Healthcare-associated infections have always cost society — the CDC estimated that in 2011, 721,800 patients in acute care hospitals contracted a preventable HAI while in the hospital, and roughly 75,000 died during their hospitalization.
Those staggering numbers are in part why the federal government started to crack down financially on hospitals with high infection rates to incentivize them to improve patient safety.
In October 2008 Medicare stopped paying hospitals for care provided to treat certain HAIs following the enactment of the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005.
The ACA took it a step further with the Hospital-Acquired Condition Reduction Program. Under the program, starting in October 2014, CMS started reimbursing hospitals with high infection rates at 99 percent of what it would have otherwise paid — in other words, hospitals with high infection rates get a 1 percent cut to their Medicare payments.
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In 2016, 769 hospitals were penalized under the HAC reduction program. Those hospitals lost roughly $430 million in Medicare funding total, according to estimates from the Association of American Medical Colleges.
As the federal government shines a brighter light on HAIs, patient safety and infection prevention has not only emerged as the responsibility of clinicians, but also of the hospital board and executive team. Clinical and administrative stakeholders must work together to reduce the rate of HAIs, provide safer patient care and protect the hospital's bottom line.
Double Down on Infection Control
Many hospitals focus first on hand hygiene efforts as a low-cost, high-impact way to reduce infections. According to the World Health Organization, practicing proper hand hygiene is "the most important measure to avoid the transmission of harmful germs and prevent healthcare-associated infections."
Despite best efforts by healthcare organizations nationwide to improve hand hygiene, healthcare providers still clean their hands less than half of the times they should, according to the CDC.
Even if healthcare providers do follow hand hygiene protocols to a T, technology like computers, keyboards, mice, tablets, cellphones and electronic monitoring devices have infiltrated the patient care space and harbor germs. Bacteria and viruses hiding on these surfaces can negate even the best hand hygiene compliance.
Hospitals spend millions to boost hand hygiene. "How much of that is effective when there isn't the same emphasis on something like a mobile device?" asks Pete DeFilippis, marketing manager with Seal Shield.
"How Do You Wash a Computer?"
Most standard electronic devices in healthcare settings harbor several germs, as evidenced by multiple studies.
"Microbial contamination of keyboards is prevalent," confirmed a 2006 study in Infection Control and Hospital Epidemiology, which found staphylococci on 100 percent of the keyboards the researchers cultured.
Cellphones, which are becoming more prevalent in patient care areas, are also notorious for housing germs that then spread to users' hands. A 2010 study in the Journal of Applied Microbiology found viruses transfer easily between fingers and touch screen surfaces, like those on tablets and cellphones, and vice versa.
Another study published in 2012 in the International Journal of Infection Control found healthcare workers' hands became contaminated with bacteria after using cellphones. "The use of mobile phones in clinically sensitive areas should be weighed against the risk for contamination and transmission of infections," that study concluded.
Further, a 2017 study in the American Journal of Infection Control cultured mobile phones in a Japanese hospital, finding 7.2 percent were contaminated with S. aureus, of which 2.3 percent of isolates were MRSA. "[O]ur data suggest that contact with contaminated mobile phones after hand-washing can recontaminate palms or fingers," the study concludes. "[A]ll healthcare workers should be aware that mobile phones and other devices used in the clinical setting can be a source of hospital-acquired infections..."
Even though it is well-documented that electronic devices can be contaminated with viruses and bacteria and transmit microorganisms to healthcare workers, provider organizations still struggle with how to clean them properly and consistently.
"You have policies around hand hygiene, but how do you wash a computer?" says Scott Filion, chief sales officer of Seal Shield. "As new technology comes into [hospitals], organizations struggle around cleaning and infection concerns." Touch screen surfaces, specifically, present a challenge since common cleaning agents are too abrasive for the coating on a phone or computer monitor.
Solution
To help hospitals prevent infections driven by electronic device surfaces, Seal Shield provides medical keyboards, medical mice and waterproof remotes for use in the hospital setting as a low-cost way to fight HAIs.
These devices are not only 100 percent submergible — allowing them to be soaked in water or bleach or run through a dishwasher — they are also antimicrobial, providing a passive "cleaning" in between active cleaning and disinfection.
Additionally, Seal Shield offers screen protectors for touch screen devices that cannot tolerate harsh disinfectants with a long dwell time, which are recommended to kill certain pathogens. When the screen protectors are used, touch screens can withstand such chemicals. The protectors also contain antimicrobial agents to reduce germ growth.
UF Health Shands Hospital's Success Story
After UF Health Shands Hospital in Gainesville experienced an outbreak of Acinetobacter on its burn unit and found its keyboards harboring the bacteria, the hospital decided to rebuild the unit and sought new solutions to prevent another outbreak.
"Our nurses were so devastated by the outbreak and so interested in what they could do to stop the spread of bacteria and viruses," Marie Ayers, RN, former interim director of infection prevention and control at UF Health Shands Hospital, said in the Seal Shield case study.
The hospital integrated Seal Shield keyboards after seeing they could withstand complete submersion in water. Nurses on the unit favored the white Seal Shield keyboards as opposed to other colors available, as dirt and debris stood out more readily on the white surface.
Antimicrobial, submergible keyboard like those from Seal Shield should be "the future and the standard for everyone in healthcare," Ms. Ayers said in the case study. "Proactively switching to a product that we can use and clean makes sense. If we clean everything and encourage cleaning high-touch areas, why not start with the keyboard?"
Device Disinfection from the Future
While Seal Shield's antimicrobial and waterproof keyboards and other devices protect hospital workers and patients against germs, they are less effective if clinicians or environmental care workers do not follow best cleaning practices for high-touch areas or electronic devices.
To combat poor compliance to cleaning best practices and reinforce accountability, Seal Shield now offers a device it calls the ElectroClave to kill two costly birds with one stone. The ElectroClave is a box that uses ultraviolet light to disinfect mobile devices like tablets and cellphones. It also charges and provides radio-frequency identification tracking of the devices.
The ElectroClave's UV light disinfection adds an extra layer to hospitals' infection prevention policies, and it can tell administrators and unit leaders which devices were recently sterilized and which were not. For instance, a device used in a room with a highly infectious patient should be disinfected. The ElectroClave system can send a push notification to the worker's phone to prompt them drop the device off to be disinfected.
Additionally, the ElectroClave allows hospitals to track assets to cut down on lost devices — an expensive problem that can put patient data at risk.
"You've really got everything you need for compliance, oversight and insight into where devices are going and who uses them," says Mr. Filion.
Hospitals with high rates of HAIs will see their bottom line and reputation suffer if they don't take steps to combat the issue. Although mobile devices are commonly used throughout the hospital and increasingly essential to care, clinicians and administrators alike must address the fact that these tools harbor and transmit potentially dangerous bacteria and viruses. By investing in devices that resist germs and are easy to wash, as well as cleaning mechanisms, hospitals can position themselves to more effectively prevent HAIs and create a safer care environment.