Proactive Intervention to Protect Those Most at Risk from Hospital Associated Infections

Broomfield Hospital United Kingdom Proactive Intervention to Protect Those Most at Risk from Hospital Associated Infections

Healthcare-associated infections (HAIs) continue to pose serious risks to patient safety. It is estimated that 4.1 million people acquire an infection every year in Europe and, as a result, 37,000 deaths occur 1. Irrespective of the country of origin, guidelines from all over the world favor a proactive approach to HAI management. In the UK, the Department of Health has set targets for the reduction of infections such as MRSA at the national and local level. Hospitals must demonstrate a proactive approach to infection prevention rather than reactive management of infections. Traditional cleaning methods are ineffective at removing dangerous pathogens and can involve the use of chemicals like formaldehyde and glutaraldehyde which can be dangerous for both healthcare workers and patients 2,3. Steam cleaning methods are effective but cannot remove spores 4. Novel area decontamination technologies, used in conjunction with manual cleaning therefore represent an important development in the prevention of HAIs. Cleaning never used to be much of a science. But it s no longer just all about rubber gloves and mops and buckets. Domestic services are moving into a new area, led by infection prevention. said Andy Wright, Hotel Services Manager at Broomfield Hospital in Chelmsford, Essex. Mid Essex Hospital Services NHS Trust provides a comprehensive range of acute and community based services to 360,000 people living in and around the towns of Braintree, Chelmsford, Maldon and Witham. The Trust, based in Chelmsford, Essex, is also home to the St Andrew s centre for plastic surgery and burns. The supra regional burns service serves a population of 9.8 million. In 2010 all of the acute services were centralised onto one site at Broomfield Hospital. The Broomfield team uses eight GLOSAIR area decontamination systems on a daily basis with a focus on the Burns Unit and Operating Rooms as extra protection for patients most vulnerable to the risk of HAIs. In addition, where patients are colonised or infected with bacteria such as staphylococcus, the system is used in rooms of such cases. The reason for this is to reduce the number of bacteria present and therefore reduce the risk of transmission to others and occurrence of outbreaks. ITU, wards and patient side rooms are also regularly decontaminated. In the ITU, the system works around multiple surface types such as the operating kit and IT systems, meaning equipment does not need to be removed. As certain sections of a ward can be isolated, it is practical to decontaminate large areas of the hospital at any one time. The area decontamination system uses a combination of hydrogen peroxide (H2O 2) in a 5-6% concentration and silver cations to kill pathogens and rapidly disinfect surfaces and reduce bioburden. Andy Wright said, The 5% hydrogen peroxide concentration was of particular reassurance from a health and safety point of view, in terms of lower risk and nervousness amongst staff around the use of chemicals. The system has proven effective against a broad range of pathogens including: Acinetobacter baumannii, moulds (particularly Aspergillus), Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, Mycobacterium tuberculosis, Enterobacter aerogenes and Klebsiella pneumonia. 3

Standard Infection Control Procedures Other Measures Cleaning Disinfection Effective and regular hand washing Appropriate personal protective clothing Appropriate sharps disposal Appropriate contaminated waste disposal Continual effective staff training Removal of visible dirt neutral detergent solution hot water (80 O C) Daily cleaning of horizontal surfaces and all toilet areas Immediate cleaning of blood and other body fluids spillages (detergent and water) Regular laundry cleaning Frequent use of disinfection methods area decontamination fogging manual sprays Deep Clean periodic episodes of extremely stringent cleaning and disinfection procedures Infection Control During an Outbreak Other Measures Cleaning Disinfection Standard procedures plus isolation of infected patients additional screening programs stringent adherence to hand hygiene Standard procedures plus perform cleaning procedures more regularly special attention to rooms of infected patients once vacated Standard procedures plus introduce additional effective disinfection procedures perform disinfection procedures more regularly special attention to rooms of infected patients once vacated Figure 1: Where the hydrogen peroxide system fits into general procedures for infection prevention (adapted from: Prevention of HAIs: A Practical Guide 5, Practical Guidelines for Infection Control in Health Care Facilities 6, and Standard Infection Control Procedures 7 ) 4

Standard infection control procedures will always be important but, for me, area decontamination is the icing on the cake. Andy Wright, Hotel Services Manager, Broomfield Hospital Decontamination cycle time is 2.5 hours which as Andy Wright explains, In the context of the overall turnaround time of patient rooms, is not that long and provides the right reassurance to patients. Recent MRSA outbreaks in the UK have led to negative media publicity around patient health and safety within the hospital environment, meaning patients and their families are well informed about the risks of infection leading to greater concern. If a patient picks up an infection, suing the hospital is not uncommon. The hospital s view is that area decontamination shows they are doing their reasonable best to minimise this risk. Domestic Team Leader at Broomfield, Debby Munn, went on to explain, We have two decontamination systems permanently in the burns unit and they instill confidence in patients, relatives and carers. Patients are continually asking us about cleanliness; it s good to be able to reassure them that we are doing our upmost to protect them. Broomfield Hospital made a conscious decision to adopt a proactive infection prevention strategy and, in addition to the health and safety benefits, it has also proven to be a good business decision. In the European Union, it is estimated that HAIs account for 5.48 billion in healthcare costs each year 8. Patients with HAIs have extended stays in hospital, typically ranging from five to 40 extra days in hospital per infection 9. The cost to an individual hospital depends on the type of infection, but broadly range from 694 to 13,880 per infected patient 10. The majority of these costs (52%) are associated with extra nursing time and medical care 11. Interestingly, in addition to cost-savings from preventing HAIs at the hospital, Broomfield has found that their decision to invest in area decontamination is providing them with a competitive differentiator. The use of GLOSAIR at Broomfield has really elevated our profile and differentiates us from other local hospitals that do not regularly use area decontamination as a way of preventing and controlling outbreaks of HAIs. We have been asked to share our knowledge and experience of area decontamination with neighboring PCTs who are also eager to understand how this complementary resource might benefit them, said Andy Wright. 5

References 1. Europa: The Official Website of the European Union. Questions and Answers on Patient Safety, Including the Prevention and Control of Healthcare Associated Infections. http://europa.eu/rapid/pressreleasesaction.do?reference=memo/08/788&format= HT ML&aged=0&language=EN [accessed 27th May 2011] 2. French GL, Otter JA, Shannon KP, Adams NM, Watling D, Parks MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect. 2004; 57: 31-37 3. Gannon PF, Bright P, Campbell M, O Hickey SP, Burge PS. Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments. Thorax. 1995;50:156-159 4. ASP data on file 5. World Health Organization. Prevention of Hospital-Acquired Infections: A Practical Guide. 2d ed. Geneva: World Health Organization, 2002 6. World Health Organization. Practical Guidelines for Infection Control in Health Care Facilities. 2004. Available at: http://www. searo.who.int/linkfiles/publications_practicalguidelinsearopub-41.pdf [accessed 27th May 2011] 7. http://www.leics.gov.uk/infectious_control_procedure.doc [accessed 27th May 2011] 8. Europa: The Official Website of the European Union. Questions and Answers on Patient Safety, Including the Prevention and Control of Healthcare Associated Infections http://europa.eu/rapid/pressreleasesaction.do?reference=memo/08/788&format= HT ML&aged=0&language=EN [accessed 27th May 2011] 9. Data on file. Original calculation in USD converted to Euros: 1USD=0.69 10. Ploughman R et al. The Socio-Economic Burden of Hospital Acquired Infection. Public Health Laboratory Service Report for the Department of Health. 1999 11. Gebhardt DOE. MRSA in the Netherlands: preventative measure raises a moral issue. J Med Ethics. 2003; 29: 212 6