Becker's Clinical Quality & Infection Control

July/August 2021 IC_CQ

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44 Executive Briefing the surrogate for SARS-CoV-2 (MS2 virus) at 450 cubic feet of air per minute. This testing was reviewed by the FDA in 2018. SARS- CoV-2 is larger than MS2, making it potentially more vulnerable to this HEPA plus UV-C device than the MS2 test organism. During a more recent study, testing of this device demonstrated 100 percent elimination of SARS-CoV-2 virus during 15 trials when compared to 40 percent reduction by two control devices, one inactive and one with UV-C only. 31 The primary differences between this novel HEPA plus UV-C device and other technologies on the market is the small size, the portability, the fact that it does not disrupt the air flow pattern, requires no installation and includes two filter banks. This ensures both inactivating circulating microorganisms using UV-C, and filtering out the particles, some of which can be hazardous, such as by-products of surgical smoke. Additionally, it has a built-in particle counter, which can be used to validate the efficacy of air cleaning before, during and after surgical cases. 16 Introduction of new technology in O.R.s often involves a perioperative executive champion who can shepherd the business case through all required committees and approval processes. To further support successful introduction, the vendor can often provide assistance with flexible funding strategies. Avoiding capital level expense can serve to reduce much of the required approvals. The most successful infection prevention programs include early adopters of new technology with proven efficacy. Looking beyond standard engineering controls is critical given the increasing airborne risks to patients and surgical teams, including the newest, COVID-19. As we continue the journey towards sustained zero preventable surgical infections, ongoing study in this area of risk will help to determine the best method(s) for optimizing air quality in O.R.s. n References 1. Wilson NM, Norton A, Young FP, Collins DW. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia. 2020 Aug;75(8):1086-1095doi:10.1111/anae.15093 2. Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic; Online April 17, 2020. American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, American Hospital Association. https://www.facs.org/covid-19/clinical-guidance/ roadmap-elective-surgery. Accessed May 24, 2021. 3. JCAHO Hospital Accreditation Standards; 2004 Environment of Care 7.10 -No. 15. 4. ASHRAE 170: https://www.techstreet.com/ashrae/standards/ashrae-170- 2017?gateway_code=ashrae&product_id=1999079. Accessed May 24, 2021. 5. Edmiston CE Jr, Leaper DJ, Barnes S, et al. Revisiting Perioperative Hair Removal Practices. AORN J. 2019;109(5):583-596. doi:10.1002/aorn.12662 6. Clark RP, de Calcina-Goff ML. Some aspects of the airborne transmission of infection. J R Soc Interface. 2009;6 Suppl 6(Suppl 6):S767-S782. doi:10.1098/ rsif.2009.0236. 7. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect. 1983;4(2):111-131. doi:10.1016/0195-6701(83)90041-5. 8. Petrova, O.E. and K. Sauer, Sticky situations: key components that control bacterial surface attachment. J Bacteriol, 2012. 194(10): p. 2413-25. 9. Zimmerli W, Trampuz A, Ochsner P. Prosthetic-Joint Infections. N Engl J Med. October 14, 2004; 351:1645-1654. 10. Owers KL, James E, Bannister GC. Source of bacterial shedding in laminar flow theatres. J Hosp Infect. 2004 Nov;58(3):230-2. 11. Eickhoff, T. C. (1994). Airborne nosocomial infection: a contemporary perspective. Infection Control and Hospital Epidemiology. 15(10): 663-672. 12. Durmaz G et al. The relationship between airborne colonisation and nosocomial infections in intensive care units. J Chemotherapy. 39: 465-471 13. Kowalski W. Ultraviolet Germicidal Irradiation Handbook. Springer Verlag, Berlin 2009. pp 399-418. 14. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery. 2017;152(8). doi:10.1001/jamasurg.2017.0904. 15. Parvizi J et al. Environment of care: is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty? American Journal of Infection Control. 2017 Nov 1;45(11):1267-1272. 16. Charkowska A. Ensuring cleanliness in operating theatres. Int J Occup Saf Ergon. 2008;14(4):447-53. doi: 10.1080/10803548.2008.11076783. PMID: 19080049. 17. Perez P, Holloway J, Ehrenfeld L, et al. Door openings in the operating room are associated with increased environmental contamination. Am J Infect Control. 2018;46(8):954-956. 18. Fletcher JN, Mew D, Descôteaux JG. Dissemination of melanoma cells within electrocautery plume. Am J Surg. 1999; 178(1):57-59. 19. OSHA Laser/Electrosurgery Plume (n.d.) https://www.osha.gov/SLTC/ laserelectrosurgeryplume/index.html Accessed May 24, 2021. 20. Schultz L. An analysis of surgical smoke plume components, capture, and evacuation. AORN J. 2014;99(2):289-298. 21. Bree K, Barnhill S, Rundell W. The dangers of electrosurgical smoke to operating room personnel: a review. Workplace Health Saf. 2017;65(11):517-526. 22. Goon PKC et al. Virus induced cancers of the skin and mucosa: are we dealing with smoking guns or smoke and mirrors in the operating theatre? Dermatol Ther. 2017 Jun;7(2):249-254. 23. Schultz L. Can efficient smoke evacuation limit aerosolisation of bacteria? AORN J. 2015;102(1):7-14. 24. Chauveaux D. Preventing surgical-site infections: measures other than antibiotics. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S77-S83. doi:10.1016/j. otsr.2014.07.028 25. Bischoff W et al. Impact of a novel mobile air purification system on the bacterial air burden during routine care. Oral presentation SHEA Conference. Spring 2018. 26. Curtis G et al. Reduction of particles in operating room using UV air disinfection and recirculation units. The Journal of Arthroplasty. (2017) 1-5. 27. Davies GS, Bradford N, Oliver R, Walsh WR. The effects of a novel decontamination-recirculating system in reducing airborne particulate: A laboratory-based study. Oral presentation: The European Bone & Joint Infection Society Conference. Nantes France Sept 7-9, 2017. 28. Gannon C et al. Reduction of total and viable air particles in the OR setting by using ultraviolet in-room air disinfection and recirculation units. American Association of Hip and Knee Surgeons Conference. November 4, 2017. 29. Kirschman D, Eachempati S. Airborne bacteria in the operating room can be reduced by HEPA/Ultraviolet air recirculation system (HUAIRS). Presented at the Surgical Infection Society (SIS) - 37th Annual Meeting. May 2 – 5 2017 in St. Louis, MO. 30. Messina G et al. A mobile device to reduce airborne particulate and prevent surgical site infections. European Health Association Conference. Marseille France November 20-23, 2019. 31. Kirschman D et al. Aerobiotix SARS-CoV-2 bioaerosol removal. Battelle Biomedical Research Center. August 2020. Aerobiotix is a pioneer in airborne infection control products that provide real-time, in room solutions for hospitals, ASCs, long term care and office-based settings. Recognizing that healthcare doesn't stop at the patient, we drive novel technologies to optimize environments of care for patients and healthcare stakeholders. Aerobiotix's mission is to provide airborne infection control solutions leveraging peer-reviewed science and providing its customers both daily protection as well as robust monitoring data to further inform and assist their infection control programs. First launched in 2017, the ILLUVIA® Air Disinfection System is a mobile air handling device which uses UV-C and HEPA filtration technologies to achieve air disinfection. It is intended to produce a directed, nonturbulent flow of air that has been treated to remove microorganisms to provide an area free of contaminants in critical healthcare settings, including surgical and procedural areas. More information can be found at www.aerobiotix.com.

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