Tackling Hospital-Acquired Infections Through Environmental Cleaning: Thoughts From Xenex' Dr. Mark Stibich
Why environmental hygiene matters
According to Dr. Stibich, infection control efforts can be divided into three main areas: medical procedure/sterilization, hand hygiene and environmental hygiene. "If you roll back the clock five years, the environment was way at the bottom of that list," he says. "We thought it didn't really matter — if we could just get our hands clean, everything would be fine." That line of thinking, of course, is flawed in several ways: First, hand hygiene rates persist at roughly 50 percent compliance, and second, environmental hygiene is proving a significant factor in preventing infection.
He says while the healthcare industry has come a long way in improving safety during procedures, through the use of surgical checklists and other tools, facilities still have work to do in environmental care. "We like to say that the standard protocol for cleaning and disinfecting is quite literally a bucket or a mop," he says. "The industry has not developed many new tools. It's not the fault of housekeeping — we're asking them to make the room pathogen-free, but we're giving them less time and no new equipment."
He says the push towards environmental hygiene may be spurred by changes in reimbursement. In 2008, Medicare instituted a "never events" policy intended to improve patient safety, refusing to pay for certain types of safety violations that occur in healthcare facilities. The never events included problems such as wrong-site surgery, bedsores, falls or trauma, hospital-acquired infections associated with surgeries or catheters, and transfusion with the wrong blood type.
"That's really gotten the attention of hospital executives," Dr. Stibich says. "Starting fiscal year 2013, CMS will move to value-based purchasing, where whole percentage points of reimbursement are at stake. Hospitals will be reimbursed based on where they fall compared to other hospitals. Whether they're worse, average or better than their competitors will shift their reimbursement."
Making housekeeping an essential part of the team
This shift could potentially cost hospitals millions of dollars — but of course, that isn't the only driver behind the focus on a clean surgical environment. Dr. Stibich credits a changing culture for the emphasis on hygiene. As the healthcare industry starts to focus on collaboration and communication, housekeeping is increasingly considered an essential part of a surgical or patient care team. "One of the biggest factors that influences the cleanliness of a hospital is how infection control and environmental services work together — and how everything is perceived at an operational and executive level," Dr. Stibich says.
He says while ORs are supposed to undergo terminal cleaning daily, housekeeping staff are often pressed for time. "It puts them in the position of saying: Do I not follow the guidelines? Do I force my staff to take shortcuts?" he says. "When you're expecting a housekeeper to clean an isolation room in 30 minutes or an OR in 15 minutes— and that means changing the trash, getting stuff off the floor, changing the bed linens as well — you're going to keep hitting this wall."
The solution to this problem may lie outside the traditional cleaning method of mops and rags. Xenex provides a tool that shines a certain amount of pulsed xenon ultraviolet light on every surface in the OR, saturating the room and killing bacteria, spores and viruses. "It shines on all surfaces and disinfects them, whether or not housekeeping has cleaned them," Dr. Stibich says.
Improving safety — in less time?
The product has been designed to contribute to cleanliness without adding time to the room turnover. A study performed at a VA hospital found that the tool resulted in a cleaner room and worked 23 percent faster than traditional methods. In addition, training to use the tool is limited: Typically, a user can pick up the process in about 30 minutes. Hospitals using the pulsed xenon device have already reported outcomes that include reductions in hospital acquired infection rates.
There are several competing technologies on the market, all of which work but may take more time to use. One is hydrogen peroxide vapor, which takes chemical action on organisms, kills spores and viruses, and then has to be sucked back out of the room. "The quickest way to do this takes two and a half hours, and the room must be sealed," Dr. Stibich says. Another option is mercury-based ultraviolet light, which takes at least 50 minutes.
Dr. Stibich says Xenex has made some changes to the device since its inception. In the beginning, the tool was powered by remote control — but, as anyone who watches television can attest to, the remote was frequently lost. Instead, they produced a physical cone with an on/off switch that stands outside the door.
He says the product has also had a significant effect on morale in the OR. "It's really nice to see the implementation process," he says. "Housekeepers start feeling like part of the infection prevention team and take this great pride in what they're doing. We also see that nurses and housekeeping are more likely to call a physician out for not washing his hands. They've been trusted with that piece of technology, so they get to be the leaders."
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