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INSIDE THE CURRENT ISSUE

September 2013

Operating Room

Outpatient Connection

Study shows peripherally inserted central catheters have similar CLABSI risk

A new study reports that peripherally inserted central catheters (PICCs) do not reduce the risk of central line associated bloodstream infections (CLABSIs) in hospitalized patients. PICCs have become one of the most commonly used central venous catheters (CVCs) in healthcare settings since they are considered easier and safer to use, with less risk of CLABSIs. The study, published in the September issue of Infection Control and Hospital Epidemiology, demonstrates that the risk of CLABSI with PICCs is based more on patient factors, rather than the device.

"As the use of PICCs has grown exponentially in vulnerable populations, caution and close evaluation of risks and benefits is warranted when using the device," said Vineet Chopra, MD, MSc, lead author of the study and assistant professor of medicine at the University of Michigan Health System. "This research provides novel ideas for advancing both clinical practice and science around the use of these devices."

The analysis involved 57,250 patients and revealed that hospitalized patients with PICCs were just as likely to develop bloodstream infection when compared with patients with other types of CVCs; however, non-hospitalized patients in outpatient settings appeared to fare better with PICCs than other devices.

The authors suggest adhering to proven prevention strategies to reduce CLABSIs in non-critical care settings with the same drive, intensity, and strategic insights that have been employed in intensive care units. The study also highlights the need for future research assessing the role of novel technologies and practices, such as chlorhexidine-impregnated site dressings and antimicrobial PICCs.

Panel urges lung cancer screening for millions of Americans

A federal task force is planning to recommend that millions of smokers and former smokers get a CT scan annually to look for early signs of lung cancer. The 16-member US Preventive Services Task Force gives that lung cancer screening test a grade of B, which puts it on the same level as mammography for women between the ages of 50 and 74.

That grade is important, because preventive tests with a grade of A or B oblige Medicare, other federal health programs and private insurers to cover the entire cost, beginning a year after a guideline is adopted. A lung scan costs about $300 to $500.

The task force estimates that its proposed recommendation will cut U.S. lung cancer deaths by 20,000 a year. That’s only about 13 percent of the nearly 160,000 people who die of the disease in annually in the U.S.

Under the panel’s proposal, screening is expected to save one life for every 320 people screened. By comparison, it takes 900 to 1,900 mammograms to save one life from breast cancer. And estimates that it takes about 500 colonoscopies to save a life from colon cancer.

 
 This Month's Advertisers

Surgical suites breathing easier?

by Susan Cantrell, ELS

The NOVAERUS NV600 wall unit treats areas up to 600 square feet, using less energy than a 40-watt light bulb.

Breathing easy is something most of us take for granted. Unfortunately, just because we get the air we need to live does not mean that the air around us is particularly healthful for us. Particulates and gases enter our nose and lungs all the time, and we are usually unaware of it. Some of those particulates are harmless; some can be deadly under the right circumstances. Ironically, healthcare facilities have all the ingredients present for unhealthful air; yet, patients expect to go there and get well again, and often do recover from their illness or injury, with nary a thought to air quality during their stay.

The National Institute for Occupational Safety and Health says, "Indoor environmental quality (IEQ) ... is determined by many factors, including lighting, air quality, and damp conditions. ... Indoor environments are highly complex and building occupants may be exposed to a variety of contaminants (in the form of gases and particles) from office machines, cleaning products, construction activities, carpets and furnishings, perfumes, cigarette smoke, water-
damaged building materials, microbial growth (fungal, mold, and bacterial), insects, and outdoor pollutants. Other factors such as indoor temperatures, relative humidity, and ventilation levels can also affect how individuals respond to the indoor environment."

Air cleansing

Nowhere is air quality more important than in the healthcare setting. Some interesting solutions have been born from the need for better quality air.

Plasma sterilization

Kevin Maughan, CEO, NOVAERUS, Tampa, FL, talked about their solution, based on plasma sterilization. The NOVAERUS field emits electrons that disrupt biofilms and cell walls of microorganisms, while using less energy than a 40-watt light bulb. "Developed for use in hospitals, nursing homes, and assisted-living facilities," said Maughan, "the NOVAERUS airborne infection-control system provides significant health, environmental, and cost benefits to patients, staff, and visitors. NOVAERUS eradicates all airborne viruses, bacteria, pathogens, mold, allergens, and odors using the company’s patented air plasma field technology. It is effective against even the most harmful contaminants, including methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, norovirus, and influenza."

"The NOVAERUS field uses a multifaceted plasma sterilization technique that is uniquely destructive to all microorganisms," explained Maughan, "with viral kill rates near theoretical perfection (99.9999999999%). The NOVAERUS system draws air into the unit and through a plasma field, rendering microorganisms inert and immediately destroying them at a cellular level. It also reduces microbial surface counts by up to 68%."

Maughan highlighted the cost-effectiveness
of the NOVAERUS plasma sterilization method. "Facilities will realize immediate financial benefits, including significant reductions in staff sick days; readmission rates associated with infections in nursing homes; amount of money facilities spend on antibiotics, isolation rooms, and chemicals to mask odors; and flu and norovirus outbreaks, which reduce the risk of closing admissions during critical times of the year. The yearly expense for installing NOVAERUS facility-wide typically equates to the cost of treating one healthcare-acquired infection."

Nothing spells success like positive experiences. Maughan spoke of two facilities that have used NOVAERUS with good results. "The West Gables Health Care Center, a skilled nursing facility in Miami, and the Bay Oaks assisted-living facility, also in Miami, are two of the first long-term−care facilities in the country to implement infection-control programs that combine the NOVAERUS plasma technology with their staffs’ proven expertise and traditional best practices. Both have all but eliminated incidents of respiratory distress among residents and staff."

"Marco Carrasco, administrator of the West Gables Health Care Center, reports that, during the first 2 months of 2013, his facility had 115 total admissions, with only 3 patients that were rehospitalized for pneumonia. This represents a significant reduction from both the previous year and the national average (18.3%). Bay Oaks administrator Kathryn Kassner has not had one resident visit a physician due to a respiratory issue since January 2013."

UV-C disinfection

HVAC coils before and after Steril-Aire UVC Emitter germicidal lamps installation.

One of the most prevalent trends in air cleansing is use of ultraviolet C (UV-C) light waves. Absorption of UV-C disrupts the DNA of microorganisms, rendering the cell unable to grow or reproduce. The inability to reproduce inhibits its ability to infect, and of course the cells die off.

Tim Leach, Healthcare Solutions Director, Steril-Aire, Burbank, CA, talked about the virtues of their system. "Since the building’s mechanical system is essentially the "respiratory system" of the healthcare facility, its bioburden has an impact on literally every area of the hospital for every patient, every visitor, every member of the hospital staff, 24/7. Installed in existing or new heating, cooling, and ventilating (HVAC) systems, Steril-Aire’s patented germicidal ultraviolet irradiation (UVGI) system keeps coils and drain pans clean, eliminating a major amplifier, reservoir, and disseminator of pathogens contributing to hospital bioburden."

"Many microorganisms that grow in air-conditioning systems are those
commonly attributed to healthcare-acquired infections (HAIs). These include Pseudomonas, Serratia, Enterobacter, Acinetobacter, Aspergillus, and Staphylococcus. The proper use of UVGI/ UV-C is lethal to mold, bacteria, and viruses. Studies demonstrated a greater than 5-log reduction of the bioburden within the HVAC system and the patient-care environments. These studies also demonstrated the improved HVAC and patient-environment hygiene was directly correlated to reduced infections within critically ill patient populations. Additionally there is no evidence microorganisms can become resistant to the germicidal effects of UV-C."

Leach also talked about the financial advantages of using UVGI. "Steril-Aire healthcare customers typically have seen a return on investment in less than 2 years. One major tertiary-care hospital reduced HAIs, saving the hospital over $850,000 annually in nonreimbursable direct medical costs on a $50,000 investment.2 Reduced HAIs [have] an impact not only on the facility bottom line but also in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores and community image."

"Because the UVGI eliminates the need to chemically clean the HVAC systems cooling coils, it can be considered green," said Leach. "No chemicals and no ozone also mean it is safe for building occupants. By keeping HVAC components clean, Steril-Aire UV-C also increases system heat-exchange efficiency, improving thermal comfort while significantly reducing energy and maintenance costs."

Leach offered scientific evidence. "Steril-Aire’s healthcare customers have realized reduced HAI rates, improved patient outcomes with shorter stays, and a significant reduction in direct and indirect medical costs."

"A peer-reviewed study2 performed at Women and Children’s Hospital of Buffalo (NY) demonstrated a >5-log microbial-load reduction per square centimeter of HVAC coil in just 6 days," said Leach. "The study showed a 50% reduction in ventilator-associated pneumonia, reduced antibiotic use in neonatal intensive-care high-risk patients, as well as medical savings of more than $850,000 in the first year." Leach added, "Rio Grande (TX) Hospital achieved over $60,000 annual savings in energy costs, while reducing maintenance and chemical costs."

UVDI's UV-C airstream disinfection systems are
installed in the facility's HVAC equipment.

Richard Hayes, President, UltraViolet Devices Inc., Valencia, CA, highlighted their extensive experience with UV-C air cleansing. "UltraViolet Devices Inc. (UVDI), has been in the UV-C airstream disinfection space for over 10 years. Our largest air-disinfection vertical is healthcare where UV-C air-disinfection systems are installed in HVAC equipment to disinfect air delivered to operating rooms, emergency rooms, intensive care units (ICUs), and burn wards, as well as general hospital air. These UV-C air-disinfection systems are on 24/7, to continuously deliver disinfected air throughout the facility."

"UVDI’s UV-C air-disinfection systems are mounted permanently in the HVAC system and are easily installed by hospital maintenance staff. Once installed, they clean the air 24/7 and deliver disinfected air to the hospital areas the HVAC system services. UVDI’s proprietary airstream disinfection modeling software, developed in conjunction with the Pennsylvania State University, accurately determines airstream microorganism kill performance based on UV-C system design, target organisms, and HVAC system parameters. With our proprietary software, UVDI has the ability to easily tailor UV-C system airstream design to achieve desired disinfection results."

"UV-C is lethal to all single-cell organisms. It has been used safely for over 100 years to disinfect drinking water. UV-C has been used for tuberculosis management since the 1950s, but, due to technology advancements, has recently gained strong interest in the healthcare space to mitigate threats from air-transmissible pathogens such as influenza, Legionella, and tuberculosis, as well as surface environmental contamination threats such as MRSA and C difficile."

Hayes cited positive experiences from users of their UV-C product. "Recently, Florida Hospital Group (FHG), Orlando, FL, a 2,247-bed healthcare provider with 7 acute-care campuses, conducted an extensive 18-month test of 4 UV-C manufacturers to determine who would be the best UV-C system supplier for their facilities. At the conclusion of the study, FHG selected UVDI as their UV-C system supplier due to efficacy but also due to the lowest cost of ownership of the systems studied."

Meredith Jimenez, Corporate Communications Director, American Green Technology, South Bend, IN, talked about a product expected to be available from the Arcalux Corporation, Houston, TX, shortly before this printing.


in ceiling

Arcalux Health Risk Management System

undercarriage

"The Arcalux Health Risk Management System (HRMS) is suited for any healthcare facility where contracting HAIs is a risk to the health of staff and patients," said Jimenez. "Employing Centers for Disease Control and Prevention’s recommended hierarchy of controls, the Arcalux HRMS eliminates pathogens at the source by using differential pressure to create airflow through a UV-C radiation chamber. Then filtration, purification, and dilution take place, resulting in continuously purified air and a reduction of pathogens causing HAIs. The HRMS is the only patented system using this technology."

"The advantages of the HRMS are numerous," said Jimenez. "First and foremost, it will help save lives. It is an energy efficient "green" product that uses less than 100 watts of power. Not only is this product simple to install but it doesn’t upset the current HVAC system in place and it is easy to maintain with tool-less lamp, filter, and ballast replacement."

Jimenez added, "According to the Report on the Performance of the Arcalux Health Risk Management System, by Wladyslaw J. Kowalski, Ph.D., PE, ‘The superior performance of the Arcalux HRMS will enable high levels of air disinfection to be achieved as well as a consequent reduction in the risk of airborne nosocomial infection in any healthcare environment.’"

Peter Gordon, Senior Partner, Germgard Lighting LLC, Greenwich, CT; Chair, IUVA Healthcare Working Group, talked briefly about their UV-C product in development. "Germgard is developing a point-of-surgery, point-of-care, point-of-use, mobile, UV-C, LED-based, air-disinfection device. It utilizes an innovative patent pending adjustable entrapment technique enabling very high efficacy against spores, bacteria, and viruses in a very compact space. Its unique size and scalable features allow it to be integrated into other infection-prevention disinfection systems or as a low-cost, environmentally friendly, low power consumption, stand-alone unit. It will provide a high level of air disinfection, preventing infectious pathogens from settling on surgical sites during procedures, on high-touch surfaces, on the patient during recovery in the ICU, or on workers or victims in emergency or disaster situations." 

Isolation systems

Mintie’s ECU2 generation of product is modular, scalable, and multifunctional, with all four levels of containment to comply with ICRA.

Airborne particulates can present an elevated risk during construction projects at healthcare facilities. Natural and man-made disasters also may call for special measures. Fortunately, there are companies that provide products designed specifically to contain and isolate. Mintie Technologies Inc., Los Angeles, CA, is one of those companies. Jim Bieritz, Director, US Sales, described some of their containment products. "Mintie ECUs [environmental containment units] are used for construction, renovation, and maintenance activities to provide safe risk mitigation for projects requiring Infection Control Risk Assessment containment levels 1 through 4 in occupied patient space. An ECU2 Bundle with the Corridor Flange solution provides for temporary surge isolation. This scalable design provides contingency options for creating larger isolation areas, such as a corridor or a wing of a facility, when emergency plans escalate. Additionally, the ICORoom option is designed for containing an OR suite when an infected patient needs to undergo a surgical procedure, mitigating risk of spreading contamination from the positively pressured OR."3

"Mintie provides mobile containment to facility engineers and contractors to contain particulate generated by their work," continued Bieritz. "Whether access to plenum or sidewall space or segregating HVAC service is required, Mintie products meet the challenge of mitigating HAIs. Disposable envelope (DE) options for existing frames add a superior option for work in critical-care areas. With proper use, Mintie containment products are an effective means to protect against HAIs related to facilities work activity, especially for patient populations that are immunocompromised and for critical-care populations. Utilizing containment mitigates the risk and costs associated with HAIs, lawsuits over wrongful death, and fines for noncompliance by the Joint Commission."

Bieritz noted their products’ ease of use. "Mintie’s frame design makes deployment simple and ready to use in minutes. The collapsible frame makes the ECU product easy to store, and it is very portable. The mobile platform allows for easy relocation without removing ladders and tools. The attachable Tow Cart can carry a HEPA unit to provide level 3, required negative pressure for
critical-care environments. The DE eliminates maintenance of the product."  

References

1. National Institute for Occupational Safety and Health. Indoor environmental quality. http://www.cdc.gov/niosh/topics/indoorenv/. Last accessed August 13, 2013.

2. Ryan RM, Wilding GE, Wynn RJ, et al. 2011. Effect of enhanced ultraviolet germicidal irradiation in the heating ventilation and air conditioning system on ventilator-associated pneumonia in a neonatal intensive care unit. J Perinatol. 2011;31(9):607-614.

3. Olmsted RN. Pilot study of directional airflow and containment of airborne particles in the size of Mycobacterium tuberculosis in an operating room. Am J Infect Control. 2008;36:260-267.