Combating HCAIs: the future

• Feb 02, 2015

A mandatory enhanced surveillance scheme was implemented in the NHS in 2007, which took into account all infections over the age of two and included the collection of patient details for each CDI episode – such as NHS number, hospital number, date of birth, and sex, as well as information concerning the patient's location, date of admission, and care details at the time the faecal sample was taken. 

Since 2007/8, the figures depict a 75% drop in the number of C.difficile infections reported and an 81% reduction in the number of cases of MRSA reported (Public Health England, Annual Epidemiological Commentary – 2013/2014, published 10 July 2014). 

Over the past decade, there has been a significant focus on HCAIs through both the media and political sectors, with an emphasis on how to reduce HCAIs in the secondary healthcare sector. This pressure has contributed to an increase in resources, training, awareness and monitoring, which contributed to the reduction in HCAIs. Recently, as hospitals have been experiencing cuts and tight budgets, there has been a noticeable pressure on the resources available for infection control purposes, as reported in the Patients’ Association Report ‘Rolling the Dice’, published in 2012. 

In addition to the above, there has been an increasing recognition of the role that a contaminated healthcare environment plays in healthcare-associated infections. This has led to a greater focus on environmental decontamination. Although some of this has been through technical, automated solutions, such as the use of hydrogen peroxide, there has also been a recognition that low-tech solutions are also highly effective.This can be achieved through the use of cleaning solutions that are practical for everyday use. Wet wipes, with combined detergent and disinfectant properties, are the most commonly used type of wipes in the NHS. 

Clinell Universal Wipes are a highly trusted wipe and widely used within the UK healthcare sector, with over 500 million wipes used every year by the NHS alone. The powerful antimicrobial formula and convenient point-of-use dispenser system has proven popular and effective in helping healthcare workers (HCWs) to decontaminate the environment without the need to constantly prepare solutions that date expire.

There are many wipes on the market. However, selecting the most appropriate wipe is only one part of the process. No matter how effective the disinfectant formulation is, or how efficient the delivery mechanism is, the product will never achieve its stated claims if it is not used correctly. There are many reasons why a product may be used incorrectly including insufficient time, scarce resources or a lack of understanding of the mechanism of action or a lack of training on the practical methods of using the product. 

Research indicates that environmental decontamination is frequently performed ineffectively, with less than 50% of hospital room surfaces being adequately cleaned and disinfected (Weber et al, 2013). This poses a significant risk to patients, since research has demonstrated that pathogens such as C.difficile and MRSA can survive on surfaces for many months (Kramer et al, 2006). 

With the focus on environmental decontamination being stronger than ever, many hospitals have incorporated automated, non-touch technologies as part of their disinfection protocols – such as hydrogen peroxide vapour (HPV) machines or ultraviolet devices, which are used as adjuncts to wet wipes and can eliminate the human factor in assuring that the process has been successfully completed.  

UV-C Devices

Ultraviolet C (UV-C) radiation is emitted by the sun and is normally stopped by the Earth’s ozone layer thereby preventing human exposure to UV-C. The UV-C rays kill pathogens by destroying the DNA component via the absorption of shortwavelength ultraviolet radiation. This deactivates the microorganisms and renders them non-pathogenic. This technology offers an additional level of assurance, in addition to a hospital’s regular decontamination procedures. This technology will target areas that may be difficult to clean thoroughly such as walls, light fixtures, windows and floors. 

There are many UV devices available, but not all UV devices are the same. The design of the device plays a crucial role in its efficacy. Rutala et al (2014), for example, found that the Clinell UV-360 Room Sanitiser is five times faster at killing C.difficile than other UV devices. 

The Clinell UV-360 Room Sanitiser uses UVC radiation to kill 99.99% of pathogens including C.difficilespores and MRSA. This particular device uses four 1.6m maximum output polymer-encapsulated UV lamps, making it exceptionally powerful. The aluminium reflector mast has been designed for optimum UV-C energy distribution to ensure that the light can penetrate below beds and above commonly touched surfaces. 

UV-C germicidal radiation has many advantages – it is a rapid decontamination process with a short dosage/contact time, taking only an additional 20-30 minutes on the time taken to perform a routine terminal clean protocol. There is no need to seal the room beforehand and, as soon as the UV device has run its cycle, the room can be used immediately. UV-C devices do not require trained staff to operate them and therefore can be used 24/7 in a hospital by all trained nursing staff. There are no consumable products required to operate the device, making it a highly cost efficient non-touch technology. 

However, no machine offers a complete solution as, even when adopting a non-touch disinfection device, the room still needs to be cleaned thoroughly beforehand to remove organic matter to ensure that the disinfecting agent is able to reach all surfaces. Additionally, it is not always possible to use automated methods for everyday use. Equipment needs to be cleaned in between uses, especially if it is being moved between patients or utilised in different areas of the organisation. There is a distinct correlation between effective environmental cleaning and a reduction in the bioburden which is available to transfer pathogens between patients, HCWs and visitors. 

As previously discussed, the use of wipes provides a ready-to-use, cost effective solution to ensuring that cleaning technology is always to hand. However, an accessible and comprehensive training scheme should be available to all staff. This should cover the basic tenets of infection control such as why cleaning is important; how to clean in the most efficient manner; and the transference of pathogens etc. 

There are many approaches and delivery mechanisms available to train staff and the best solution will differ between Trusts. Some Trusts prefer individual training sessions, while others may prefer group training and some tailored ward-based training. 

GAMA Healthcare has the resources available to help organisations by providing an integrated cross platform solution which will satisfy all training requirements. Its team of infection control nurse trainers are available to provide bespoke onsite training built around Trust-specific policies and procedures. This can either be focused on a new product introduction or a refresher course on IPC best practice. 

In January 2012, GAMA Healthcare invited over 20 senior infection prevention and control professionals, including several past and present members of the Infection Prevention Society (IPS) board, to form an advisory board. The board was tasked with creating a comprehensive and accessible training package. Their experience combined with the research undertaken on over 200 relevant studies have enabled GAMA Healthcare to create a training package which details a practical and scientific approach to effective environmental cleaning practices within a healthcare setting. Based primarily on a 10 inch Android powered tablet, it is both accessible and enjoyable. 

In order to enhance learning, it features five fun and engaging games which help to emphasise key learning points and measure understanding. The application is designed to be used individually or in a small or large group. The videos and instructional diagram sheets explain simply and clearly the most effective way to reduce contamination from microorganisms found on the most common items within a hospital.The educational content has been approved by the IPS education committee. 

The training program also has the ability to monitor and measure results and then generate comprehensive data reports. This provides valuable information and statistics for the senior Infection Prevention and Control Nurse (IPCN) and to the organisation thus giving assurance that training has been delivered and that a level of competence has been achieved. The Clinell Training Package is offered free of charge to all Clinell customers (subject to terms and conditions) and forms part of a comprehensive benefits package and after sales support. 

Leeds Teaching Hospitals NHS Trust (the largest Trust in England, with over 13,000 staff) was a recent recipient of the complete array of training that GAMA has to offer. Leeds switched to Clinell wipes and were provided with three months of bespoke on ward infection control training. In addition, the support is ongoing as there are regular sessions throughout the year. 

Sarah Miller, the IPC Matron at the Trust explained: “Training was performed in a methodical manner identifying Trust priorities, providing posters and frequent updates which included training lists and feedback by three Clinell IPC Nurse Trainers.”

“The Clinell Training Package has allowed us to train people who may have had limited training in the past,” added Gary Thirkell, IPCN specialist. 

Towards zero tolerance

GAMA Healthcare recommends a comprehensive approach to improve environmental cleaning efficacy. Their two-step product approach is as follows. Step 1: use the most effective wipes available to ensure rooms and equipment are as clean as possible. Step 2: supplement with a dose of UV-C radiation to ensure effective disinfection in all areas. 

Ultimately, there is no single solution in the battle against HCAIs, but with increased knowledge and better technology, we do appear to be turning the tide. Professor Jason Leitch, clinical director, Quality Unit, Scottish Government, commented at Infection Prevention 2014: “Zero should be the target. If we cannot get to zero, how many would you like? How many are you willing to tolerate?” 

With the best products, robust procedures, comprehensive training and simple, effective technology, we can reduce HCAI rates and strive towards achieving this zero target, which many previously thought unachievable.