Pain, progress in the prevention process

July 17, 2019
2019 Infection Prevention Buyer’s Guide

Infection Prevention

Infection preventionists (IPs) are key to the many efforts that hospitals must make to keep patients safe before, during and after treatment. Each day they work diligently across departments sharing best practices and guideline updates, tracking infections rates, interfacing with regulatory agencies and educating those who work on the frontlines. Most patients are probably unaware of how important these experts are to achieving positive clinical outcomes – in fact most are probably unaware that “infection preventionist” is even a job title.

Paradoxically, however, is that many healthcare leaders in the C-suite also seem unaware of just how crucial and far-reaching an IPs’ contributions are to their system’s overall success – or if they do, they fall short on letting their IPs know. Last year, when HPN surveyed IPs and asked them if their C-suite appreciates and understands the role they play, less than half thought they did, and more than 14 percent said they didn’t know. But this could be changing. In this year’s annual infection prevention salary survey, perceived C-suite support inched up five percentage points with 55 percent of respondents reporting that they believed these executives viewed them as an important member of the team. Maybe it shouldn’t be a surprise, as healthcare systems everywhere are grappling with increasing numbers of disease epidemics and drug-resistant infections, including the current measles outbreak, which continues to spread, and Candida auris, an emerging fungus that the Centers for Disease Control and Prevention now cautions is a serious global health threat.

“Diseases now travel as quickly as we do. It is not what the next outbreak will be, but when,” said Lorene Campbell BSN, RN, CIC, Infection Specialist, Valley Children’s Hospital, Madera, CA. “We no longer live in a time where the spread of diseases moves slowly. As infection preventionists, we have been taught that we should always be prepared and ready for possible outbreaks. Identify-Isolate-Inform was the motto we learned from Ebola, and it is still one of the most important things we can do today.”

We’re also well-into a new era of value-based care where clinical outcomes, infection rates, readmissions and patient satisfaction are tied inextricably to reimbursement outcomes. “The one constant in healthcare is there is always change. We cannot change the legislation, but we can look at our processes to see if there is a better, more economical way to do something,” said Campbell, adding that hand washing is a constant priority at her facility. “I believe everyone who works in healthcare does so because they want to help others. No one intentionally forgets to wash their hands. That is why we promote a team approach. In our facility we celebrate the wins. The focus makes all the difference in how the regulations are viewed. We recently celebrated National Hand Hygiene Day by passing out lifesavers to staff when Hand Hygiene was observed. We acknowledged the action and added ‘Thank you for being a Lifesaver.’”  

Choosing the best products and services are also part of the infection prevention equation. HPN asked a handful of suppliers that are known for providing cutting-edge IP solutions two questions about their products:

  1. How does your infection prevention solution make a direct impact on reducing the spread of pathogens in hospital and other healthcare settings?
  2. Why is it a good investment (show us some real figures, strong outcomes data and other information to support your claims)?

What follows are the responses we received, including a brief showcase of what they are selling to help organizations protect patients from HAIs.* We’ve also included HPN’s annual Infection Prevention Buyer’s guide, a vendor-packed directory featuring a variety of products and services developed with infection prevention in mind.

Direct patient protections

PDI Healthcare: Joan Hebden, Independent Infection Prevention Consultant and Research Coordinator, explains how the company’s Profend Nasal Decolonization Kit is a valuable tool for defending patients against infections. “Up to 30 percent of adults are nasally colonized with S. aureus and/or MRSA. S. aureus and MRSA account for over 30 percent of SSIs and are also a key contributor to other HAIs such as CLABSIs (Central line-associated bloodstream infections) and VAP (Ventilator-associated pneumonia). Nasal colonization with these bacteria increases the patient risk of developing an SSI by nine times. To help reduce this risk, Povidone-Iodine is used as it is a broad-spectrum antiseptic that has been proven effective in reducing both S. aureus and MRSA. It offers an added advantage over the widely-used nasal antibiotic, mupirocin, in that there is no known bacterial resistance to it, thereby supporting antibiotic stewardship within the healthcare environment. By offering the Profend Nasal Decolonization Kit, you are ensuring that customers receive the product they need to help support their SSI and other HAI reduction goals.

“An estimated 157,500 SSIs resulting in more than 8,000 deaths occur annually in the U.S. healthcare system. The estimated excess length of hospital stay (LOS) for these infections is 11 days with a cost of $20,785; if MRSA is the causative pathogen, the LOS and cost increases to 23 days and $42,300, respectively. Since S. aureus is the top ranked pathogen for SSI and S. aureus carriers are two to nine times more likely than non-carriers to have SSIs, perioperative nasal decolonization has been instituted and studied as an SSI prevention strategy. By preventing an SSI, a hospital can allocate the dollars saved towards necessary supplies, equipment, and staff.” 

Mölnlycke:Peter Gross, Sr. Marketing Manager describes how Hibiclens antiseptic skin cleanser reduces bacteria, viruses, and fungi on the skin. The chlorhexidine gluconate (CHG) in Hibiclens kills germs on contact but also has a persistent effect and continues to kill 99 percent of pathogens for up to 24 hours. The unique formulation is ideally balanced to deliver infection prevention benefits but gentle enough to minimize skin irritation and deliver better patient satisfaction and encourage bathing compliance.

The patient bath is a critical component in any healthcare facility’s infection prevention protocol and Hibiclens has been shown to be clinically effective against MRSA, VRE, and C. diff.  Use of Hibiclens foam allows for multiple baths per patient during their stay vs. some other products. Hibiclens has several studies (with more in progress) that show how using it for patient bathing can reduce the risk of hospital acquired infections and their associated cost. Hibiclens is proven effective on some of the more difficult and costly infections to treat such as C. diff, CLABSI, and CAUTI infections.  One study showed disposable CHG impregnated wipes cost as much as $5.52 per patient bath resulting in $228,000 in annual expenditure. Hibiclens price per patient treatment is lower than with CHG wipes. It is also approved and versatile enough for general skin cleansing and as a surgical hand scrub and personnel hand wash so healthcare facilities can carry fewer products on the shelf.”

BD: Michael Garrison, Worldwide President of Surgery, said ChloraPrep skin preparation with sterile solution “is the only fully sterile chlorhexidine gluconate (CHG) antiseptic skin preparation commercially available in the U.S. ChloraPrep is a rapid-acting, persistent and broad-spectrum antiseptic for a wide range of procedures. The 2 percent CHG and 70 percent IPA formulation acts fast and keeps fighting bacteria for at least 48 hours.

ChloraPrep with sterile solution undergoes a proprietary and patented process to sterilize the antiseptic solution inside the sealed ampoules located in the ChloraPrep applicator. The new ChloraPrep sterile solution will include a mark to indicate that it is sterile. Though not required by the FDA, BD developed this mark to distinguish sterile solution from non-sterile antiseptic skin preparations. The sterilization process reduces the risk of intrinsic contamination by assuring less than one in a million chance that a viable microorganism can exist in a ChloraPrep applicator. 

ChloraPrep provides real world evidence that demonstrates its ability to decolonize skin of bacteria that can potentially cause skin infection and is supported by more than 50 clinical publications. It received FDA-approval in April 2019 and will be available to customers later this year.”

The EVS evolution

KleenEdge: Karen, Goelst, President, illustrated how privacy curtains spread harmful bacteria and how the KleenEdge solution works: “Everyone touches the curtain, but due to ceiling mounted cubicle tracks requiring tall ladders to remove they often get exchanged only once per year. Additionally, due to the exchanges currently being recorded manually no meaningful data surrounding Isolation Room exchanges nor protocol compliance exist. Multiple white-papers indicate that curtains are infected after just weeks in place. For patient and staff safety it’s imperative that curtains get cleaned just like all other high-risk touchpoints in a patient room.

“KleenEdge provides a cost saving solution for cubicle curtains that will enhance a hospitals’ operational efficiencies while mitigating HAIs through two key elements: Protocol Compliance Software platform sets, flags, and fully automates documentation  and data surrounding exchanges, including isolation room, gathering critical HAI metrics in the background; and our suspended cubicle track reduces curtain install and material cost by 80 percent, empowering hospitals to increase their exchange frequencies thus reducing HAI risk due to contaminated curtains.”
Halosil:Maryalice StClair, Vice President, Business Development, said the Halo Disinfection System meets the Centers for Disease Control and Prevention’s recommendations for environmental disinfection. “The Halo Disinfection System dispenses HaloMist (5 percent hydrogen peroxide and 0.01 percent ionic silver) with a HaloFogger to deliver an EPA registered (No. 84526-6) 6-log kill (99.9999 percent) of C. difficile spores in an entire room. HaloMist is also recommended by the CDC for combating the emergent pathogen C. auris. The simple-to-operate system does not wet surfaces and has excellent material compatibility. And the sporicidal efficacy of the Halo Disinfection System comes at a surprisingly low price. EVS staff can be easily trained to treat spaces with the Halo Disinfection System in less than one hour. The HaloFogger is simple to operate, sturdy, reliable and easily transported and stored.

“When Beebe Medical Center began researching the use of whole-room disinfection in 2016, an inter-disciplinary team was addressing the C. difficile rates at their facility. At that time, Beebe’s rates were just under 3 times the national average as reported on the CMS website. Currently, after implementation of the Halo Disinfection System, the SIR for C. difficile for Beebe is at 0.85, a rate that is well below the CMS target rate. Per Tim Gwaltney, Director of EVS, “There are several initiatives that have helped Beebe in achieving this milestone, and I am a convinced the use of the Halo System has been a major contributor.”

: Steve Baiocchi, Chief Operating Officer, explained how the RD UVC System bolsters terminal cleaning. “Manual cleaning techniques are used, but this type of IP isn’t fully effective on its own because of factors like human error and high resistance of antibiotic resistant organisms. Combining manual cleaning with UVC technology as a “bundled” approach is one of the most effective ways to reduce HAIs. UV technology uses UVC light to penetrate the cell walls of bacteria and viruses and render them unable to replicate. Dangerous pathogens can’t reproduce and spread after being treated with UVC energy.

“The RD UVC System design uses multiple remote sensors throughout the room that measure actual dosage delivered vs. estimated time-based systems that only rely on length of exposure. This is a critical difference when trying to prevent life-threatening infections. The ability to easily move RD UVC helps ensure that all areas receive the necessary direct light in the fastest treatment time to address the quick room turnaround time needed in today’s busy hospital settings. The RD System also includes a patented pause and reposition feature that allows the unit to be moved mid-cleaning to ensure disinfection is happening throughout the entire room

“There are obvious and tragic human costs of HAIs, prolonged sickness, hospitalization, and even death.  From a fiscal perspective, one study showed that HAI reduced net inpatient margins by $5,000 per patient on average. Being able to prove that your IP tools, like the RD UVC Systems, is doing its job to kill specific microorganisms is an example of quantifiable results and proof of compliance that helps lower costs.”

Skytron: Chris Batts, Director, UV-C Sales, said the SmartDosage UV system supports terminal cleaning. “Due to healthcare facility demands, a UVC device must simultaneously meet two primary but conflicting criteria – a high degree of assured effectiveness and a short runtime. Assured effectiveness means delivering an appropriate germ-killing dose of UVC energy to target surfaces. The proper dose of UVC is critical, otherwise you incur the danger of under-dosing which can leave harmful pathogens remaining on high touch surfaces.

“The Skytron design team recognized that the key to fast and highly effective assured disinfection treatments was generating high levels of UVC combined with intelligent dose assurance technology. Skytron’s proprietary SmartDosage UV measures the distribution of UVC in real-time then scientifically calibrates the proper treatment duration to ensure that a thorough dose of UVC energy is completely applied to entire treatment area every time. This approach removes human error, avoids the danger of under-dosing, and ensures a superior level of disinfection in the shortest possible time.  Flooding the room with UVC light enables whole-room disinfection treatments in a single-cycle without repositioning.

“In the peer-reviewed white paper, Clinical, operational, and financial impact of an ultraviolet-C terminal disinfection intervention at a community hospital, independent researchers compared the HAI rates of five MDR organisms before and after a 12-month facility wide UVC intervention using Skytron’s disinfection robots.  Not only was the UVC disinfection intervention associated with a significant reduction of multidrug-resistant HAIs but their financial analysis showed a cost savings of $1,219,878 over a 12-month period due to a reduction in patient length of stay.

“In a 6-month trial at McLaren Oakland Hospital, use of Skytron robots resulted in a 72 percent reduction in HAI C. Difficile cases and a $236,880 cost savings from the reduction in C. Diff alone.”

Micro-Scientific: Jocelyn Rasor, Senior Marketing Manager showed how Opti-Cide MAX Disinfectant Cleaner can make a direct impact on reducing the spread of pathogens in hospitals. “Opti-Cide MAX is the next evolution in Micro-Scientific’s surface disinfectant offering.  It is the best alternative for an everyday, multiple-use surface disinfectant.  It is fast, broad spectrum, compatible with surfaces and an excellent cleaner.

“Opti-Cide MAX kills tested organisms in 30 seconds to one minute, except on TB which is killed in two minutes. Faster kill times mean faster turnovers. Opti-Cide MAX also kills the dangerous ESKAPE and ESKAPE MDRO organisms in one minute. ESKAPE bacteria are responsible for approximately two-thirds of all HAI’s.

“Opti-Cide MAX is safe on clinical surfaces such as acrylic, aluminum, brass, copper, stainless steel, chrome, plastics and more. It cleans better than high alcohol formulas (55 percent) as it won’t affix blood and soil to surfaces. Our low alcohol formula (20 percent) won’t cloud plastics like high-alcohol formulas. Opti-Cide MAX has a powerful scrubbing ability to quickly and effectively clean surfaces, while still being safe on surfaces. Opti-Cide MAX is a true broad-spectrum disinfectant this is bactericidal, fungicidal, virucidal, and tuberculocidal.”

Hygiena: Sergei Lepeshinki, regional sales/marketing director,discussed the company’s SystemSure Plus and EnSureATP monitoring system to verify cleaning efforts and identify potential contamination. “The ATP monitoring system relies on luciferase reactions that will emit light in direct correlation to ATP levels. The ATP system has been used in operating rooms, patient suites, and on a wide range of equipment from Mayo stands and bed remote controls to ultrasound devices. The ATP monitoring systems allow cleaning staff to easily swab surfaces and determine possible contamination levels in 15 seconds. Staff also can record data on the testing device as well as with a free software package that allows reporting and tracking.

“While ATP measures the presence of any organic bioburden and not just bacteria or fungus, it does provide a general measure of possible contamination. When used as part of a bundle of cleaning, monitoring and other controls, it can be effective at reducing the risk of infections. The state of Maryland Clean Collaborative of 24 hospitals has been using the Hygiena SystemSure Plus ATP monitoring system to measure whether reductions in relative light units (RLUs, the units of measurement from an ATP luminometer) corresponded to reductions in HAIs. The Maryland study showed that participating facilities that improved their cleaning procedures saw a 10 percent reduction in RLUs over 12 months, as well as a 14.2 percent reduction in Clostridium difficile rates during the same time. Non-participating facilities saw just a 5.9 percent decrease in C. diff.”

* Please contact these companies directly for references.

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About the Author

Valerie J. Dimond | Managing Editor

Valerie J. Dimond was previously Managing Editor of Healthcare Purchasing News.