, the acoustic dampening of rubber flooring will enhance patient healing. “Patients may not realize the materials that are around them, but they experience the space as a whole,” says Roleofs. “They may not understand that you don’t hear people walking or rolling a bed down the corridor. They may not realize that a space is more beautiful because you don’t have the dirt or traffic that you might see on another floor. But if a floor looks good and it performs well for them, they understand that the space is just naturally more beautiful.”
While hospitals are improving their clinical, hand hygiene, and cleaning procedures to help reduce the likelihood of patients contracting HAIs, new regulations and safety protocols are holding the hospitals responsible for readmissions within 30 days of discharge, helping increase focus to the discharge conditions and process. Here, again, the environment as a whole comes into play. There is more to infection control than individual hygiene. Today’s healthcare facilities face these challenges and admit they require more than just cleaning. It’s about effectively and efficiently stopping the chain of infection. Patient safety and satisfaction require finding ways to reduce the risk of HAIs and one way is by creating and promoting an ideal atmosphere for quality patient care. With a careful balance of productivity and safety in mind, facilities can prevent patient readmission, while also enabling and empowering staff.
Rubbermaid HYGEN Microfiber is the brand’s most comprehensive microfiber cleaning system that helps to prevent infection at the source. It offers launder-able microfiber as well as an innovative disposable microfiber solution. In third party testing, Rubbermaid HYGEN Microfiber offered superior performance, removing harmful microbes by eliminating live pathogens’ food source for optimal cleaning.
The brand has continued to expand the HYGEN line by introducing Rubbermaid HYGEN Disposable Microfiber. While many healthcare facilities clean with disposable products, they do not all clean equally. Traditional disposable products cannot remove microbes, leaving behind a food source for live pathogens. Rubbermaid HYGEN Disposable Microfiber is proven to remove 99.9 percent of microorganisms, including C. Diff. This removal eliminates the food source for live pathogens and combines microfiber cleaning in a disposable application to prevent cross-transmission, reducing the occurrence of healthcare-associated infections.
Infection control begins in the hands of the staff, healthcare workers, and patients, but travels down thorough all the touch-surfaces in the patient’s environment to the very floor they all walk on. Infection control requires a comprehensive approach, including all the surfaces where HAI elements can fester.
Tom Inglesby is an author based in southern California who writes frequently about medical technologies and improvement strategies.