Reducing the risk in the environment — Striving for zero infections
Healthcare-associated infections are a primary source of illness and death among hospitalized patients, and the fifth leading cause of death in U.S. acute care hospitals. Each year, approximately 1.7 million HAIs occur in U.S. hospitals, resulting in 99,000 deaths and an estimated $20 billion in healthcare costs.
To reduce risk, cleaning and disinfection of hands, surfaces and equipment is critical. Although there has been much focus on improving hand hygiene for decades, it is still estimated that only 50 percent of healthcare workers follow basic hand hygiene measures. Even if the hand hygiene compliance rate were higher, there is still the risk that hands can become re-contaminated by touching contaminated surfaces, which is why hand hygiene and surface cleaning, and disinfection are both important factors to reduce infection.
Studies have shown that the environment can act as a reservoir in healthcare settings. Pathogens can live on surfaces for days, weeks and even months. Unfortunately, data has also shown that cleaning and disinfection of patient rooms, operating rooms and shared patient equipment is suboptimal. Previous studies have demonstrated that less than 50 percent of patient room surfaces and less than 25 percent of operating room surfaces are properly cleaned and disinfected during terminal cleaning. It has been demonstrated that a patient entering a room that was previously occupied by a colonized or infected patient has significantly higher odds of contracting that illness.
Consumerism of healthcare
Another aspect for consideration is the evolving consumerism of healthcare. Ensuring the healthcare consumer is a core focus of an organization’s strategy is key to improving outcomes, saving costs, improving satisfaction levels and ensuring consumers return or recommend a provider for a future experience. In a recent survey of 1000 patients conducted by Health Industry Distributors Association, patients revealed that a “visible commitment to infection prevention” was the leading factor that drove their satisfaction level with providers. Satisfaction levels also impact reimbursement and brand. HCAHPS is a patient satisfaction survey required by CMS for most hospitals in the United States. The survey results affect reimbursement levels and are publicly reported on the internet for all to see; directly impacting a healthcare organization’s finances and reputation.
Creating a safer environment of care
To create a safe environment for patients, it is important to reduce risk of environmental contamination during stays and to ensure the environment is effectively cleaned and disinfected before the next patient enters the room. A three-pronged approach should be considered to help reduce the risk while demonstrating a “visible commitment to preventing infection.” This article addresses these in detail.
1. Ensuring daily cleaning is optimal
2. Deploying Targeted Moments of Environmental Disinfection™ (TMED™)
3. Adding assurance at every discharge with UV–UVCqDC™
1. Ensuring daily cleaning is optimal
Both thoroughness and frequency of cleaning are key to outcomes. There are many considerations to ensure optimization including:
a. Clearly defined roles and responsibilities. A checklist of all surfaces, equipment and areas to be cleaned and disinfected, along with who, when and how often these tasks are to be performed is key to ensuring staff members understand their role. It is important for staff to understand not just what to do, but also why these tasks are so important for the safety of staff, patients and visitors. Well-defined procedures need to be in place outlining how to effectively complete these tasks along with tools to reinforce learning.
b. Having the right tools to do the job, drives compliance and efficiency. Labor represents the largest cost in healthcare, so it is critical to provide staff with the right products and tools to streamline activities, reducing labor and turnover time. Products and tools that get the job done faster (quicker dwell times, fewer steps) can drive efficiency. To ensure cleaning compliance of high touch surfaces, products selected should be non-irritating to patients and staff to ensure that key activities, such as disinfecting surfaces near the patient, are pleasant for the patient, and also safe for use by staff.
c. Deploying a validation program with ongoing training to address areas of opportunity. If cleaning and disinfection compliance is important, it needs to be measured. A measurement program to ensure the job is getting done correctly will improve the odds of success. The data generated through the program can be used to recognize great performance and address areas of opportunity with constructive feedback and increased training.
2. Deploying Targeted Moments of Environmental Disinfection (TMED™)
Every human is covered in microorganisms, which can be shed into the environment by patients, staff and visitors entering a patient room. To address this, healthcare settings typically incorporate a daily cleaning regime. Typically, environmental services staff members spend 15 minutes on a daily clean (Source: AHE 2018 Trends Survey).
Every patient deserves a safe environment of care. Yet we know that after that daily cleaning, patient care activities continue to happen throughout the day, generating contamination that can create risk for the patient or contaminate the hands of healthcare staff. Because of this, surfaces may need to be addressed more than once a day.
a. Identify patient care activities that create the highest level of environmental contamination. By assessing the level of environmental contamination created by standard patient care activities, it is possible to identify those which create the highest risk. Examples would include procedures involving feces or respiratory secretions, since these body fluids generally have high microorganism counts. Once these moments are identified, procedures and roles and responsibilities can be outlined to incorporate cleaning and disinfection into these activities, reducing contamination in the environment of care.
b. Educate staff on moments of environmental disinfection. Similar to the World Health Organization’s 5 Moments of Hand Hygiene, the TMED concept is designed to emphasize when cleaning and disinfection should be performed to minimize the risk of pathogen acquisition by the patient or on to the hands of staff. By educating staff on these moments, a programmatic approach can be developed to reduce the bio-load in the patient’s environment between daily cleanings.
c. Provide the proper products for successful implementation. To drive success, it is necessary to ensure that disinfectant cleaners are easily accessible when and where staff need them, typically at the point of care. Consideration should be given to the placement, ease of use, and the safety profile of the disinfectant to ensure that staff, visitors and patients are able to use them to reduce contamination, without the risk of irritation or inconvenience. Disposable, pre-wetted, nonhazardous (non-irritating to eyes, skin and respiratory tracts) wipes, mounted at the bedside or on portable patient care equipment are ideal.
Educating staff members, visitors, and even patients, in the role of surfaces in pathogen transmission and encouraging their engagement in helping address the risk through hand hygiene and the cleaning and disinfection of surfaces can help improve outcomes.
3. Adding assurance at every discharge
Manual cleaning may not always be enough. Experts agree that thorough cleaning and disinfection of environmental surfaces is an essential element of an effective infection prevention program; however, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. Inconsistent manual cleaning processes, time pressure and lack of an auditing process can affect the efficacy of manual disinfection. Human error will always add risk to the manual disinfection process.
Adjunct technologies, such as UV-C disinfection devices, have become a critical part of how healthcare settings control HAIs. Augmenting terminal cleans in patient rooms and operating rooms has proven effective in reducing the risk for HAIs.
Numerous studies have shown that standard manual cleaning and disinfection of surfaces can reduce, but often does not eliminate, important pathogens such as Clostridium difficile and methicillin-resistant Staphylococcus aureus. Of 1,917 patient rooms cleaned using standard processes, nearly 25 percent still contained strains of MRSA, according to a 2014 study in BMJ Journals. This suggests hospitals cannot rely on manual cleaning alone to fully eradicate pathogens. Even more compelling is research that has shown that a patient entering a room where the previous occupant was colonized or infected with a multidrugresistant organism has a significantly higher risk of acquiring that pathogen.
There are numerous studies supporting the efficacy of UV-C in reducing the viability of a broad range of problematic pathogens, particularly antibiotic resistant strains. UV-C also covers surfaces wipes may miss, helping healthcare facilities achieve better cleaning outcomes.
Because turnover time is so important to many facilities, cycle time is an important consideration when selecting a UV-C device. Other considerations are tied to the usability of the device – safety features, portability, ease-of use, and the ability to easily transport and store the devices so they are available when and where they are needed. All of these features also factor in to the return on invested capital — the more rooms that can be disinfected in a designated time frame, the higher the return.
In many cases, due to capital and time requirements, UV-C disinfection is being limited to a small sampling of rooms; however, with newer technologies, cycle times and cost of use have been reduced, enabling UV-C to be used more broadly across facilities. This may also drive patient satisfaction by demonstrating a firm commitment to preventing infection.
In summary, having a three-pronged approach can significantly reduce the potential risk associated in transmission. An effective and efficient manual cleaning program, coupled with the ability to address targeted moments, can help keep patients safe during their stay. Incorporation of manual disinfection followed by UV-C technology can ensure that healthcare facilities are creating a safe environment for the next patient, promoting safety and satisfaction for patients while curbing the financial burden of HAIs and lengthy patient stays.
Diversey can help you assess your risk and recommend best practices to keep patients safer during their stay, while helping you improve turnover times, increase productivity and deliver improved outcomes.
More articles on quality:
10 hospitals seeking RCM talent
Analysis: New York's surprise-billing solution is causing healthcare costs to climb
Missouri hospital's finances dragged by unpaid patient debt