How to Improve Infection Prevention in the Environment of Care

Updated June 15, 2014.

Hospitals, ambulatory care clinics, and long-term care facilities are a battlefield. Bacteria wages war on patients, their family members, and staff on a daily basis, around the clock. It is an enemy that never sleeps.

Furthermore, these pathogens can out-maneuver us because they are in never-ending supply. Each new day patients enter your facility transporting a trojan-horse of life-threatening infectious disease that can be transmitted through touch, in the air, and by moisture.

The Centers for Disease Control and Prevention have reported that Healthcare Acquired Infections are a tremendous financial and human burden to the U.S. population and its healthcare system.

• Roughly $30 billion in annual direct medical costs to hospitals.
• Roughly 1 in 20 hospitalized patients each year contract an infection during their stay in the hospital. This equates to about 2 million people, with around 90,000 patients dying from these infections annually.

So the burden is real, and it has the full attention of the CDC. It should also have the attention of anyone who plans for the care of patients, and anyone who has profit and loss responsibility for their healthcare organization.

There are over 200 recognized healthcare acquired infections. Some of the most common are:

• central line associated blood stream infections
• surgical site infections
• ventilator associated pneumonia
• catheter associated urinary tract infections
• Clostridium dificile-associated disease

The Resources to Fight

The American World War II-era General Omar N.

Bradley has been attributed with the saying, "Amateurs talk strategy, professionals talk logistics." What I believe he meant to teach us is that the most brilliant strategy still cannot be executed successfully unless the means and supplies to execute it are also planned and allocated.
So, my fellow armchair generals, here are some ideas, and products, to consider when planning your battle against the insidious pathogen attack on your patient population, your staff, and your balance sheet:

1. Air
   • Air handling systems with HEPA filters, as well as smaller mobile units on the market today that kill germs via ultraviolet technology and clean the air upwards of six times per hour, are at the facility planner's disposal as an armament to battle airborne pathogens.
2. Water
   • Controlling the spread of waterborne microorganisms through appropriately-timed hand-washing with soaps, lotions, and even waterless disinfectants.
3. Environmental Services
   • A few highlights that are worth quoting directly from the CDC:
     • Select EPA-registered disinfectants, if available, and use them in accordance with the manufacturer's instructions (270-272). Category IC (EPA: 7 United States Code [USC] 136 et seq.)
     • Do not use high-level disinfectants/liquid chemical sterilants for disinfection of either noncritical instruments and devices or any environmental surfaces; such use is counter to label instructions for these toxic chemicals (273-278). Category IC (Food and Drug Administration [FDA]: 21 CFR 801.5, 807.87.e)
     • Follow manufacturers' instructions for cleaning and maintaining noncritical medical equipment.
     • Clean noncritical medical equipment surfaces with a detergent/disinfectant. This may be followed by an application of an EPA-registered hospital disinfectant with or without a tuberculocidal claim (depending on the nature of the surface and the degree of contamination), in accordance with germicide label instructions (274).
     • Detergent and water are adequate for cleaning surfaces in nonpatient-care areas (e.g., administrative offices).
     • Clean and disinfect high-touch surfaces (e.g., doorknobs, bed rails, light switches, and surfaces in and around toilets in patients' rooms) on a more frequent schedule than minimal-touch housekeeping surfaces.
     • Clean walls, blinds, and window curtains in patient-care areas when they are visibly dusty or soiled (270,282-284).
4. Medical Equipment
   • Equipment rail can be worth your time evaluating. It may be one of the lowest-technology products in healthcare today. You have a rail that you install to the wall, and a universal quick-release bracket that fastens to the back of your wall-mounted equipment, such as:
     • paper towel dispensers
     • sani-wipe dispensers
     • hand sanitizers
     • Sphygmomanometers
     • otoscopes
     • opthalmoscopes
     • thermometry
     • Laryngoscopes
   • The infection prevention value that equipment rail offers is the capability to do an effective terminal clean. The equipment listed above, thanks to the quick-release brackets, can be removed from the rail and cleaned all around, including the back of the device, which normally could not be cleaned if it were screwed directly into the wall.
   • Equipment rail and its brackets are made of aluminum and steel, so they are easily cleanable. Some equipment rail manufacturers can make them out of corian, a solid-surface material that also is easy to clean.
5. Healthcare Furniture
   • Furniture in healthcare spaces can be upholstered in vinyl, which is non-porous and therefore easy to wipe down to eliminate bacteria.
   • In addition to vinyl, there are treated-fabric options such as nanotex and crypton.
   • Even the wood arms and legs, the wood trays, and the wood tables and bedside cabinets, are treated with SilverBan technology. SilverBan works by infusing silver ions into the wood finish. The silver ions inhibit the growth of mold, mildew, fungus and bacteria on wood surfaces, as well as odors caused by bacterial growth, by over 99%.
6. Architectural Finishes
   • Silver, stainless steel, and copper can provide anti-bacterial benefits when incorporated into various architectural finishes and fixtures.
7. Flooring
   • Carpet tile is gaining acceptance in healthcare spaces. When considering carpet for an area of a healthcare facility, carpet tile may be a more cost-effective option. If there is a spill or other type of soil on the carpet, the individual carpet tile(s) that are affected can be replaced quickly and inexpensively.