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08
Nov

Showcase hospitals local technology review reports


As part of the Department of Health’s Healthcare Associated Infections (HCAI) Technology Innovation Programme, Showcase Hospitals have undertaken local technology reviews of infection related products or technologies in which they have a specific interest. This is with the objective to help Directors of Infection Prevention and Control and other stakeholders to decide whether they should consider any of these products or technologies as part of their Trust’s strategy to reduce healthcare associated infections. Below are the findings from three such reviews.


Bio-Cav40 Ultrasonic Cleaning is a cleaning technology that has been used in industry such as automotive, sporting, printing, marine, medical, pharmaceutical, electro-plating, engineering and weapons industries. The process involves the use of a generator or transducer in a water tank which transmits high frequencies to create millions of bubbles. These small bubbles expand and eventually implode and the force of this gently removes dirt from equipment by accelerating the detergency of the cleaning agent. This process is known as biological cavitation.
The system was used at Calderdale and Huddersfield NHS Foundation Trust for an initial period of three months, which was extended to six months.

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Southampton University Hospitals NHS Trust (SUHT) chose to review Timestrip®, a device which aims to give a visual indication of the dwell-time of in-situ peripheral cannulae to prevent the cannula dwell-time exceeding the usual recommended time period of 72 hours or less [1]. Timestrip® is a single use, push-activated button associated with a graphic timeline mounted on an adhesive backing. On depression of the button, dye is released over an indicator scale to show time elapsed.


The use of cannulae to ensure reliable intravascular access is an important aspect in terms of monitoring and intervention in modern healthcare [2]. Bloodstream infections are a significant clinical problem [2]. Studies have clearly demonstrated that every type of vascular cannula has the potential for causing bacteraemic infection [3]. It is therefore important that cannula do not remain in-situ for longer than necessary.


Monitoring of peripheral cannulae at SUHT presently relies on ward staff keeping written records of time of insertion and removal, and observation of cannula sites for signs of infection. At SUHT this is currently documented on a cannula care form. Audit data at SUHT shows high levels of compliance with care of peripheral venous cannulae and timely removal. This Timestrip® evaluation aimed to gain data on the usability of the device in the clinical setting, whether it added value to the existing systems for monitoring peripheral venous cannulae and whether it enabled patients to actively participate in their care.


Timestrip® was evaluated over a five-week period during September and October 2010 on the Acute Medical Unit and the Surgical Admissions Unit at SUHT. It was attached to the dressing of the peripheral cannula at the time of cannula insertion on adult patients. It was evaluated by the staff inserting the cannulae, by the nurses responsible for the ongoing care of the cannulae and by patients who the Timestrip® device was attached to.

•89 per cent of responding staff felt that the Timestrip® device was easy to attach to the cannula dressing.

• 82 per cent of relevant responding staff from the acute medical ward and surgical admissions ward stated that the Timestrip® was easy to activate.

•55 per cent of staff experienced problems when attempting to reattach the Timestrip® to a new cannula dressing while 50% experienced some degree of problems with the Timestrip® becoming dislodged or detached.

•95 per cent of patients revealed that they experienced no discomfort from the Timestrip® device.

•100 per cent of patients agreed that the Timestrip® was clearly visible

•77 per cent of patients revealed that they chose not to refer to the Timestrip® during their hospital stay.

•13 per cent of patients experienced problems with the Timestrip® becoming dislodged or detached.

Timestrip® would add an additional cost to each peripheral cannula placement. The added cost of Timestrip® must be weighed against added benefit. Consideration must be given to the effectiveness of existing systems to monitor dwell time of peripheral cannula and whether the addition of Timestrip® would add benefit to this or not. The problems identified in this report with dislodgement and re-attaching Timestrip® reflect on the reliability of Timestrip® if this method is used to attach Timestrip® to the peripheral cannula dressing. Further development of this innovative product by the producer may resolve these issues.

Refs:

[1]Department of Health (2010) High Impact Intervention Peripheral intravenous cannula care bundle. Available from:
http://hcai.dh.gov.uk/files/2011/03/2011-03-14-HII-Peripheral-intravenous-cannula-bundle-FIN….pdf
[2] Issued by Standards Unit, Evaluations and Standards Laboratory Centre for Infections (2008).National Standard Method Investigation of Intravascular Cannulae and associated specimens. Available at
http://www.hpa-standardmethods.org.uk/documents/bsop/pdf/bsop20.pdf
[3] Maki DG, Mermel LA (1998). Infections due to infusion therapy. In: Bennett JV, Brachman PS, editors. Hospital Infections. 4th ed. Philadelphia: Lippincott-Raven Publishers; 689-724.

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Finally, a study conducted by the National Audit Office found that many Trusts did not feel they had sufficient IT or clerical resources to support their system of surveillance.
Lewisham Healthcare NHS Trust decided to review Kairos Audit Manager (KAM), which is an electronic data capture and reporting solution (EDCRS) that may provide a viable solution to surveillance and data handling for IPC departments.


The evaluation involved compliance audit of the Green is Clean sticker, which indicates the cleanliness of stored medical equipment.


A 450 bedded acute district general hospital conducted seven weekly¬randomised audits of inpatients’ clinical areas using a modified Infection Control Nurses Association’s (ICNA’s) Management of patient equipment (general) audit.


During the two-week baseline periods, audits were carried out using the established methods (auditing, transcription and reporting); then audits were conducted over five weeks using KAM
At the conclusion of the evaluation, each IP&C nurse, matron and ward/ deputy manager was given self-administered questionnaires to determine attitudes and views. Eighty Four per cent of respondents preferred electronic reporting. One hundred per cent of the respondents agreed/strongly agreed that KAM saved time. Eighty four per cent of stakeholders found weekly feedback helpful and 71% believed that KAM assisted in the identification of risk.
As surveillance of wards increased, compliance also increased and auditing time decreased.

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