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KSR Publishing, Inc.
Copyright © 2016
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         Clinical intelligence for supply chain leadership

 
 
 

INSIDE THE CURRENT ISSUE

June 2015

CS Connection

 
 


 

Going under cover to fight HAIs

Latest healthcare linens and textiles fight infection, provide comfort, convenience, performance

by Kara Nadeau

The healthcare linens and textiles category covers a broad range of products from privacy curtains to scrub apparel. When designing these materials, manufacturers must take into account a variety of factors, including functionality, durability, convenience and comfort. At a time when there is heightened awareness of healthcare-acquired infections (HAIs), the role of textiles and linens in spreading infections is another critical consideration. Furthermore, as healthcare reform drives facilities to deliver higher quality care in a more cost-effective manner, they must address how these products, and their management of them, impact both costs and clinical outcomes.

The HAI-fabric connection

Numerous studies show how healthcare linens and textiles can harbor a variety of bacteria:

  • One study found admission to a room previously occupied by a methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) positive patient increased the odds of transmission by 40 percent.1

  • An analysis of privacy curtains in intensive care units and a medical ward found 95 percent of curtains were contaminated on at least one occasion, including 21 percent with MRSA and 42 percent with VRE.2

  • An analysis of unwashed operating room (OR) scrubs revealed 79 percent were positive for some type of gram-positive cocci, with 10 percent of those classified as Staphylococcus aureus, and 69 percent were positive for coliform bacteria.3

  • Between August 2008 and July 2009, five children died of Mucormycosis fungal infections following an outbreak at the Children's Hospital of New Orleans likely spread by contaminated bed linens, towels or gowns.4

"In order to keep both healthcare providers and patients safe, it is important that infection preventionists and other healthcare professionals view textiles as a possible vehicle for transmission of bacteria," said Karan Jhunjhunwala, Founder of LifeThreads. "Most people working in hospitals assume that laundry returned to them is in-fact clean and therefore safe. Laundry may certainly have had the dirt removed, but it is far from sterile. In many cases, infection control teams are encouraged to take laundering very seriously to prevent outbreaks."

Protection through engineering

One way to minimize the spread of bacteria through contaminated textiles and linens is to engineer protection into the materials themselves. There are a number of manufacturers that offer products featuring antimicrobial protection or fluid repellency, along with moisture and odor control.

Vestagen Vestex active barrier protective fabrics

For example, Vestagen recently launched specially designed scrubs for OR staff made with its Vestex technology that meet the new Association of Perioperative Registered Nurses (AORN) attire recommended practices (http://isgweb.aorn.org/
ISGWeb/downloads/
CEA12503-0001.pdf). Vestex active barrier protective fabrics combine antimicrobial, fluid repellent and breathability properties. The company notes that healthcare lab coats, scrubs and patient gowns made with Vestex fabric are clinically proven to protect workers and patients from dangerous contaminants. Published clinical research showed a 99.99 percent reduction of MRSA on active barrier uniforms worn in an intensive care unit compared to traditional non-protective uniforms, both at the beginning and end of the work shift.5

"Active barrier attire fills a gap in provider and patient safety from unexpected exposures — a gap that is widening due to an increase in superbug prevalence and the globalization of emerging infectious disease threats like Ebola," said Ben Favret, Founder and President of Vestagen Technical Textiles Inc. "Hospitals and health systems need simple, effective solutions to better protect their staff and help lower the risk of contracting a hospital-acquired infection."

Paul Ford, CEO of Sciessent states that, in the past, many of the products that provided repellency, moisture management, antimicrobial and anti-odor finishes did not have the durability to survive aggressive laundering procedures. He explains how Sciessent is now offering highly durable, functional finishes for healthcare linens and textiles that survive up to 100 launderings. 

Comfort Line’s central-line medical garment with Sciessent’s AGION

"In the case of Sciessent, we work with customers to infuse our AGION silver- and copper-based antimicrobial technology into the surface of fabrics, polymers or coatings," said Ford. "Silver and copper are some of the most highly effective and long-lasting antimicrobial agents, and testing has shown that they are effective when applied to medical devices against resistant bacteria, including CRE, MRSA and VRE. Sciessent’s technology works through the controlled release of elemental ions, which attack microbes and inhibit their growth."

Comfort Line, a company that provides central-line safety solutions for medical providers and patients, recently integrated Sciessent’s AGION antimicrobial technology into its patented central-line medical garment. Comfort Line’s garment was designed to safeguard, secure and store a central line, while providing easy access to caregivers. Infused with natural silver and copper ions, the garment provides smart antimicrobial protection on demand.

According to Kelly Kirby, Commu­nications, PurThread, her company is focused on improving antimicrobial textile technology to make it more efficacious, durable, versatile, and easy to manufacture.

"PurThread has achieved this by embedding natural, non-nano silver in fiber and yarn at the molten stage of production so that the antimicrobial effects of the silver are permanent and disbursed evenly throughout the resulting textile—the embedded silver doesn’t wash away or wear off over time," said Kirby. "Also, because the silver is embedded rather than woven in, it is ‘invisible’ to the resulting fabrics, making it more versatile for manufacturers—allowing dyeing, bleaching, and blending with other fibers for additional product features."

A recent University of Arizona study conducted by renowned microbiologist Charles Gerba, Ph.D. showed PurThread killed 99.9 percent of MRSA, CRE, VRE, C. diff, E. coli, and a number of other bacteria on healthcare textiles within two hours.6 Additional studies have shown that PurThread continues to work at the same high rate even after 100 caustic industrial launderings (data available on request from PurThread).

Karin Mueller, Vice President of Marketing for Noble Biomaterials Inc., explains how linens and textiles permanently bonded with a layer of 99.9 percent antimicrobial silver should serve as one piece of an overall soft surface bacterial management strategy, including conducting a soft surface risk assessment, audits of cleaning and storage procedures, proper laundering and monitoring.

Scrubs Powered by X-STATIC Technology

"Staff education is also paramount," said Mueller. "If they aren’t treating contaminated soft surfaces the same way as contaminated hard surfaces, they might not realize that they are re-contaminating their hands if they place them in a pocket or pull back a privacy curtain."

Noble Biomaterials’ X-STATIC antimicrobial technology is used in healthcare fabrics such as scrubs, uniforms, privacy curtains and lab coats. Since it is embedded in the fabric, it provides permanent protection between launderings, lasting the life of the product. X-STATIC has been proven to reduce 99.9 percent of bacteria on the surface of fabrics within one hour (contact Noble Biomaterials for data). It is registered as an antimicrobial with the Environmental Protection Agency, made in the U.S. and is used by Olympic athletes, U.S. armed services and leading athletic brands.

LifeThreads antimicrobial bed sheets and pillowcases

LifeThreads has introduced antimicrobial bed sheets and pillowcases made from a new fabric, called Grace, that maintains the look and feel of cotton and other blends, but will not lint or shrink, has inherent stain resistant properties and provides superior durability. According to the company, its linens can withstand multiple washings and can be easily laundered. They also offer better pilling and stain resistance. Treated with an EPA-registered antimicrobial ingredient, LifeThreads’ linens are shown to inhibit the growth of bacteria concentrations by 99.99 percent in laboratory tests.

"There have been many new initiatives that work to combat infections including patient surveillance, hand hygiene, contact precautions, environmental sanitization, hard surface cleaning and most recently, soft surfaces, but no single innovation can be effective without an integrated approach," said Jhunjhunwala. "Adding antimicrobial textiles to an existing infection control strategy limits the chances of cross-contamination, creating a safer healthcare environment."

Using color to clear up confusion

Another way healthcare facilities are mitigating the risk of patient room-to-room contamination is through color-coded textile products. According to George Clarke, CEO of UMF Corporation, use of the company’s PerfectCLEAN Color-Coded System and "one-per-room" methodology has been shown to play a valuable role in multimodal efforts to reduce the rates of Clostridium difficile (C. difficile) infections, and the process has also contributed to increasing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

UMF Corporation Orange PerfectCLEAN products for the bathroom

To reduce the chances of bacteria spreading via cross-contamination, a color-coded process works like this:

  • A fresh set of color-coded products are used in each room, including bathrooms, patient rooms and operating rooms

  • These products never cross the threshold into a second room

  • Instead, they are used once then laundered according to Center for Disease Control guidelines for Blood Borne Pathogens before being put back into service

  • PerfectCLEAN orange products are used only in the patient bathroom; blue products are used in the patient room, green products in the operating room, yellow for intensive care and gray for common areas.  

"There’s been a tsunami of news and events of late that has triggered some heightened focus from healthcare professionals on how to more effectively combat the challenges of HAIs," said Clarke. "In the wake of these circumstances, enlightened healthcare professionals have realized that facility-wide multimodal intervention is the only type of enterprise-wide program that has any chance of success in confronting these HAI challenges."

Caregiver clothing

Medline's three-arm isolation gown

Because many linens and textiles come in close contact with the bodies of patients and healthcare workers, they must be not only durable and hygienic, but also comfortable and convenient.

According to Kristen Kanka, Vice President of Marketing for Textiles, Medline, providing clinicians with better quality products that are easier to use benefits both healthcare providers and patients.

"Half the battle with infection control is around staff compliance to rules and regulations," said Kanka. "Medline offers a three-arm isolation gown that has 360 degree coverage, promoting compliance. Not only is there no right or wrong way to don the gown — although most prefer to wear it like a coat — there are no ties and does not require the assistance of another person to put it on. The gown meets all Association for the Advancement of Medical Instrumentation (AAMI) standard requirements for protection."

As David Schechter, Vice President of Marketing for Fashion Seal Healthcare points out, style is also an important consideration when it comes to healthcare worker apparel.

Fashion Seal Healthcare’s
SimplySoft scrub apparel

"Just like all of us, healthcare workers want to look good and feel good in their uniforms," said Schechter. "Gone are the days of stiff, scratchy fabrics in only blue and green. Now employees can look great, reflect their individual style, and have all the features that make them comfortable at work. Employees who look good and feel good will provide better patient and family interaction and care."

Fashion Seal Health­care’s latest line of SimplySoft scrub apparel includes stylish, industrial laundry-friendly scrub shirts, pants and warm-ups. Paired with fashion forward designs, the SimplySoft line utilizes a brushed finish in a 65/35 poplin to provide a soft, comfortable wear for end users. Key benefits include softer hand for enhanced comfort, retail-inspired styles to please fashion forward employees, the perfect fit, and practical features including moisture-wicking side flex panels and specialized pockets.

Patient pleasers

Comfort, convenience and style are equally important for patients, according to Kanka.

"If a gown offers more coverage, the patient will be more confident to get up and be active — encouraging and enhancing the healing process," She states. "If pediatric gowns feel like familiar pajamas and feature a friendly and familiar face like our exclusive Disney collection, we are helping to reduce the anxiety of the situation for the child and creating a bond between the clinical team, patient and family."

Knowing that patient experience continues to be a significant focus for healthcare facilities, Medline developed a patient apparel collection that maintains dignity through full coverage and colorfast options. Kanka notes that the company’s PerforMAX adult gowns look new even after hundreds of washes.

"Almost every patient who walks into an acute-care facility will come into contact with a gown and this is an opportunity for the facility to make a positive impression," said Kanka.

Encompass Fusion Patient Care Underpads by MIP

Patient care underpads and slider sheets for patient positioning are two other product categories where comfort, convenience and durability are paramount. Janice Larson, Vice President of Clinical Resources, Acute Care, Encompass Group LLC, points to new reusable technology that is highly absorbent, soft on at-risk patient skin, durable and cost effective.

"Many hospitals are unaware that there is a reusable underpad alternative to the array of highly absorbent disposable underpads that have flooded the market of late," said Larson. "In addition, the introduction of the reusable slider sheet has provided caregivers with a breathable, launderable product that supports the microclimate of the skin, can be left on the bed, and provides a much a safer way to position patients than traditional draw sheets."

Surface Medical’s CleanPatch

According to Brenda Marks, Senior Product Manager for Surface Medical Inc., no matter what types of linens are being used, one very important issue is the condition of the underlying surface of the mattress cover. She points out how the FDA issued a Safety Communication in April 2013 warning that damaged medical mattresses present a potential risk of cross contamination from blood or body fluids penetrating the mattress core (http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm348016.htm). The agency recommends that mattresses be regularly inspected for any signs of damage such as cuts, tears, cracks, pinholes, snags, or stains.

Surface Medical’s CleanPatch is the first FDA-registered Class I Medical Surface Repair Patch specifically designed for damaged patient mattresses and stretchers. Marks notes how Infection Prevention and Control professionals have embraced the product with over 500 hospitals using it in the United States, Canada and the UK.

"CleanPatch was inspired by an ICU nurse manager who understood the importance of intact surfaces underneath the linens and was frustrated by the inconvenience and extraordinary cost of replacing a mattress each time a small tear or puncture occurred," said Marks.

Linen management

According to the Textile Rental Services Association (TRSA), an international organization representing companies in the textile rental services industry, nearly 90 percent of all linen used in U.S. hospitals does not reach its useful life, costing the healthcare industry more than $840 million annually.7

Jhunjhunwala points out that there are two models healthcare facilities typically follow for linen management, either buying and maintaining their own products or renting from a launderer, and each requires a different strategy to avoid linen loss.

"For facilities that own their own products, avoiding the high cost of linens loss can be addressed by purchasing a superior quality product which lasts longer and can withstand multiple launderings," said Jhunjhunwala. "Facilities can also implement policies that prohibit healthcare professionals from wearing their uniforms outside of the facility and laundering the garments at home. Not only does this prevent loss, it protects the staff from the possibility of taking germs home on their clothes."

"If the facility works with a third-party laundry service, they must be selective when choosing a partner," Jhunjhunwala adds. "This entails ensuring the laundry company buys quality products, uses the right chemicals to wash them and properly tracks the inventory. Tracking inventory can be accomplished through the use of radiofrequency identification (RFID) chips and barcoding."

Larson states that a key step in addressing linen loss is to identify the specific items incurring the majority of the cost of unexplained loss — not to be confused with usual replacement — and then benchmark to see if their loss of these items is above average.

Once you know what and how much you are losing, you can put together specific action plans on how to address the loss. Including administration, medical staff, nursing, security, linen and laundry in those plans as appropriate is key to controlling loss," said Larson.

According to Schechter, barcoding and RFID technology are two solutions to address and control linen and uniform losses, noting how with this technology, garment and linen lifecycles are tracked on a more accurate and granular level. 

"RFID allows facilities to track and count uniforms and linen more accurately and on a real-time basis helping to realize loss more quickly and potentially identify the source of the loss," he said.

While policies and technologies can aid in linen management, staff education is a critical component to any loss prevention strategy.

"We work closely with our laundry partners and product end users to clearly understand how our garments are being used, and what they might experience under normal and extraordinary conditions," said Schechter. "Based on that understanding we work to educate end users to recognize the limited situations where a garment should be discarded rather than returned for processing. We often find that garments are being discarded too quickly, resulting in unnecessary losses. We also work with our laundry partners to educate end users on best practices for garment issuance and control procedures with focus on loss prevention."

TRSA and its members are taking the lead to educate healthcare providers on the financial impact of linen loss and what steps can be taken to help reduce it. The organization has produced an animated video (https://www.youtube.com/
watch?v=OKU_gYw3ibc) to bring awareness to the issue, and a follow-up digital video is in the works to use as an educational tool during Linen Awareness programs and potentially for new hire in-servicing at the facility level. TRSA has also produced a new animation (https://www.youtube.com/watch?v=
pOFWNOdmBqo) on the commercial laundering process.

Dan Sanchez, Vice President of Textiles Sales for Medline, adds that textile providers and laundry processors also offer tools, such as linen audits, trash audits and Linen Awareness days, to aid in staff awareness and education.

"Over the years during many linen audits, we at Medline have found nursing staff has the strong desire to protect and care for patients," said Sanchez. "When linen becomes heavily soiled, they cannot comprehend something so dirty can actually become hygienically clean again. When we inform them the laundry utilizes washers as big as a school bus along with time, temperature and chemicals that get the linen clean on the first wash about 98 percent of the time — the remaining 2 percent is sent through a re-wash or ragged out — they are more likely to not throw the linen in the trash with other disposable waste. The more we can educate, the better chance we have of reducing linen loss."

Judy Reino, President of Reino Linen Service, offers the following tips to minimize linen loss in the healthcare environment:

  • Establish an easily understood linen loss metric in the laundry service’s contract.

  • Promote coordination between the laundry and distribution. What happens when one entity processes the linens and another is responsible for distribution? What is the best approach to keep control?

  • Eliminate complexity in the system. For example, costs go up and losses increase when a healthcare system is using several different kinds of gowns, multiple specialty items, etc.

  • Place trash receptacles and linen hampers strategically in order to avoid linen ending up in the trash. Many hospitals place them side-by-side and linen is easily placed in the wrong container.

  • Educate staff about why linen should not be thrown away, even when it appears to be overly soiled or pharmaceutically contaminated.



References

1. Arch Intern Med. 2006;166(18):1945-1951. doi:10.1001/archinte.166.18.1945.

2. Am J Infect Control. 2012 Dec;40(10):904-06. doi:10.1016/j.ajic.2011.12.017.

3. Am J Infect Control. 2012 Aug;40(6):539-43. doi: 10.1016/j.ajic.2011.07.015. Epub 2011 Dec 16.

4. A Deadly Fungus and Questions at a Hospital, The New York Times, April 28, 2014. http://www.nytimes.com/2014/04/29/us/a-deadly-fungus-and-questions-at-a-hospital.html?_r=0

5. Bearman, G., et al. A Crossover Trial of Antimicrobial Scrubs to Reduce Methicillin-Resistant Staphylococcus aureus Burden on Healthcare Worker Apparel. Infection Control and Hospital Epidemiology. March 2012; 33(3).

6. Gerba, Charles P., PhD., Maxwell, Sheri, Assessment of Antimicrobial Efficacy on New Fiber Embedded with Silver, presented IDWeek 2014.

7. Linen Loss in Hospitals Exceeds $840 Million a Year, TRSA, http://www.trsa.org/linenloss