The Challenge for Healthcare Providers
Many healthcare facilities have had some success with temporarily reducing their HAI rates, however the industry overall has not been able to sustain these reductions. A big part of the challenge is controlling the presence of infectious agents in the patient room.
Current infection control protocol focuses on manual cleaning, i.e. wiping hospital room and bathroom surfaces with a disinfecting solution. There are three types of cleaning/disinfecting processes, each of which also includes a variety of different disinfection products: (1) Daily – typically 10 to 15 minutes in each room; (2) If there’s an Outbreak; and (3) Terminal – a more thorough process. A more detailed description is in the Appendix to this document.
There are many issues that complicate effective disinfection including:
- Design: The bathroom is an area of high contamination. Toilets are located close to the sink and countertops. When flushed, they release a plume of microbial contamination into the air, ultimately landing on surfaces. Healthcare workers, the patient and visitors frequently use this room with many opportunities for acquisition and transmission of microbes throughout the patient care environment. Despite this, during a patient’s stay this room is typically cleaned only once a day.
- Materials: Multiple surface materials and textiles cannot all be cleaned and disinfected effectively the same way. For instance, when damage occurs to surface materials, it can leave protective reservoirs for microbes to proliferate in and not be reached by the biocides used to destroy them.
- Lack of Time: Staff are not given sufficient time to do a thorough job. The average daily room disinfection time is 10 minutes. It is impossible to effectively clean and disinfect a hospital room, including the bathroom, in 10 minutes let alone an area that is highly contaminated.
“No-touch” solutions are gaining acceptance by providing additional disinfection to the standard and required manual disinfection protocol described above. Many of these have been successful in addressing areas that may not have been disinfected effectively before. Examples of products include: (a) Hydrogen peroxide vapor or mist to get disinfectant into areas not always reached in the regular wipe-down, and (b) robots that shine UVC light to kill bacteria. Each of these solutions have limitations:
- Room occupation: Both solutions require that the room be unoccupied. As a result, they can only be used for “terminal” disinfection following patient discharge.
- Line of sight: UVC solutions require “line-of-sight” to the affected areas. Microbes on surfaces outside the line of sight of the light source are not affected. When used in a patient bathroom for example, UVC robots cannot reach areas such as the inside of the sink bowl, drain and areas behind the faucet.
|Current Typical Cleaning/Disinfection Types||Emerging Recommended Protocol|
Figure 1: Surface experts and infection prevention professionals increasingly recommend a multi-modal approach for successful cleaning and disinfection. This includes incorporating solutions that operate continuously.
Leading infection control experts are beginning to realize that healthcare facilities need to use a multimodal approach to be effective. While nothing will entirely replace the standard disinfecting surface wipe-down, it needs to be supplemented with other modalities. A comprehensive approach to infection control must address a variety of situations and use multiple or bundled methods, that ensure effective and sustainable disinfection. These could include:
- The standard protocols for daily manual disinfection by wiping down surfaces
- Terminal disinfection (i.e. when a room becomes empty)
- Disinfection when there’s an outbreak
- No-touch solutions, UVC, hydrogen peroxide mist or vapor, antimicrobial or microbial resistant surfaces
- Replacing surface materials that provide a safe sanctuary for microbial growth away from the reach of biocides
- Automated solutions that can operate continuously