Infection Prevention: Understanding Efficiencies and Improving Outcomes

The CDC estimates that on any given day, 1 in 31 hospital patients and 1 in 43 nursing home residents has a healthcare-associated infection (HAI), which is an infection that occurs while being treated in a medical facility. HAIs can have devastating effects on physical, mental/emotional, and financial health. In addition, they cost billions of dollars in added expenses to the healthcare system.

To reduce these numbers and establish efficacies in infection prevention, we need to understand the role environmental surfaces and patient care equipment play in these types of infections. Poorly maintained and contaminated surfaces are primary sources for pathogens to reside, and they put patients and healthcare workers at risk of infection and/or spread via direct contact.

5 Steps for Proper Surface Infection Prevention

The following steps can help healthcare settings minimize surface-based infections.

Step 1: Make Sure the Right Equipment is in Place

For proper surface disinfection, it is paramount to have the right equipment, and that equipment must be evidence based. For example, in terms of disinfectants, healthcare settings need to look for products/solutions that clearly outline their microbial kill claims. Knowing what pathogens are the most concerning in a particular healthcare environment will help determine the best disinfectant to use.

When evaluating disinfectants, there are two main considerations healthcare settings should be looking for: kill time and safe use and handling. Kill time is the length of time a surface must stay wet for the disinfectant to kill the pathogens on the surface. For example, if a disinfectant evaporates too quickly, it may not have had time to destroy specific pathogens. And, when it comes to safety, research has shown that healthcare staff are less likely to use products that could be harmful to themselves and/or their patients.

The Environmental Protection Agency (EPA) has done toxicity studies to determine the hazard ratings of disinfectants and ranked them in six categories:

• Acute Oral (ingestion)
• Acute Dermal (skin)
• Acute Inhalation
• Primary Eye Irritation
• Primary Skin Irritation
• Dermal Sensitization

Products are then categorized into one of four levels of toxicity. Category 4 (or IV) is the least toxic, meaning it does not require personal protective equipment (PPE) or warning labels and can be used in patient environments. Products with lower risk can translate to more staff comfort with the product, which encourages regular routine usage. It could also translate to fewer work-related product injuries and reduced PPE costs. To further encourage use, products should come in user friendly forms (ready-to-use, wipes, dilutable)

Cost may also be a factor when selecting a cleaning/disinfectant program. Additional costs that should be factored into a decision include:

1. Labor: The time it takes to set up and use the product
2. Laundering: If using reusable wipes there is a cost to transport, use water and reagents, time for sorting and getting back to the user area, and potential shrinkage. Also confirming that the laundered products are “germ-free”
3. Non-compliance: Such as when a worker does not use the product because of safety concerns or odors, the product is not readily available to them, or they simply don’t have time. This leads to increased patient and staff risk and additional costs when HAIs inevitably increase.

Step 2: Establish Streamlined Processes

For many pathogens, it is not enough that surfaces and healthcare equipment are cleaned. They need to be cleaned and disinfected frequently. Reports suggest consistent daily cleaning/disinfection can lower the pathogen count on surfaces that are frequently touched, which can ultimately lower the risk of transmission.

Care tasks with patients that involve blood, feces or other bodily fluids can result in a contaminated environment. Implementing a cleaning/disinfection process after this type of care can reduce contamination, preventing pathogens from migrating to other areas of the healthcare setting.

Tips to consider:

1. Study best practices across the healthcare setting and work with cleaning suppliers to help guide those practices
2. Evaluate optimal scenarios for cleaning and disinfection. This helps to streamline practices, workflows and establish a proper timeline to complete jobs
3. Have clearly defined roles and responsibilities

Step 3: Tools for Training and Reinforcement

Once processes have been established, implement uniform training, checklists and reinforcement tools for healthcare workers, which will help with compliance. Those tools have to outline what must be done and why. They should also explain:

1. Procedures, including which products to use on which surfaces
2. How to properly apply cleaning/disinfectant products
3. Which surfaces should be cleaned and how frequently

Here are a few additional tips:

1. Make sure reinforcement tools are in place for staff. This can include wall charts, checklists, infographics, videos, etc.
2. Clearly communicate and train staff on their roles during implementation, with documentation of this training
3. Provide ongoing communication channels to continually reinforce healthcare policy

Step 4: Validate Your Work

While surface cleaning and disinfection are important, this should also be measured. Reports have illustrated that employees will react to constructive feedback and improve compliance when consistent and objective measurement data are provided. This feedback along with focusing on continual improvement helps to ensure compliance.

Applications that use fluorescent marking systems or ATP monitoring, combined with continual feedback and reporting can help healthcare settings continually improve.

Step 5: Affirmation

With busy staff, patient care, visitors, etc., healthcare settings can be a very complex environment. Some reports have illustrated that contamination of surfaces can still exist even when traditional cleaning and disinfection methods have been employed, which shows there is a genuine need to address these traditional cleaning processes and the need to employ additional disinfectant technologies.

Ultraviolet-C (UV-C) Devices

Beyond cleaning/disinfection, many healthcare settings are also deploying no-touch, chemical-free disinfection systems, such as ultraviolet-C devices, which can be extremely effective against bacteria, viruses and spores. As promising as this technology is, UV-C is not a replacement for manual cleaning and disinfection. However, UV-C added to a regimented cleaning/disinfection program has proved to reduce bioburden, thus further reducing the risk for HAIs.

When evaluating UV-C technology:

1. Understand your healthcare setting’s needs, including allowed turnover time and where and when the device(s) will be deployed. This helps to determine the number of devices needed for a given location
2. Note that different UV-C product designs have different benefits. Healthcare settings should think about cycle times, usability by staff and the capital and operating costs of such devices

In the war against HAIs, UV-C products can improve a healthcare setting’s environmental hygiene program. It can also promote safety, patient satisfaction and lower patient stays/readmission.

By adhering to the steps above, healthcare settings should, in short order, start seeing improved patient outcomes, reimbursements and an enhanced brand image.

Jim Gauthier, is senior clinical advisor of Infection Prevention at Diversey.