Shifting to offense from defense [Healthcare Purchasing News]

Antimicrobial products central in HAI combat

It is difficult to believe, but there was a time, not so very long ago, that the environment was downplayed as a serious reservoir for healthcare-associated infections (HAIs). Even worse, those who were charged with the task of environmental services were treated as little more than broom pushers.

Not so anymore. Environmental services' work is predicated on science-based evidence and finally is being recognized for the valuable role it plays in keeping infection down.

No doubt, Medicare's refusal to continue bearing the cost of HAIs, with private insurers following suit, is, to a large degree, responsible for the sea change. Loss of reimbursement has the medical community increasingly and diligently searching for ways to reduce the potential for infection. One area that has been the happy recipient of more attention is the environment and those charged with the task of caring for it.

Industry is responding with innovative infection-prevention products and services for the healthcare environment. Healthcare Purchasing News talked to some companies who have developed such products. Prepare to be dazzled by the array.

Soft surfaces

Soft surfaces, such as textiles, certainly come in contact with patients and provide opportunity for cross-infection. Peggy Prinz Luebbert, MS, MT(ASCP), CIC, CHSP, founder of Healthcare Interventions Inc., and consultant to Noble Biomaterials, Scranton, PA, explained why soft surfaces are efficient vehicles of transmission and how Noble's X-STATIC antimicrobial fabric helps to achieve a cleaner, safer environment. "The bacterial contamination of soft surfaces - such as curtains, lab coats, and scrubs- is a critical issue in the quest to prevent infections. Studies prove that soft surfaces are highly contaminated and that cross-contamination with hands occurs. Studies also prove that laundering is not sufficient, due to rapid recontamination after [being] put in use. Despite this clinical evidence, there are currently no protocols to address the problem as part of everyday infection-prevention practices."

Luebbert described how the antimicrobialfabric technology works. "Soft surfaces powered by X-STATIC provide a continuous, permanent, and comprehensive solution. The technology lasts the lifetime of the product and requires no change in staff behavior. X-STATIC is made by permanently bonding 99.9% pure metallic silver to the surface of a textile fiber. This silver layer creates an ionic shield that quickly and continuously inhibits the growth of bacteria and fungi directly on the fabric surface. Fabrics powered by XSTATIC have been proven to reduce environmental contamination on soft surfaces, which constitute 90% of the patient environment."

Luebbert cited anecdotal evidence supporting the efficacy of X-STATIC's antimicrobialfabric technology. "X-STATIC antimicrobial-fabric technology is clinically proven to reduce pathogenic bacteria directly on the surface of fabrics. In one trial, a comparison was made of 3 different curtain types on 2 medical wards at Queens Medical Centre in the United Kingdom. The 3 types of curtains were silverimpregnated fabric, polyester fabric without the silver weave, and ordinary cotton curtains. Four curtains of each type were studied on both a medical-gastroenterology ward and a medical-dermatology ward. Clean curtains were hung in place on the 2 wards, then sampled daily for overall bacterial contamination and twice weekly for MRSA [methicillinresistant Staphylococcus aureus] contamination, using the sweep-plate sampling method. The trial lasted for 1 month."

"The study found the rate of contamination was fastest with the cotton curtains and slowest with the silver-impregnated curtains. The cotton curtains reached a steady state of overall bacterial contamination by day 7; however, steady state was not reached until 14 to 21 days for the silver-impregnated curtains. The overall contamination of these was slightly lower compared to both the cotton and polyester control curtains. MRSA was found in only 4 of 96 samples (4%) from the silver-impregnated curtains, but in 21 of 192 samples (11%) from the cotton and polyester control curtains."

"X-STATIC is now available in Encompass Performance RX lab coats and uniforms for healthcare staff," said Luebbert. "For more information visit www.InfectionPreventionTextiles.com."

PurThread Technologies Inc., Durham, NC, also aims to help hospitals reduce bioburden on fabric surfaces. Kathryn Bowsher, vice president of clinical and regulatory strategy, said, "PurThread Technologies is finalizing the development of its products, pending appropriate regulatory registration. In the lab, data shows a reduction of bioburden within 15 minutes using PurThread fabrics. In the clinical environment, PurThread privacy curtains have shown a measureable impact (study publication pending)."

"Contamination in the patient environment makes hand hygiene critcal, yet insufficient, to the challenge of reducing HAIs," stated Bowsher. "Most environmental surfaces are cleaned, at best, once every 24 hours. At PurThread, we believe that continuously active surfaces with antimicrobial properties are a valuable tool in the broader infectionprevention efforts of hospitals. PurThread textile products, such as privacy curtains and scrubs, are designed to reduce bioburden on frequently touched, hard-to-clean, soft surfaces. As an effective horizontal strategy, continuously active surfaces can offer additional layers of protection between patients and healthcare workers' hands, allowing both to focus more on what matters most: the improved health of the patient."

Bowsher briefly described some of their products. "PurThread products include sheets, scrubs, blankets, white coats, and privacy curtains, just to name a few. Silver and copper have a wellestablished history of safe antimicrobial effects, and PurThread has captured these attributes to reduce the bioburden on fabrics themselves in the hospital environment. Silver and copper kill pathogens upon contact through their natural positive charge. When these atoms come in contact with pathogens, they pull off electrons from those cells, and cause the cell walls to rupture, resulting in cell death. By incorporating these antimicrobial elements into every yarn, the active ingredient is evenly distributed and does not wash off or wear out. The antimicrobial elements are integral to the fibers themselves and not a topical treatment. PurThread's proprietary integration technology is designed to give our fabrics the same soft, high-quality textile feel you would find in a comparable standard fabric."

InPro Corporation, Muskego, WI, manufactures door and wall protection, washroom systems and commercial surfaces, expansion joint systems, cubicle track and privacy curtains, and signage. In July, a study was released at the 112th General Meeting of the American Society for Microbiology in San Francisco showing that Shield fabrics reduced 99.9% of bacteria within 1 hour, eliminating almost all of the microorganisms that contaminate hospital curtains, including MRSA, vancomycin-resistant Enterococcus (VRE), and multidrug-resistant gram-negative bacilli. InPro is the sole North American distributor of Shield fabrics.

Mattresses, seeing a high turnover in occupants, present an opportunity for transfer of HAIs. Joseph Downey, CEO, Trinity Guardion, Batesville, IN, noted that studies have linked some facility outbreaks to contaminated mattresses, "the highest patient touch point." Downey described why the Trinity Bed Protection System is effective in thwarting transmission of pathogenic organisms. "A recent study showed that germicides used on mattresses only kill 80% of the bacteria. Trinity Guardion has been proven in a clinical study to provide a consistently cleaner mattress surface through the laundry process rather than using germicides."

The Trinity Bed Protection System is a fluid-proof cover containing a silver-ion antimicrobial that encapsulates the mattress and bed deck. "It is laundered between patients, using CDC [Centers for Disease and Control and Prevention] laundry guidelines," said Downey, "and provides a 99.9 % clean surface in the end-to-end process, without affecting the clinical performance of the underlying mattress. A recent clinical study proved that the laundered Trinity Guardion mattress cover is 10 times cleaner than using germicides to clean mattresses."

Furniture in patient rooms also gets a workout from constant use. Seams and tucks in upholstery provide perfect breeding spots for bacteria and hiding places for bedbugs, a growing problem. ergoCentric Seating Systems' solution is seamless, moisture-proof, and durable.

Ken Hammond, vice president, sales, US, ergoCentric Seating Systems, Millersburg, OH, described their product: "ergoCentric Seating Systems offers healtHcentric, a line of seating designed to provide optimal cleanability and durability to help prevent the spread of infectious disease while providing comfort and support to staff, visitors, and patients. healtHcentric chairs are upholstered in IC+, the most durable and cleanable PVC-free upholstery product on the market today. Its proprietary technologies stand up to all hospital cleaners and disinfectants to offer a truly cleanable solution that ensures the removal of pathogens from its chairs' seat and back surfaces."

"IC+ is the only upholstery solution used to form a seamless moisture-proof barrier, including the underside of the seat pan, on all healtHcentric chairs, making them easy to clean, disinfect, and bed-bug proof. healtHcentric seating also features a unique clip system, allowing the seats to be easily removed for cleaning. Proprietary to ergoCentric, IC+ offers a 10-year warranty against cracking, punctures, and tears." Hammond added, "In addition to potential superbug outbreaks, hospitals have identified bedbugs as a rising problem. Infestations can occur frequently due to patient turnover rates and the continual influx of visitors that healthcare facilities see every day." He cited an experience with their product: "Guelph (Ontario) General Hospital installed healtHcentric chairs in its waiting areas with IC+ upholstery on its seat pans, including underneath the seat pan. With no seams or crevices for the bugs to enter, the chairs did not have to be thrown out should an infestation occur. The impermeable and seamless surface ensured both bug types could be easily cleaned against creating a cost-effective solution for this high traffic area."

Hard surfaces

Silver has long been recognized as an antimicrobial, and now copper is another metal gaining popularity for its inherent antimicrobial properties.

Michele Salimbeni, marketing manager, commercial and residential, Cooper Wiring Devices, Peachtree City, GA, talked about how their company uses copper to fight infection in the patient environment. "HAIs are a growing concern among hospitals everywhere. According to the CDC, 1 in 20 patients will contract an HAI, resulting in up to 100,000 deaths annually. These facilities are looking for solutions to this growing problem. Therefore, we have launched the Arrow Hart line of switches and wall plates that are made with CuVerro (GBC Metals, LLC) antimicrobial-copper touch surfaces. CuVerro is ideally suited for commonly touched surfaces, such as switches and wall plates, where transmitting infections are a concern. CuVerro is the only EPA-registered solid-surface material that actively kills bacteria. Salimbeni briefly described the two products. "The Arrow Hart wall plates are stamped of the CuVerro antimicrobial-copper alloy, and the switches feature a CuVerro insert on the touch surface of the paddle."

Results of laboratory testing provide proof of the pudding. "The CuVerro material delivers continuous and ongoing antibacterial action. It also helps inhibit buildup and growth of bacteria within 2 hours' exposure between routine cleaning and sanitizing steps. Laboratory testing shows that, when cleaned regularly, CuVerro antimicrobial copper surfaces kill greater than 99.9% of the following bacteria within 2 hours' exposure: MRSA, S aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and Escherichia coli 0157:H7."

To see field trial studies, visit www. Cu Verro.comandwww.antimicrobialcopper.com.

Growing use of technology brings with it more opportunities for cross-contamination. SealShield offers waterproof computer keyboards and mice, television remotes, and iPad shields.

Bradley Whitchurch, CEO and president, observed: "HAIs are driving the need for cost-effective infection control products and services, and have become the paramount issue for hospitals in the US and abroad. Common touch surfaces can harbor bacteria and spread infection. Seal Shield products are washable, disinfectable, and feature antimicrobial protection to mitigate the growth of bacteria. Seal Shield includes Silver Seal antimicrobial technology in a number of its products. Silver Seal is among the safest and most effective antimicrobial solutions in the industry, utilizing the properties of pure silver to protect from mold, mildew, fungi, and the spread of bacteria and viruses on product surfaces."

Whitchurch recounted two experiences of Seal Shield users. William H. "Bugz" Hamilton RN, CIC, infection prevention and control coordinator, VA Central California Health Care System-Fresno, said, "From the infection prevention standpoint, I believe this is the most significant advance I have seen in this 'contaminated little corner' of the hospital environment in 2 decades of practice."

Another anecdote is from Pete Fletcher, Geisel School of Medicine at Dartmouth, Hanover, NH: "During the fall term of 2008, a number of students, estimated around 200 to 300, contracted a pink-eye infection. Among ways the pink-eye infection was spreading, we believed, was contact with public keyboards. People were rubbing their eyes, then using the keyboards. We decided to replace keyboards and began to disinfect machines; however, the cost of replacing keyboards was rising at an alarming rate. I needed to find a better solution."

"Since putting Seal Shield keyboards in place, the number of replacement keyboards was almost zero. There have been no reported cases of pink eye. Because the keyboards are run through a dishwasher at the end of each term, students and staff are much happier at the cleaner look. I also explained to the students that the keyboards are antimicrobial, which will help prevent cross-contamination. They are amazed by this and are happier to be using them."

Noso Control LLC, is a subsidiary of Command In Hand Inc., Tampa, FL, which makes television remote controls for the healthcare industry. Noso Control, LLC, was created specifically to address the spread of H Als. In conjunction with the University of Arizona, UCLA Medical Center, and others, they have conducted studies demonstrating that television remotes are a leading carrier of pathogenic organisms. Their product, Clean Remote, tested 99% cleaner than standard remotes and helps to reduce germs and viruses often found on patients' television remote controls.

EquipSystems, New York, NY, provides medical facilities the service of caring for rolling stock. Carl Runge, operations manager, explained: "EquipSystems is the leader in equipment deep cleaning, disinfecting, results testing and reporting for healthcare facilities. We clean and disinfect the equipment that is used by everyone, owned by no one, yet has an impact on everything. Hospital patient-care equipment falls through the cracks of most facilities' cleaning and disinfecting efforts. EquipSystems provides a comprehensive program that not only completes the service, but also tests the equipment' s cleanliness and reports it, and returns the cleaned equipment back to the facility."

"With Equipment Management Solutions (EMS) we provide deep cleaning, disinfecting, results testing, and reporting for rolling stock facility-wide. EMS can also be tailored to highuse areas like the operating room, emergency department, and intensive care unit. Customers that have used our program have experienced immediate improvements in HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] patient satisfaction scores."

Runge briefly outlined the process:

* Evidence-based cleaning: remove tape, dried fluids, stickers, hair, string, and sutures

* Minor repairs: fix or replace non-working casters and rubber tips, and lubricate moving parts

* Disinfection: the detergent and quaternary sanitizer used kills 99.99% of bacteria, viruses, fungi, and yeasts

* ATP testing: demonstrates reduction of infectious reservoirs by measuring actively growing microorganisms through detection of adenosine triphosphate (ATP)

* Tracking and documentation: barcode and tag all serviced equipment for a detailed report that can be used during inspections and surveys

"Our service brings infection control back to the basics of understanding that a clean facility and clean equipment will lower infection rates," said Runge.

Disinfection

There is no attack on cross-transmission of pathogenic organisms any more important than keeping the patient environment squeaky clean. Ecolab disinfectants both kill and deodorize. Linda Homan, RN, BSN, CIC, senior manager, clinical and professional service, Ecolab Healthcare, St. Paul, MN, said, "Ecolab develops infection control products and programs to help hospitals provide cleaner, safer, and healthier environments for patients and staff. We continually strive to develop disinfectants that are effective against infection-causing pathogens, have a fast kill time, and are compatible with a variety of surfaces."

"Hospitals and healthcare facilities continue to face pathogens that persist for long periods of time in the environment, making environmental hygiene more important than ever. Of particular concern is the Clostridium difficile bacterium, which forms a spore that cannot be eradicated with typical hospital disinfectants. C difficile infection is now one of the most common healthcare-associated infections in the US."

"To combat hard-to-kill pathogens like C difficile, Ecolab offers EPA-registered Virasept, a ready-to-use, non-bleach, hard-surface disinfectant. Virasept delivers clear benefits over other disinfectants used to kill C difficile spores, including improved material compatibility and improved cleaning efficiency."

C difficile infection arrives with heavy-duty diarrhea, so a product that kills and deodorizes is a really attractive option. Homan, Ecolab, continued: "Virasept is a one-step product that cleans, disinfects, and deodorizes at the same time. Its patented, noncorrosive chemistry is formulated for daily cleaning of high-touch areas and works within 10 minutes of application against C difficile and in 4 minutes or less for a broad spectrum of other pathogens, including MRSA, VRE, E coli, HIV, hepatitis ?, influenza A (HI NI), and norovirus."

"Using Virasept, healthcare facilities can be confident that surfaces are fully clean without causing damage to equipment and other hard surfaces or leaving a residue. There's no longer a need for multiple products to combat C difficile."

Clorox Professional Products Company, Oakland, CA, also makes environmental disinfectants. Brad Ferris, senior public relations manager, said, "Clorox Healthcare develops efficacious, EPA-registered disinfectants specifically for healthcare personnel to use on environmental surfaces and medical equipment to help reduce the spread of pathogens that cause HAIs, like C difficile."

"Clorox Professional Products Company is committed to continually improving its offerings to meet the needs of healthcare professionals in the fight against HAIs. For example, Clorox Healthcare Bleach Germicidal Wipes were recently registered by the US Environmental Protection Agency (EPA) to kill C difficile spores in 3 minutes, the fastest C difficile contact time available for disinfecting wipes. (Note: 3-minute C difficile spore claim has been registered by the Federal EPA and may not yet be available in all 50 states. Check with your sales representative for updates in your state. Use as directed on pre-cleaned, hard, nonporous surfaces.) Clorox Healthcare Bleach Germicidal Wipes are EPA-registered to kill a total of 51 microorganisms, including all ESKAPE pathogens (Enterococcus faecium, S aureus, Klebsiella pneumonia, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter aerogenes) in 30 seconds, norovirus in 1 minute, and tuberculosis and C difficile in 3 minutes. The wipes are ready-to-use, hospital-grade disinfectant wipes and are trusted by more US hospitals than any other bleach wipe (based on responses given by 278 environmental services personnel and infection-prevention decision makers in acute-care facilities when asked to identify wipes used in their facility)."

Hand hygiene

Amy White, senior marketing manager, healthcare segment, Georgia-Pacific Professional, Atlanta, GA, talked about their products and educational contributions to environmental safety. "Georgia-Pacific offers a range of hygienic products designed to encourage a better experience in healthcare settings. The company also implements a number of educational initiatives such as the Spread Wellness (http://www.gppro.com/wellnessroom/ ) campaign to help raise awareness of proper handwashing techniques and increase compliance throughout healthcare facilities."

"Georgia-Pacific Professional's vision is to be a leading provider of towel, tissue, and skincare by offering hygienic and effective solutions. For example, enMotion automated foam soap and sanitizer dispensers offer healthcare personnel fast-response, no-touch dispensing to help minimize crosscontamination risks and prevent illness."

"Implementing enMotion touchless soap and sanitizer dispensing systems can help healthcare facilities combat the spread of HAIs by offering fewer touched surfaces, thus reducing the risk of cross-contamination. Because of the ease of use, professionals and patients may even be more inclined to use touchless dispensers in their daily routines."

Dry skin is the bane of the healthcare worker. It is not just a matter of aesthetics; dry, cracked skin offers hiding places for bacteria to colonize. "Proper hand hygiene is one of the most important measures in preventing the spread of infections. Because frequent hand washing can be rough on hands, Georgia-Pacific Professional offers skincare solutions designed to enhance hygiene while helping to protect healthcare workers' skin from dryness."

"Georgia-Pacific Professional offers three product types for use in the dispensers: enMotion gentle foam soap with moisturizers, enMotion antimicrobial foam soap with moisturizers, and enMotion foam hand sanitizer with moisturizers. Each product is formulated with aloe and other conditioners, to help protect against dry skin typically associated with frequent hand washing, and comes in a hygienic closed system to minimize the risk of bacterial growth."

Pest control

Pests could not ask for a more hospitable environment than hospitals. They provide everything a pest needs to be happy and proliferate: food, water, shelter, and comfortable temperatures. Pests are not just an annoyance; they present a health threat to people who are already sick. Greg Baumann, vice president, training and technical services, Orkin, Atlanta, G A, said, "When it comes to protecting a healthcare facility from pests, we are keenly aware that some pests carry bacteria and diseases that can affect patients with a compromised immune system."

Patients, staff, and visitors alike benefit from the proactive approach now preferred. The objective is to prevent infestation, which decreases the need for harmful chemicals.

"From our standpoint, taking proactive measures to deter these pests, such as rodents, flies, and birds, from entering a facility is the way to help reduce their ability to transmit disease. With Integrated Pest Management (IPM), preventive steps are taken to help decrease pest access to food, water, and shelter. These measures may include facility maintenance, stringent sanitation, and targeted remediation to ensure that disease-carrying pests remain outside of sensitive patient areas. Many of the sanitation practices that are recommended as part of an IPM program are in line with cleaning standards that help reduce HAIs."

Orkin works with the Association for the Healthcare Environment (AHE) to educate environmental services professionals on best practices in pest management. Orkin Gold Medal Protection for Health Care customers qualify for a free AHE membership. For more information, go to http://www.orkin.com/commercial/ahe/.

Cooper Wiring Device's Arrow Hart switches and wallplates made with CuVerro antimicrobial copper

Seal Shield products are washable, disinfectable, and antimicrobial.

EquipSystems provides deep cleaning, disinfecting, results testing and reporting for rolling stock.

Ecola b's EPA-registered Virasept, a non-bleach hard-surface disinfectant effective against C difficile

Orkin's Gold Medal Protection service neips remforce sanitation protocols and reduce pest threats to support infection control programs.

by Susan Cantrell, ELS