Healthcare-associated infections constitute a huge burden for both providers and patients. These infections can hinder overall care quality, compromise outcomes, drive up care costs and drain hospital resources. A comprehensive infection prevention strategy is necessary to address the burden of HAIs, and including ultraviolet disinfection in that strategy can help support infection control goals.
According to the CDC, one in 31 hospital patients has at least one HAI on any given day.
"This is really a significant problem," said Alice Brewer, director of clinical affairs at Tru-D SmartUVC, during a Nov. 18 webinar hosted by Becker's Hospital Review and sponsored by Tru-D. "I think it's important to remember that these are people that we're talking about. These are not just statistics. They are actual patients that are in our hospitals every day, and we need to make sure we are doing our best to make sure they are not leaving sicker than they arrive."
Ms. Brewer noted there are a number of factors that contribute to HAIs, such as contact with other patients, contact with healthcare workers and the hospital environment. Environmental contamination can affect patients in two ways — via direct contact and indirectly through healthcare workers or family members who touch devices and surfaces in patient rooms and then interact with them. Patient rooms see a lot of traffic, with healthcare workers, patients and family members moving around and going in and out of the room. All surfaces need to be disinfected with equal vigor, said Ms. Brewer. There is no evidence showing that certain, more frequently touched surfaces are more likely to cause infection than other surfaces.
UVC disinfection systems are a no-touch disinfection technology that has been proven to be an effective way to ensure complete surface decontamination, said Ms. Brewer. Studies have shown that UVC can disinfect not only high-touch surfaces and frequented areas of a patient room, but also the surfaces that may go overlooked as targets for disinfection, such as below patient beds or the backsides of chairs.
However, while UVC technology is an evidence-based cleaning solution, it is important to remember that "UVC is not a so-called silver bullet," said Ms. Brewer.
"It is not a standalone solution," she added. "You really cannot apply it in your hospital and expect that it alone is going to reduce your infections significantly."
UVC technology must be a part of a comprehensive infection prevention bundle, said Ms. Brewer, which should be founded on the following principles:
1. Culture: The infection prevention strategy needs to be ingrained in the hospital's culture. Everyone must be on-board and support the strategy to help the hospital achieve high-quality care.
2. A multidisciplinary team. The strategy must include cooperation from all healthcare workers, not just the infection prevention experts. It needs to involve everyone who plays a role in patient care.
3. Education. Hospital staff not only need to be routinely trained and educated on the latest infection prevention practices, but also be told the 'why' behind those practices.
4. Ongoing monitoring. It's important to return to the infection prevention strategy and review it frequently to ensure there are no barriers to key processes.
Case study: Robert Wood Johnson Hospital Hamilton
Robert Wood Johnson Hospital Hamilton (N.J.), a 180-bed community hospital with eight operating rooms, has been on a journey to improve its HAI rates, particularly with regard to Clostridioides difficile reduction, for years, said Anne Dikon, RN, director of infection prevention at the hospital.
The hospital participates in the States Targeting Reduction in Infections via Engagement (STRIVE) program, funded by the CDC. It has implemented several best practices to improve HAI rates, including early identification and isolation of patients with C. diff, reviewing of antibiotic usage and environmental cleaning processes as well as annual staff education sessions, Ms. Dikon said.
And while the hospital did see a reduction in HAI rates, it decided to add UVC technology to further solidify those improvements to patient care.
"We decided we needed to make sure everything else was in line before we went to UVC because … UVC is like the icing on the cake," Ms. Dikon said. "When you make a cake, you can eat the cake without the icing, but the icing kind of adds an extra…a little oomph to the cake. But you have to make sure you put the batter and all the ingredients together first."
The hospital researched different vendors and decided to implement the Tru-D UVC technology in February. It conducted several training sessions for the environmental services staff and nurses and began using the technology to clean patient rooms as well as operating rooms, when no surgeries were scheduled. Ms. Dikon stressed that communication was key to ensure staff was comfortable with the technology
In May, the hospital shifted focus and began to use the Tru-D technology only in rooms which had previously held patients under isolation precautions. Environmental services staff would report the number of rooms where Tru-D was used after isolation patient discharge at the team's daily huddles. They discovered that they needed more Tru-D operators on their team and went from three to four to 12 operators, Ms. Dikon said.
The hospital saw significant reductions in HAIs in the first and second quarters of 2019 with the use of Tru-D. In the third quarter, there was a sudden spike in HAI rates, but the hospital identified breaks in the process that were contributing to the spike, including inappropriate antibiotic usage.
"So our challenge continues," said Ms. Dikon. "And I tell the staff that just because we have Tru-D, doesn't mean we can skip any of the other additional pieces."
To learn more about Tru-D, click here, and watch the webinar here.