INFECTION PREVENTION CHALLENGES REQUIRE INNOVATIVE SOLUTIONS

Background:

COVID was front-and-center of the minds of Infection Preventionists (IPs) and nursing leaders in healthcare facilities from 2020-2022. ?The daily demands of preventing the next HAI proved to be a puzzle with missing pieces. Today, the IPs struggle to meet the demands of preventing hospital-associated infections (HAIs) with inadequate information, incomplete training, and insufficient staff.

Hospital-associated infections such as MRSA are up 15% compared to pre-COVID levels. One reason for the increase in HAIs is inadequately cleaned patientcare equipment that becomes both a fomite (a contaminated surface capable of transferring pathogenic organisms to the hands of caregivers) and a vector (a fomite that travels throughout a facility patient-to-patient without being decontaminated). The CHAIN of INFECTION REMAINS UNBROKEN.

The CDC’s (Centers for Disease Control and Prevention) “Guidelines for Environmental Infection Control in Health Care Facilities” emphasizes “Cleaning and disinfecting environmental surfaces as appropriate is fundamental in reducing their potential contribution to the incidence of healthcare-associated infections.”?

Patient care equipment and frequently used items serve as reservoirs for pathogenic microorganisms. Without a comprehensive program of identifying responsibilities for cleaning and disinfecting each piece of patient care equipment, “orphans” remain untouched and become a fomite and a vector. By taking care of the “orphan” patient care equipment, your facility’s infection prevention strategy will become more comprehensive. But you need a new CHAIN BREAKING solution that will provide one of the missing pieces of the infection prevention puzzle.

But first, we need to define terms before we suggest a solution.

Definitions:

Biofilm contributes towards healthcare-acquired infections (HAIs). The risk of HAIs comes from direct transfer of pathogens released from biofilm to patients, compromised by inadequate cleaning and decontamination. This clearly raises a question over the validity of routine cleaning practices for healthcare surfaces. Think of Biofilm as a ‘microbial village,’ with an identifiable infrastructure supporting a disparate mesh of bacteria, viruses, fungi, protozoa, and spores embedded in exopolymeric substances (EPS).

Cleaning is the removal of visible soil (e.g., organic, and inorganic material) and biofilm from furniture, wheelchairs, stretchers, and patient care equipment and normally accomplished manually by washing or scrubbing a surface while applying 1-2 pounds of pressure. This is necessary to physically remove soil and organic material such as blood and body fluids while taking many pathogens with it. High-tech solutions and plenty of hard work are needed in the intensified fight against surface contamination. Cleaning alone does not kill germs. But, by removing the germs, it decreases their number and therefore any risk of spreading infection.

The actual physical removal of microorganisms and soil by wiping or scrubbing is as important, if not more so, than any antimicrobial effect of the cleaning agent used.

Rethink Cleaning Methods

What are the implications of biofilms, particularly for cleaning and disinfecting within healthcare and senior living facilities? Two things stand out.

First, cleaning has never been more important. These biofilms, particularly dry surface biofilms, are tenacious, residential, and require specific products to both remove biofilm and kill the bad bugs. These products should be used by trained staff for “between-patient-cleaning.” Products purchased without thorough knowledge of their intended use can lead to ineffective cleaning practices, and an increased opportunity for microbes to thrive.

The guiding principle in cleaning is always remove germs if possible rather than kill them, and then when necessary use the least amount of disinfectant that will do the job of killing the “survivors.”

Second, cleaning monitoring is a critical requirement to get right. We need to ensure that both qualitative and quantitative systems of monitoring are routinely employed to document that a cleaning program is efficacious.

Remember, bugs want to survive. They may not intend to kill patients, but if substandard cleaning is the approach accepted, then patient morbidity and mortality may be a consequence of their survival.

Cleaning of Medical Equipment

Manufacturers of medical equipment should provide care and maintenance instructions specific to their equipment. These instructions should include information about a) the equipment’s compatibility with chemical disinfectants, b) whether the equipment is water-resistant or is able to be immersed for cleaning without being damaged, c) how the equipment should be decontaminated before being serviced by the biomed department.

Fit for purpose (see definition below) describes surfaces cleaned to the point that human health is protected, but they still have some contamination. A risk of disease exists, but it is at an acceptable risk level. At a minimum, cleaning must always achieve a state of “sanitation.” An unsanitary condition poses a health risk. The purpose of cleaning is to correct the risky condition. Therefore, if a risk has not been reduced to a level we call sanitary, cleaning has is not complete.

Disinfection describes a process that eliminates many or all pathogenic microorganisms on pre-cleaned surfaces. The efficacy of any disinfectant is diminished when soil is present. Disinfection is less lethal than sterilization because it destroys 99.9999% of the most recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores).

Disinfection of Medical Equipment

For equipment to be considered disinfected we remove or make safe the vast majority (>99.999%) of harmful substances on it. We eliminate the pathogens that are most threatening to patients. A disinfected condition can be achieved, but only with much effort.

Fit for Purpose is dependent upon the risk classification of the surface or item to be cleaned. For example, to be fit for purpose a telephone in a patient’s room should be cleaned at least daily because it may be touched by many individuals, including those with infectious illness. A telephone in a manager’s office may only be cleaned periodically as it is used primarily by one person with no known illness to be fit for purpose.

Orphans in healthcare are created by a failure by leadership (stakeholders) to identify “Who Cleans What and How Often?” Environmental Services (ES) techs are not usually expected to clean specific patient care items such as IV pumps, Hoyer lifts, “Crash Carts,” wheelchairs, etc. including electronic items (monitors or their cables). These are nursing responsibilities. Not only has this division of cleaning responsibilities caused confusion for managers charged with setting standards, but it has also meant that a full range of objects have been missed from the cleaning schedule (see Cleaning Medical Equipment definition above).

Doubtless there are more “orphans” depending on when and where cleaning audits are performed. Even if specific objects are assigned cleaning responsibility, they may not receive the requisite attention simply because staff do not have sufficient time or the EVS Department is trying to function with 15%-25% of their positions unfilled.

Increasing workload caused by labor shortages will compromise infection control activities. Do not compromise patient’s and staff’s health with PCE that is not fit for purpose.

DO NOT ALLOW IMPROERLY CLEANED PCE TO CONTRIBUTE TO HAIs

Hospitals have benefitted from both labor savings and improved patient outcomes by cleaning wheelchairs, bedside commodes, walkers, stretchers patient beds, IV poles, etc. in an Aqua Phase AQ-4000 Washer-Disinfector machine (think of your kitchen dishwasher’s BIG SISTER!)

The CDC estimates that when a patient’s room is terminally cleaned, less than 50% of the surfaces in the room meet the hospital’s expectation for breaking the Chain of Infection. One important part of the terminal processing of the room is the bed that must be cleaned and disinfected by an EVS team member before the next patient can occupy the room.

Do you realize the number of nooks and crannies that bed has? Those nooks and crannies provide shelter for Clostridium difficile spores that can infect subsequent patients for the next year! The process of cleaning and disinfecting the bed is NEVER done the same way by two different people.

You can eliminate the possibility that spores survive the manual cleaning of a patient bed and cut the time from 15 minutes to 5 minutes in the Aqua Phase?AQ-4000 to flush those spores down the drain AND disinfect the entire bed. It would take an EVS tech 15 minutes to do the same job and the CHAIN OF INFECTION would remain UNBROKEN.

Take the next step to remove the “food” (soil) from the “orphans” (equipment that nobody is cleaning because you do not have an effective plan of separating “clean” and “dirty” equipment). Your patients expect a clean environment.

By regulations, your facility must “…reduce the risk of infections associated with medical equipment, devices and supplies” by ensuring that all shared non-critical patient care equipment is cleaned according to the manufacturer’s instructions for use-cleaning and disinfecting.

The labor shortages in healthcare facilities and infection prevention challenges require INNOVATIVE solutions. Meet your challenges with Aqua Phase.