There’s clean & then there’s Tru-D clean: The importance of a strategic plan to implement a Successful UVC Disinfection Program

Tru-D SmartUVC understands the importance of building a comprehensive communication strategy for the implementation and successful management of an enhanced UVC disinfection program.

According to a recent study in the American Journal of Infection Control, “Acquisition of a UV-C disinfection system can be a substantial purchase for a health care facility, and as a result, it is imperative that a comprehensive evaluation of a facility’s need for UV-C disinfection, the potential for improved patident outomces, and a return on investment can be demonstrated to the C-suite.”(1)

As an infection preventionist (IP), you play a critical role in the process of driving any type of strategic, enhanced terminal room disinfection strategy. While much of the execution of a UVC disinfection program lies in the hands of your environmental services (ES) team, IP is vital in the structuring and ongoing monitoring of such a process to ensure you are minimizing risk of infection while maximizing utilization of the UVC device and productivity of the ES staff.

This content is sponsored by Tru-D

Best Practices for Implementing Tru-D

Tru-D’s first priority is to pull together strategic partners within our client facilities to discuss the common behaviors that occur when dispatching transfer and discharge cleaning within their facilities. Understanding the flow of information that is disseminated to key departments is essential to identify where gaps may occur that impact efficient responses as isolation discharges are dispatched, therefore impacting patient throughput and creating opportunities for increasing the utilization of the device. What we find during these critical conversations are common gaps of communication that can be solved with collaborative strategies for a heightened awareness around dispatching of isolation discharges.

ES and Clinical Administrator(s) should be notified daily via a generated report per your hospital communication system(s) (EPIC, Teletracking, Meditech, Maestro, etc.) of current C. diff and/or other isolations related to any multidrug-resistant organism (MDRO). Infection Prevention and Nursing typically will own this responsibility to code patient rooms where there have been validated isolation cases. This initial type of communication allows the Tru-D Operations team the capability to plan for deployment of Tru-D and assignment of Tru-D Operators. It also is a precursor for Admissions or the Bed Placement team to plan for managing the placement of patients within the framework of prioritizing Enhanced Disinfection opportunities.

When the patient is discharged, the Bed Tracking protocols are set into motion. Whether manual or electronic, the UVC Operations Team will be notified that Room XXX is ready for an Isolation Terminal Cleaning, and simultaneously, the Admitting Department and/or the Bed Placement team will plan for that particular isolation room to be “held” for UVC Disinfection. Ivy Hester, Patient Placement at Duke Regional, stated, “When I know that a room is coded for contact enteric or contact isolation cleaning, I immediately plan to work with our Environmental Services Team by first communicating when the room is available for UVC Disinfection, and then by holding that room open until they contact me back that the UVC cycle is complete and the room is available. Sometimes, this means that I will place patients in other available open rooms. The reality is that I am able to see the big picture!”

Statistics for isolation discharges may be tracked manually, or some bed tracking systems can deliver reports indicating the number of isolation cases discharged daily, weekly or even annually. When these statistics for isolation discharges are tracked, either manually or electronically, Infection Prevention and the ES Manager gain a keener knowledge of how many devices are actually needed to meet the facility opportunities for disinfection. Understanding the average opportunities per day for enhanced disinfection, provides the ES Manager the wisdom to make decisions on best locations to stage devices for effective deployment and manage labor within the department to achieve maximum efficiencies and track utilization.

Managing an enhanced UVC disinfection program requires a strategic approach to communication—the most important equation of a successful implementation. A commitment to communication between Infection Prevention, Bed Management and the Operations Team will be a necessary component to managing your enhanced disinfection program.

A communication strategy will be key to managing utilization of your UVC device(s). However, some hospitals choose to take their own approach to determining how best to use Tru-D in their facilities. Several hospitals have done trials and studies to determine Tru-D’s effectiveness prior to a full implementation including Rochester General Hospital which saw a 56% reduction in C. diff infections between 2011 and 2015 and a 46% reduction between 2012 and 2015.(1) Yavapai Medical Center conducted their own, unique 30-day trial to determine Tru-D’s effectiveness in reducing the cumulative bioburden throughout a specific wing of its hospital.

Q&A with Kim Horn of Yavapai Regional Medical Center

UV disinfection has been proven to be an effective, chemical-free method of enhanced terminal room disinfection. The first randomized clinical trial on UV disinfection, The Benefits of Enhanced Terminal Room-Disinfection (BETR-D) study which was published earlier this year, proved that Tru-D SmartUVC was able to reduce the risk of infection of four targeted multidrug-resistant organisms (MDROs) among patients admitted to the same room by a cumulative 30 percent.

Much of the research on UV disinfection focuses on enhanced disinfection at the time of patient discharge. In most cases, Tru-D is deployed when an isolation/enteric patient leaves the room—either at transport to another wing or out of the hospital completely. However, Kim Horn, MPH, CIC Infection Preventionist of Yavapai Regional Medical Center sought to prove that a solid baseline of cleanliness and disinfection together with terminal room cleaning and disinfection would reduce the incidence of MDROs, specifically C. diff, among patients in the hospital.

Kim Horn and her team conducted a 30-day trial to attempt to reduce the cumulative amount of bioburden in her facility. She outlined a process that included complete disinfection of an entire wing of the hospital, ensuring every piece of equipment that went in and out of a room as well as every nook and cranny—employee restrooms, public restrooms, medical rooms, equipment supply rooms, etc.—was disinfected. After each and every discharge, she and her team disinfected the room with Tru-D, whether it was an isolation case or not, in order to create a baseline of disinfection. For approximately 38 days, the focus was on all discharges on this one unit that had experienced some ongoing transmission of C. diff. Since December 8, 2016 when the study concluded, there has not been a single, reported hospital-acquired infection in the hospital wing used in the trial.*

Question: What prompted you to want to conduct a trial on Tru-D SmartUVC?

Most hospitals use Tru-D SmartUVC at the time of discharge of an isolation patient. While we know UV disinfection has been proven to be an effective method of enhanced terminal room cleaning, we wanted to create a baseline of cleanliness in our facility to remove as much bioburden as possible. In doing so, we hoped to conclude that by removing the bioburden, we would be able to reduce infection rates throughout our facility.

Question: Can you share the structure of the trial?

We focused on one wing of our hospital and made every effort to clean the entire area including equipment and all other contents of a room. During the baseline trial period, we were able to target 80% of our total discharges, locker rooms, staff breaks room, med room, equipment rooms, public restrooms, dietary room, EVS closet, etc. We thoroughly documented each room and its contents using equipment codes, and if something did not have a code/number we assigned it one to ensure we disinfected the entire wing of the hospital in order to establish a baseline of cleanliness.

Question: What were some of the outcomes or takeaways from the trial?

We determined that by creating a solid baseline of cleanliness and reducing as much bioburden as possible throughout the unit, we were able to reduce transmissions. In fact, Yavapai has not had a transmission reported since December 8, 2016.*

Question: How was the trial affected day-to-day cleaning and disinfection at Yavapai?

Now that we have one wing with a baseline of cleanliness and disinfection established, we want to do the same thing with our other wings and also the operating rooms (ORs). We realize there are cross-contamination possibilities with patient rooms and ORs, so by focusing on the ORs in the next phase, we hope to reduce the risk of spreading disease through cross contamination.

*At the time of publication

References

Spencer, M., et al. A model for choosing an automated ultraviolet-C disinfection system and building a case for the C-suite: Two case reports. American Journal of Infection Control. 2017 288-92.

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