Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

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Thursday, November 27, 2014

Apathy: A Tale of Two Cows

My intent for this week's blog was to continue along the vein of apathy in our healthcare system when it comes to cleaning and disinfection, the use and choice of products and instilling compliance regarding their use to ensure positive patient outcomes.  Nothing spells apathy to me then hearing someone say "I don't care what disinfectant we use, you're the one who pays for it".... it was then that the narrative for the blog started forming.

And then I came across The Center for Disease Dynamics,Economics and Policy's blog titled "A tale of two cows: Why we have a cowmap and not a healthcare acquired infection map".  Now that I have sufficiently recovered my composure after reading the blog, I knew I had to share.  My discussion on apathy as it relates to cleaning and disinfection will have to wait until next week!

Drs. Saman and Kavanagh eloquently weave a satirical tale using the agriculture industry's ABILITY to account for EVERY cow in EVERY county in the US comparing it to the healthcare industry's INABILITY to agree on how to define or how to account for every HAI that occurs within their facilities.  The following is an excerpt that I hope will entice you to read the full blog:

"First there was intense disagreement on what a cow is.  Not everyone used the same definition.  Some farmers defined cows as black-haired mammals with at least four white spots, while others defined them as four-legged mammals with three black spots. Confusion certainly prevailed.  Some farmers asked whether cows in ponds are counted the same as cows eating grass.   It was then decided to only count cows standing in streams.  Called Cow Stream Infestations (CSIs) or cowteremia, this classification provided data that some praised and all could agree upon.  But the CSIs occurred so infrequently that meaningful comparison between farms could not be made."

Perhaps I found the comparison so vastly amusing because I grew up on a beef farm and knew how many cows we had, what breed (or crossbreed) they were, and what calf belonged to what cow going back three generations... 

Drs. Saman and Kavanagh summarized by stating "We believe our vision of cow counting utopia, applied to HAIs, can contribute to reducing unnecessary and mostly preventable infections and deaths.   This satire is not about public reporting, for that introduces another plethora of excuses of why it cannot be done.  The satire is about having the data for action, for community and federal response to a large and dangerous epidemic in our nation."

If we are to stop the spread of HAIs we need to work together to agree to black and white definitions.  The definition should not be defined in such a manner as to shed a "better" light on our facilities.  The definitions should be set to allow for clear classification, clear identification and clear means to create an action plan on how to improve.   Are we being apathetic towards the true concern of HAIs due to our inability to create clear definitions that everyone agrees to use?  What do you think?

Bugging Off!



Nicole

Thursday, November 20, 2014

Please accept my condolences

There are times when I hate knowing what I do about infection prevention. A few weeks ago a friend reached out to learn more about C.diff.  Her mother-in-law had gone to the hospital with an UTI and pneumonia and contracted C.diff.  We talked about transmission, proper cleaning and the need to ensure that proper hand hygiene was being followed - as in if you didn't see the nurse or doctor squirt some hand sanitizer into their hands, ask them to do so!  We were going to meet so I could give her some disinfectant wipes that the family could use in the room to clean the bedside rails and other high touch areas.

We never met so I could give her the wipes.  Instead last week I attended a visitation. Her mother-in-law at the age of 67 had died of an HAI and her sons, 4 and 6 were wondering what was going on and asking when Grandma was coming back. A life was lost, senselessly. There was a break in infection prevention. Another statistic can now be added to the growing number of deaths that occur each year due to HAIs.

I'm really not sure where to begin.  I think we all know what C. diff is.  Lee wrote a blog about C.diff back in 2011 that includes links to fact sheets and guidelines.  I think we all also know that cleaning and disinfection works to stop environmental transmission. In Sept of last year in a blog titled "Cleaning and Disinfection Works" we reviewed a study looking at just that. In fact, cleaning alone can remove sufficient spores from the surface to minimize transmission (refer to our blog "SOS- Spores on Surfaces"  that reviewed a paper by Rutala et al).

It's really not that difficult. 

  1. We need to wash our hands following the principles of the moments of hand hygiene: BEFORE touching a patient, BEFORE an aseptic procedure, AFTER body fluid exposure risk, AFTER touching a patient and AFTER touching the patient's environment.  
  2. We need to clean and disinfect the patient's environment thoroughly and frequently using elbow grease, taking enough time to do the job correctly and not cutting corners because the surface looks clean to the naked eye or because someone is pressuring the housekeeping staff to "hurry up".
  3.  We need to clean and disinfect shared patient care equipment every time after each use.
  4.  We need to practice judicious use of antibiotics.

Sometimes the loss of a single life can be the catalyst for change.   As expressed by Mary Elizabeth Frye in a poem in 1932 "Do not stand at my grave and cry; I am not there. I did not die."  Let's not accept loss of life from an HAI as the cost of doing business.  Let's not accept the fact that while there was a death due to an HAI the overall  facility's infection rates are below their standard baseline or lower than similar facilities in the area. Let's work together to target zero. Let's work together so that you do not have to attend a visitation for a friend or family member who was one of the unlucky ones.

Bugging Off,

Nicole


Friday, November 14, 2014

Keypad or Touchscreen: Which is the Lesser of Two Evils?

The fact that cellular phones and other mobile communication devices can become contaminated with potentially pathogenic organisms is not new. To my knowledge, the Brady article, “Is Your Phone Bugged”, from the American Journal of Infection Control was first to identify these devices as potential reservoirs for pathogens.  Even when cellular phones were banished from hospitals, Brady discovered that up to 25% of healthcare workers’ personal phones were contaminated with healthcare-associated microbes, including MRSA and VRE.  As concern about disturbance of electromagnetic fields diminishes - even airlines allow us to keep our phones and tablets on -  mobile phones and other such high-touch communication devices are making strong inroads to acute care settings. Their presence is generating new studies on the infection transmission risk associated with their use.

A group from University College London published an article in the Journal of Infection Prevention, comparing keypad phones to touch screen phones, particularly in an acute care hospital setting (“Keypad mobile phones are associated with a significant increased risk of microbial contamination compared to touch screen phones”,). The authors observed that the majority of healthcare professionals use the same mobile phone inside and outside the workplace, and thus risks contamination to other departments, hospitals, and the community. Many of the phones in use today have touch screens with a solitary smooth surface, as opposed to a keypad with separate buttons and numerous crevices. The authors postulated that, of the two styles of devices, bacterial contamination would be lower on touch screen phones.

Even in this rather small sampling, the results were telling.  Nine of the 67 samples grew either MRSA or VRE, all but one of those being from keypad phones. All of the “on-call” phones were keypad models, which might have skewed the results, since 40% of these phones showed MRSA or VRE contamination. Of the touch screen phones, 17 were iPhones, none of which were contaminated with potential pathogens.  To confirm their results the authors repeated the study in another hospital, and with a larger sampling of 126 touchscreen phones, and 47 keypad phones. This second facility had a lower baseline MRSA rate than in the first hospital. In this second attempt, 5 of the touchscreen phones (4%) were contaminated with MRSA. None of the keypad phones were contaminated with MRSA or VRE, but overall the bacterial colony counts were higher with keypad phones.

The authors concluded that touchscreen phones have lower bacterial colonization when compared to keypad phones. Keypad mobile phones were more likely to be contaminated with higher colony counts of bacteria, and the majority of drug-resistant bacteria were isolated from keypad phones. The keypad is the area in contact with the fingertips, and intermittent handling of mobile phones during and between patient consultations is a means for transmission and conceivably reduces the effectiveness of hand hygiene.

I suppose I should be "happy" that my iPhone and iPad, which are frequently played with by my 5-year son, would be expected to have fewer bugs than similar devices with keypads. That is, at least before he got his hands on them!  But moving outside of the hospital where the frequency of cleaning and disinfection does not occur with the same frequency, what level of contamination would we see?  I shudder at the thought of the level of contamination to be found on the keypads of debit machines.....how many times have you paid for groceries and then proceeded to have a snack on the way home without cleaning your hands first? To that I can answer....not anymore!


Bugging Off!
Nicole


Friday, November 7, 2014

Just Clean It!

I love writing, but admit there are times when I stare my computer screen watching my cursor flash on a blank page waiting and hoping for inspiration to hit. Last month I was in Tampa, FL at AHE's annual conference - Exchange 2014.  One of the sessions I was fortunate to attend was "Disney's Approach to Service and Culture" given by Patrick Jordan, a "cast member" (aka employee) at Disney. Part of the descriptor behind the session was, "It starts with extraordinary attention to detail in hiring and training, which ensures Disney on-boards people who fit the culture and consistently do what their roles ask of them.....you will gain insights to help you not only hire the right people, but also develop them into employees who are comfortable in their roles and know their purpose."

Wow.  Is this not the struggle all employers face daily regardless of the market they are in?  

From a cleaning and disinfection perspective in particular, nothing could be truer. We struggle daily with cleaning and disinfection of environmental surfaces and shared patient care equipment. Cleaning and disinfection is critical to reduce the risk associated with pathogens, and yet often times we find there are not clear roles and responsibilities as to who does what, when it needs to be done, and how to do it. Inevitably someone is breathing down someone's neck yelling "Just Clean It!" or "Why is it taking so long!"

We know there is strong evidence to demonstrate that daily cleaning and disinfection of surfaces in a patient’s room, such as bed rails, can significantly reduce the transmission of pathogens to healthcare workers' hands.  We also know that there is evidence to prove that a room previously occupied by a patient with a multiple drug resistant organism significantly increases the risk of the next patient to acquire an HAI. If we have proof to show that the investment of time for daily cleaning and disinfection of environmental surfaces and shared patient care equipment can decrease the risk for coming in contact with a pathogen and prevent the transmission of HAIs, why do we struggle so much to do it?

Could the answer be as simple as, "It’s not the magic that makes it work; it’s the way we work that makes it magic.”  Perhaps we need a paradigm shift in our thought process.  What if we stopped chasing after the silver bullet - that disinfectant that kills everything, that room decontamination device that we use as a fail-safe measure because we do not trust our staff to do the job they are supposed to do the first time? What if instead we focused on ensuring that we are hiring the right people?  Where we ensure that the people we have hired are comfortable in their roles, understand what they are expected to do, and know how important their job is and its impact on the health and well-being of the patients, colleagues, and other employees. 

What would HAI rates look like in a facility that had 100% compliance in cleaning and disinfection of environmental surfaces by housekeeping staff?  What would the HAI rates look like in a facility that had 100% compliance in cleaning of shared patient care equipment? 

Perhaps you'll join me next week on Wednesday November 12th for a webinar hosted by ICT as part of their Science Summit on Emerging Pathogens Disinfection Toward Perfection.  The webinar will address potential challenges faced in cleaning and disinfecting of healthcare surfaces and equipment, and strives to outline how these challenges can be overcome using evidence-based practice and thought leadership.

Personally, I think it's the work that makes it magic.  The magic of marrying people with products and processes!

Bugging Off!

Nicole