Becker's Clinical Quality & Infection Control

31 Executive Briefing: Infection Prevention Improvement Sponsored by: H ealthcare-associated infections are the fifth leading cause of death in acute-care hospitals in the United States and the fourth leading cause of death in Canada. Each year it is estimated that over 720,000 HAIs occur in U.S. healthcare facilities, and worse, approximately 75,000 people will die from them. These infections have a significant impact on patients, families, healthcare institutions and the economy. For patients, it means longer hospital stays, increased pain and suffering, potential ongoing issues or even death. For families it can mean the loss or debilitation of a loved one and significant fi- nancial burden. Healthcare institutions face reductions in reimbursements and their brand equity, and the economy faces bil- lions of dollars in excess healthcare costs. From emerging pathogens to "super bugs," the public has never been more aware of infection control challenges, which are fre- quently cited in headlines. Bacteria have become more resistant to antibiotics, which leaves healthcare professionals with limit- ed, or in some cases, no effective treatment options. And emerging pathogens, such as Ebola, are forcing healthcare facilities to look closer at their current practices to ensure staff, patient and visitor safety, and proper care. As reimbursements become more aligned to the quality of care, there has never been a more compelling business case for healthcare institutions to focus on prevent- ing infection. While there are several factors that can impact infection rates — including early identification of infected or colonized patients, antibiotic stewardship and hand hygiene — a focus on improved cleaning and disinfection practices is warranted. Cleaning and Disinfection Needs Improvement Recent studies have shown that the en- vironment may play more of a role in the transmission of infection than previously thought. Studies have shown that patho- gens can survive on environmental sur- faces and equipment for days, and even months. These contaminated surfaces can play a role in the transmission of infec- tion when a patient either contacts these surfaces directly or when these pathogens are picked up on healthcare worker or visi- tors' hands and then are indirectly trans- ferred to a susceptible patient. Several studies have also shown evidence that a patient's risk of acquiring an infection, especially a multi-drug resistant infection, is higher if the prior-room occupant was infect- ed or colonized, further implicating the role of the environment in the spread of infection. To reduce this risk, proper cleaning and dis- infection of hands, surfaces and equipment is critical. In recent years, there has been a major focus on improving hand hygiene, but still it is estimated that only about 50 percent of healthcare workers follow basic hand hygiene measures. Even if the hand hygiene compliance rate was higher, there is still the risk that hands can become re- contaminated by touching contaminated surfaces, which is why hand hygiene and surface cleaning and disinfection are both important factors to reduce infection. Unfortunately, data has shown that clean- ing and disinfection of patient rooms, op- erating rooms and shared patient care equipment is suboptimal. Previous stud- ies have demonstrated that less than 50 percent of patient room surfaces and less than 25 percent of operating room surfac- es are properly cleaned and disinfected. The outcomes are potentially even worse in the clinical area where cleaning and dis- infection of surfaces or shared equipment may not part of the core job description. Evidence has demonstrated that daily clean- ing and disinfection of surfaces in a patient's room, such as bed rails, can significantly reduce the transmission of pathogens to healthcare workers' hands. Further, Carling's studies also demonstrated that improved training along with monitoring and feedback on the process can significantly improve cleaning and disinfection compliance. "There are a variety of issues that can impact proper execution, including a lack of time to do the job properly, inappropriate tools to do the job and a lack of understanding of how important cleaning and disinfection is, which is compounded by not measuring its effec- tiveness," says Carolyn Cooke, vice presi- dent of the North America healthcare sector at Sealed Air Diversey Care. It is clear that cleaning and disinfection is critical, and there is no doubt that it needs improvement. There are also a number of challenges that can impact the effectiveness of cleaning and disinfecting, from product, to process, to program. To have a successful program, it is important to understand the barriers and how to overcome them. Just Because You are Using a Disinfectant Doesn't Mean You are Disinfecting What does this mean? Germs are invisible. It is difficult to tell if the job was done properly. A surface can look clean, while still housing a significant amount of pathogens. The real question is how do you know the surface was truly cleaned and disinfected? Roles and responsibilities. In many fa- cilities, cleaning and disinfection roles and responsibilities are unclear. There is con- fusion about who is cleaning what. As an example, in some facilities, environmental services is not responsible for daily clean- ing of bed rails because they don't want to disturb that patient — yet the clinical staff isn't doing it either. Bottom line, what is known as an effective method for reducing pathogen transmission to hands of health- care workers isn't happening. Just Because You are Using a Disinfectant Doesn't Mean You are Disinfecting: The Business Case for Improving Infection Prevention

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