HealthTrust monitors tools to reduce environmental contamination and prevent the spread of germs
As every healthcare worker knows, the best way to reduce environmental contamination is through frequent handwashing and thorough cleaning and disinfection of patient rooms and other high-touch surfaces. “The solutions seem simple and easy to do, but they are not always performed adequately,” says Marcia Williams, HealthTrust director of Nursing Services.
Despite rigorous adherence to these protocols and the best of intentions by hospital staff, healthcare-associated infections (HAIs or nosocomial infections) still occur at too high of a rate. According to the Centers for Disease Control and Prevention, there were an estimated 722,000 HAIs in U.S. acute care hospitals in 2011—that’s one in 25 patients hospitalized on any given day. (See related story on emerging pathogen management.)
Williams says the rate of compliance with good hand-hygiene practices directly impacts the rate of contaminant transmission, as can incomplete environmental cleaning, but also to blame are the enormous amounts of bacteria and other pathogens that exist in healthcare settings.
“Bacteria and spores that can survive on surfaces for extended lengths of time create an environment in which even good cleaning practices are not always fully effective,” she says. “Couple that with the increasing rates of antibiotic resistant bacterial contamination in the healthcare environment and one can see a need for additional infection prevention resources.”
Recognizing the limitations of standard decontamination practices, infection preventionists are turning their attention to emerging technologies that work to reduce environmental contamination to prevent the spread of germs. Here are three of the most promising ones (and see infographic below):
Because copper has proven antimicrobial properties and can continuously kill microbes, manufacturers have begun incorporating copper alloys into certain high-touch, hard hospital surfaces, such as IV poles, overbed tables, bed and stretcher rails, doorknobs, light switch plates, and equipment handles. Williams says various studies have found that copper surfaces used in healthcare settings can be effective in quickly reducing pathogens like vancomycin-resistant enterococci, coliforms and methicillin-resistant Staphylococcus aureus (MRSA), but they have so far proven inconclusive or less effective against pathogens like Clostridium difficile (C-diff).
Advantages: Copper is a passive method, meaning no behavioral modifications are required for it to be effective. As long as it isn’t obviously soiled, it remains effective. “The implications are appealing because the copper surface works consistently regardless of healthcare provider practices, such as hand hygiene,” Williams says.
Disadvantages: Copper is expensive and in order for a copper surface to be antimicrobial, it needs to contain at least 58 percent of the heavy metal. “It takes a lot of copper to cover some of the surfaces that would benefit most from it, so it definitely is cost-prohibitive,” Williams says.
Given the cost, researchers have yet to provide a direct link between copper surfaces and the reduction of hospital-acquired infections. “One published study associates copper coatings on specific high-touch surfaces with a reduced rate of hospital-acquired infections, but the contribution of copper technology to a direct reduction in HAIs is unresolved and requires additional study,” says Julia Moody, MS, director, Infection Prevention, Clinical Services Group at HCA.
Silver is another heavy metal known for its antimicrobial properties. Unlike copper, silver can be used to coat products that are in direct contact with the patient. It acts as a broad antibiotic and, because silver’s nanoparticles are effective in reducing pathogens, the metal can be incorporated into a variety of products. These include fabrics, such as cubicle curtains and uniforms, as well as environmental cleaning products to help enhance the basic practice of cleaning and disinfecting patient rooms.
Advantages: Silver is ultimately cheaper to implement than copper because less of it is needed to create an antimicrobial environment. Plus, the role of silver is already proven in decreasing HAIs from peripherally inserted central, urinary and dialysis catheters, as well as from silver dressings and surgical instruments. Williams notes that using products made with silver tend to be more expensive, but there are guidelines for determining when the use of those products may be appropriate.
Disadvantages: One concern with silver is that tolerance can develop and its effectiveness can wear off over time. Moody adds that its direct correlation to reducing HAIs is also unresolved and that additional studies are needed before its widespread use in reducing environmental contamination can be recommended.
In direct surface contact within certain ranges, UV light can kill a variety of pathogens that cause HAIs, including C-diff. It’s most often used to aid in terminal cleaning of patient and surgery rooms that occurs upon a patient’s departure, since the areas being treated have to be secured with no one present while robots emit the disinfecting UV light. Williams says UV light can also be used to help disinfect public spaces such as lobbies, as well as equipment in a supply room, which can be helpful during an outbreak.
“UV light and other no-touch technologies may make sense if rates of HAIs remain at either high endemic or epidemic rates despite documenting compliance with basic environmental and other infection prevention practices,” Moody says.
Advantages: UV light is proven to be effective against C-diff. In a 2014 study published in the American Journal of Infection Control, authors Hass, et al. observed a 17 percent reduction in hospital-acquired C-diff with the use of UV light. Other studies have found similar, or better, rates of effectiveness.
Another advantage of UV light is its mobility. Since most UV light disinfecting robots are mobile, they can easily be used in various hospital areas. Their automated process also helps reduce the risk of human error during environmental decontamination.
“For outbreaks, no-touch technologies have been valuable as special technology interventions after careful consideration of the likely sources of the outbreak,” Moody says.
Disadvantages: Adding UV light to the cleaning process increases the turnaround time of a room. However, Williams notes that the technology is improving, with some robots now requiring just 20 minutes to disinfect a room.
One robot, the Tru-D SmartUVC Room Disinfection System, uses eight calibrated sensors to scan the room and acquire its dimensions. It can then disinfect the entire room from a single optimized location.
While these emerging technologies show promise in helping reduce environmental contaminants in the healthcare setting, Williams cautions, “There is no panacea. Any of these products should be used as an adjunct to hand hygiene and thoroughly cleaning rooms, which are still fundamental in reducing the transfer of pathogens to patients.”