Today, environmental services is developing into a science that no healthcare facility can afford not to integrate into its infection-prevention program. The payoff is real, in both lives and dollars.
Soft surfaces as a source of infection
A number of industry experts weighed in on soft surfaces, one area of environmental services that is gamering increased attention recently. Soft surfaces can be a source of crosstransmission and is why disinfection of soft surfaces should be an important part of an effective environmental-services and infectionprevention program.
"There are now more than 20 published studies that identify soft surfaces as a risk for transmitting pathogens that cause infection and illness in healthcare and household settings," said
Considering the advantages, why might there be hesitation to include soft-surface decontamination in environmental services and infection-prevention programs? "Most regulatory guidelines and recommendations are outdated," stated Mueller,
Tips for containing cross-contamination
Since it is unlikely that medical facilities can completely divest themselves of soft surfaces, what can be done to minimize the risk of crosscontamination via soft surfaces? The experts had some definite opinions and some good advice on that front.
Mueller suggested, "Take a soft-surface risk assessment. This will be the foundation for an intervention and help address priorities, whether that is specific floors, units, staff, or types of soft surfaces. Understand behaviors and staff perceptions in regard to soft surfaces." The reason? "Education drives adoption," said Mueller. "Staff should be educated on the risks of coming in contact with soft surfaces throughout the delivery of care."
Mueller outlined the next step. "Evaluate potential product solutions. Laundering needs to be included in a soft-surface protocol, but multiple studies prove it cannot be the only line of defense. Only consider solutions that are
Consider the type of soft surface and its particulars, suggested Favret, Vestagen Technical Textiles. "Contaminated soft surfaces come in multiple forms: those that are fixed, those that are portable, and those that are mobile. Each type of soft surface, depending on its use, has a different set of design needs, manufacturing specifications, and safety considerations. Fixed soft surfaces include items covered in fabric or upholstery, such as chairs and couches. Portable soft surfaces, such as bedding, linens, and privacy curtains, do not travel from patient to patient. Mobile soft surfaces, such as healthcare-worker uniforms, scrubs, and lab coats, move from patient to patient, room to room, environment to environment. It is these mobile soft surfaces that need to be addressed urgently."
"Think of soft surfaces just like you think about hands and hard surfaces," recommended Favret. "You wash your hands and wipe surfaces to remove visible soil or bulk contaminant, then disinfect, which is two steps. To prevent spread of pathogens from soft surfaces during a work shift, bulk contaminants, in the form of blood or body fluids, must be repelled to reduce bioburden; then, the residual microorganisms need to be inhibited, a dual mechanism of action, two steps."
Cooke, Diversey Care, suggested minimizing the use of soft surfaces in the healthcare environment, where possible. "There cire many substitutes for porous fabrics in a healthcare setting that can be considered attractive and create a warm, caring, inviting environment. While soft surfaces are part of creating a more visually appealing environment for the patient, they also cannot be disinfected; so, inherently they are believed to carry more risk."
"When the use of soft surfaces is desired," said Cooke, "it is important to have a consistent cleaning process in place to reduce the potential pathogen load on these surfaces. They should be put on a regular cleaning schedule to help reduce the risk of cross-contamination. For items that may be laundered, such as privacy curtains, the curtains can be changed between patient discharge and admission of new patients. For stationary objects, such as furniture with soft surfaces, these should be cleaned regularly and extraction-cleaned on a rotating basis."
According to Grimes, PurThread Technologies, "Continuously active soft surfaces are a valuable tool for hospitals' broader infectionprevention efforts. Hospitals have two clear choices: increase the frequency of cleaning patient rooms and facilities or increase the amount of active surfaces in the patient environment. It is simply not practical or cost-effective to clean every surface after each touch. That is why continuously active soft surfaces will be a key part of infection-control efforts moving forward."
Products that reduce bioburden on soft surfaces
Lurie described Clorox's disinfectant product. "Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectant Spray and Citrace Hospital Disinfectant & Deodorizer are
As always, scientific evidence of a product's efficacy is of paramount importance. When investigating a new product, never fail to ask to see the scientific evidence, particularly evidence published in respected medical or scientific journals or presented at major scientific or medical meetings in the form of papers or posters. Most vendors are delighted to share the evidence with you.
Lurie pointed to information presented at two high-profile medical meetings focusing on
"Rutala et al presented results from a preand post-intervention study on hospital privacy curtains at the
Qutaishat, Diversey Care, talked about Oxivir Tb, which she described as "a hydrogenperoxide-based disinfectant that belongs to the improved hydrogen-peroxide class of disinfectants. This class of disinfectants is highly effective against most multidrugresistant healthcare pathogens. Multiple studies have demonstrated that this class of disinfectants has superb dwell time and excellent log reduction of pathogens for surfaces in healthcare facilities."4
Oxivir Tb is virucidal, bactericidal, tuberculocidal, and fungicidal. It kills MRSA and norovirus, and it meets Bloodborne Pathogen Standards for decontaminating blood and body fluids.
Continuously active textiles work to inhibit growth of pathogenic microorganisms. Favret explained why he believes adding antimicrobial fabrics to the infection-prevention mix is important. "Vestex-protected garments provide both protection and comfort. Vestex-protected uniforms repel fluids, to reduce bulk contaminant and to avoid exposures to blood and bodily fluids. Fluids literally bead up and fall off the garment. Vestex-protected uniforms contain an antimicrobial, to inhibit bacterial growth. Its performance persists for the life of the garment and has been proven to retain effectiveness in the industrial laundry setting."
Favret offered scientific evidence of their products' efficacy. "Bearman et al,
PurThread Technologies also employ an antimicrobial to inhibit bacterial growth in their fabrics. "PurThread medical textiles incorporate a patented antimicrobial agent developed by
"The active agent in PurThread textiles is not a topical coating or superficial treatment. PurThread's award-winning manufacturing process incorporates the agent into the core of each fiber, ensuring even distribution of the antimicrobial agent throughout the fabric and the agent's efficacy over time, regardless of wear and washings. PurThread fabrics work just like traditional linens and do not require any special training, equipment, or laundering procedures. Adding PurThread products to current infection-prevention efforts is a simple and cost-effective horizontal strategy to implement that requires no change in behavior."
Grimes referred to research published in a prominent medical journal supporting PurThread's claims. "Results from a double-blinded, randomized clinical trial conducted in two ICUs of a tertiary teaching hospital found PurThread privacy curtains took 7 times longer to become contaminated than control curtains and were 8 times less likely to be contaminated with the superbug vancomycin-resistant Enterococcus."6
According to Mueller, X-STATIC has undergone extensive safety testing and is environmentally friendly. "It is important to note that X-STATIC is not a nanotechnology or temporary topical solution, and no metallic silver is released or leeched into the environment.
Get educated on the solutions
Companies have spent untold resources on research before their products hit the market, so take advantage of this existing body of knowledge. Here is a sampling of the educational offerings from these vendors.
Lurie described information and tools they make available online. "
"Diversey Care provides extensive educational expertise and resources throughout
Favret talked about resources offered by Vestagen. "Vestex fabrics are rooted in research and published evidence. We are committed to sharing information and best practices to optimize health care, patient safety, and quality. We will launch our professional education website this winter, with online and in-person continuing education opportunities. Courses address fundamentals from our WASH, WIPE, WEAR campaign; expand leadership through building a culture of safety; and create foundations through policies of protection. Topics include bloodborne pathogens, aseptic technique, and multidrug-resistant organisms, as well as business skills, such as how to develop policies and procedures incorporating new technologies like Vestex fabrics. Stay tuned at vestexprotects.com."
White papers are not published in medical or scientific journals, but they can still be a good source of information. Mueller pointed to two white papers on soft-surface bacterial management that
1. Ohl M, Schweizer M, Graham M, et al. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. Am J Infect Control. 2012;40(10):904-906. doi: 10.1016/j.ajic.2011.12.017.
2. Rutala WA Gergen MF, Weber DJ. New technology in environmental cleaning and evaluation." Presented at the
3. Reynolds KA, Sexton JD. Evaluation of a soft surface sanitizer in healthcare environments. Presented at IDWeek;
4. Rutala WA, Gergen MF, Weber DJ. Efficacy of improved hydrogen peroxide against important healthcare-associated pathogens. Infect Control Hosp Epidemiol. 2012;33(11):1159-1161.
5. Bearman GM, Rosato A, Elam K, et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol. 2012;33(3):268-275.
6. Schweizer M, Graham M, Ohl M, et al. Novel hospital curtains with antimicrobial properties: a randomized, controlled trial. Infect Control Hosp Epidemiol. 2012,33(11):1080-1085.
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