Cleaning and hygiene are fundamental tools in the ongoing battle against the spread of bugs and superbugs in hospital. If the healing environment is not clean it is not a healing environment, yet in spite of the £725m the NHS spends every year on cleaning, it is an activity that is often under-valued. Pulse looks at some of the latest technology, advice and challenges for hospital cleaning services.
Speaking at the 2016 Professional Development Forum of the Association of Healthcare Cleaning Professionals, ahcp, Derek Butler, Chair of MRSA Action UK, said: “The easiest way to build up resistance to bacteria is prevention.” Derek may have stated the obvious when he urged healthcare employees to communicate and to do their job properly the first time.
Hospital cleaning teams are adopting ever closing working relationships with infection prevention and control, which is vital to beat the bacteria, which Butler described as the best bio-chemists on the planet, resilient and quick to change.
Bacteria might be clever, but the power of technology, applied by professionals who understand the science of cleaning, the processes they are carrying out and why makes for a formidable combination and a worthy adversary.
Microfibre
Microfibre was introduced to UK hospitals 20 years ago. Microfibre is a textile comprising very fine, composite, synthetic fibres, which are engineered to have a large surface area. It is the pile and large surface area that makes microfibre so effective in the removal of soil and microbes from surfaces.
Early studies into the cleaning results possible with microfibre, carried out at UCLH Environmental Research laboratory and in-situ at two London Hospitals, produced compelling evidence that microfibre provided a superior cleaning result in comparison with traditional, non-woven cloths. However, the barriers to its widespread adoption throughout the NHS mean that now, two decades later the endless trials of microfibre continue.
The technology, inevitably, has continued to develop and the market is now seeing the introduction of third and fourth generation microfibre, so-called ‘Smart Textiles’ as well as disposable microfibre.
Microfibre can contribute significantly to quality improvement in environmental hygiene, but the successful implementation of a microfibre programme is not assured by the textile itself. Training and materials handling/laundry remain critical factors and control points.
Is it really clean?
Just because a surface looks clean does that mean it really is clean?
The simple answer is ‘no’. Hygiena International explains that visual assessment, which is the most commonly used procedure, is subjective and only detects gross lapses in prctice. The ability to actually measure the cleanliness of a surface is important.
Hygiena International developed its ATP bioluminescence method as a means of measuring how clean something really is.
ATP bioluminescence is a simple and rapid method for measuring organic soil. It specifically measures adenosine triphosphate (ATP) which is the universal energy molecule present in all living things. The procedure requires a small hand held instrument and an all-in-one sample collection and testing device, these generating a numerical result in 15 seconds. This provides an objective yardstick and benchmark to describe and communicate levels of contamination and demonstrate what cleanliness really means. The use of ATP bioluminescence for cleaning verification is well established, and has the highest recommendation by the Rapid Review Panel of the Department of Health and Public Health England in support of the fight against HCAIs. The test is also recognised by the CDC in USA and is written into a standard for cleaning procedures in Denmark and Sweden.
Early adopters such as North Tees and Hartlepool NHS Trust have shown a consistent and marked improvement in cleanliness and reduction in infection rates since its introduction in 2008. The results have shown a >20% improvement in pass rates and a large reduction in fail scores to fewer than 5% with a corresponding decrease of 35% in C. difficile cases and a 39% reduction in infections per 10,000 occupied bed days.
Southport and Ormskirk Hospital NHS Trust has also obtained impressive results with ATP bioluminescence since it was introduced five years ago. Andrew Chambers, Consultant Nurse and Deputy Director of Infection Prevention and Control explains: “The results of ATP monitoring are incorporated into weekly infection prevention and control performance reports which are circulated Trust-wide. It is there to encourage people and make them aware, and also adds a competitive edge to drive everyone to achieve a low score. If they're doing a good job, it’s a low score and the staff are delighted. The benefit with ATP is that we can react immediately to the results on site and put any necessary interventions into immediate effect; that way we're safeguarding patients, which is what it is all about.”
Decontamination
A just published white paper from Bioquell focuses on the new regulations covering bio-decontamination claims and processes in Europe.
The use of hydrogen peroxide-based decontamination systems is increasing in hospitals. The white paper looks at the differences between the systems currently available on the market and highlights how some suppliers mix hydrogen peroxide with silver, which could be harmful to humans and equipment.
Many suppliers misleadingly brand their equipment as ‘hydrogen peroxide vapour' (HPV). True 30-35% HPV systems diffuse a vapour and produce a micro-condensation effect which is critical to achieve a 6-log kill efficacy. Systems that only generate a mist, fog or spray should be labelled as ‘aerosolised hydrogen peroxide’. Usually, these systems use lower concentrations (circa 5%) of hydrogen peroxide with added substances.
Some manufacturers add ‘silver’ to their hydrogen peroxide solutions to supposedly achieve superior efficacy. Such biocidal efficacy is often not yet fully proven in real world situations but this should change when authorised under the European Biocidal Products Regulations (BPR). Commonly, manufacturers claim that a product contains silver, when in fact it contains silver nitrate. This toxic compound has a very low exposure limit, doesn’t naturally break down and is hence very likely to remain in the environment after a decontamination cycle.
It is also important to note that aqueous silver nitrate takes part in a displacement reaction when added to copper. Considering that most electronic circuit boards have copper tracks, it is important for users to understand how the silver nitrate affects electrical equipment present in an enclosure during a decontamination cycle.
Hand hygiene
Good hand hygiene is one of the biggest tools to be used in the battle against the spread of infection in hospitals. Healthcare workers should wash their hands thoroughly, following the World Health Organisation (WHO) guidelines, both immediately before and after coming into contact with a patient or carrying out care. There are other obvious guidelines around when hands should be washed, such as after using the washroom and before handling food. The National Institute for Health & Care Excellence (NICE) highlights that such basic hygiene protocols – for staff and visitors – may be overlooked by some health professionals, particularly when in the middle of a busy shift. It is worrying that hand hygiene procedures may not be followed as vigilantly as they should be, particularly as the evidence of the importance of this simple strategy continues to mount.
A first-of-its-kind study has been published in the American Journal of Infection Control. The study shows a direct correlation between using data from the DebMed® Electronic Hand Hygiene monitoring system to improve compliance with the World Health Organisation’s (WHO) Five Moments for Hand Hygiene guidelines and significantly reduced hospital onset Methicillin-resistant Staphylococcus aureus (MRSA) infections.
In the UK alone in 2015, there were 301 Trust assigned cases of MRSA costing an estimated £7.5m to the NHS.
The study, 'Electronic Hand Hygiene Monitoring as a Tool for Reducing Healthcare-Associated Methicillin-resistant Staphylococcus aureus Infection', was conducted at Greenville Health System (GHS) in the US state of South Carolina.
Researchers utilised hand hygiene compliance data from the DebMed system to measure the impact of hand hygiene compliance rates on the incidence of healthcare-associated infections (HCAIs), such as MRSA. In addition, the study showed that costs associated with providing care to infected patients over an extended length of stay were avoided.
Among the key findings, hand hygiene compliance rates increased by 25.5%, hospital onset MRSA HCAI rates decreased by 42% and total costs of care avoided were approximately $434,000.
In England, approximately 300,000 patients develop a healthcare associated infection every year, with 5,000 of those cases proving fatal. HCAIs are estimated to cost the NHS up to £1 billion each year.
“If electronic hand hygiene monitoring systems can reduce the rate of healthcare-acquired MRSA infections by as much as 42% this will surely help save lives and prevent tragedies,” says Andrea Jenkyns, MP for Morley and Outwood and founder of the Handz campaign that aims to raise awareness of hand hygiene in hospitals. “I would like to see every hospital taking this issue more seriously."
