Factors that influence the choice of disinfection procedure for Environmental Surfaces:

-Nature of item to be disinfected

-Number of organisms present

-Innate resistance of organisms

-Amount of organic soil present

-Type & concentration of germicide contact

-Specific indications & directions for use.

Consider efficacy, spectrum, versatility, ease of use, safety profile and cost.

It is cheaper and more effective to prevent environmental & health damage than to attempt to manage or cure it. Prevention requires examining the entire life cycle of products. It encourages the exploration of safer alternatives and the development of cleaner workplaces.

There has been a lot of media attention about the Institute of Medicine’s (IOM) report “To Err is Human,” especially over outbreaks of community-based Methicillin-resistant Staphylococcus aureus (MRSA). However, we should concentrate on the second report from the IOM, “Crossing the Quality Chasm,” which provides a road map for quality.

In this report, the IOM describes “Six Aims” to ensure health care quality. The Six Aims are identified as: safe, timely, effective, efficient, equitable and patient-centered health care. So what does this mean for ASHES members?

There is no other service in the health care environment that more intimately and consistently touches patients than environmental services. The patient comes in constant contact with our products, from the textiles that they wear and sleep on to the furniture, fixtures and various pieces of equipment they touch on a daily basis.

Taking this into consideration, our base of operations must be in complete balance with the Six Aims. A health care institution may employ the best in clinical care and purchase the finest technology available, yet little of it will matter if the institution is not properly cleaned and disinfected where appropriate. At its very core, environmental services’ reason for being is patient-centered. If we do not perform our roles in a safe, effective, efficient, equitable and timely manner we compromise the quality and health of our patients.

Environmental services staff and the roles they play are often the forgotten heroes in the quest for quality. As the rest of the institution works to achieve and improve upon the Six Aims, our services are often viewed as a way to improve timeliness and the core purpose is defeated. It is our job and obligation to make sure that everyone in the institution and within the industry is aware of how vital our services are to the safety and the healing environment of the patient.

There is no substitute for a clean environment that is free from potentially harmful organisms. The quality initiatives of environmental, waste, linen and transport services cannot be minimized or overlooked as insignificant in the quest for quality improvement.

What can you do? Get involved! In the IOM report, quality is defined as, “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Professional knowledge is not limited to our profession. Be knowledgeable about other professions and their roles in quality as well. Be knowledgeable about what is going on in your institution. Make sure when the rest of your institution is working on the Six Aims, that you and your staff are involved and that you have allies in the infection control, safety and quality departments so you are included in the discussions and decisions when initiatives are being developed.

It is common for improvement initiatives that seem simple in the planning phase to turn into a problem for another department further down the continuum of care. This is not done intentionally; it usually occurs from lack of awareness about the rest of the cycle. Do not let this happen to you. Keep your eyes and ears open to what improvements are being discussed in your institution and play an active role.

Quality should be a topic when you meet with your boss, your peers across the institution and your staff. They tend to know more than we do at times, because they are on the units every day.

What steps have you taken in order to be consistent with professional knowledge? Let’s talk about it.

On the road to excellence!

Tina L. Cermignano, CHESP
Operations Manager
Children’s Hospital of Philadelphia
Philadelphia

Sit back and enjoy this short video on the history of today’s MRSA.

What is MRSA?

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that causes serious infections that are resistant to many of the strongest antibiotics, including methicillin and other more commonly used antibiotics (including penicillin and amoxicillin). (1)

MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems and are being treated in hospitals and healthcare facilities. (2) These healthcare-associated infections (HAIs) include surgical wound infections, urinary tract infections, bloodstream infections and pneumonia. (3) People who have been hospitalized or had surgery within the past year or who are receiving treatments like dialysis are at increased risk for infections with MRSA. (4)

MRSA infections have risen sharply in recent years. In 1972, MRSA accounted for only two percent of all Staphylococcus aureus HAIs reported to the Centers for Disease Control and Prevention (CDC) in the U.S. (5) Recent data show that MRSA now accounts for 50 to 70 percent of Staphylococcus aureus infections. (6)

Staphylococcus aureus (“staph”) organisms are common bacteria that can live on the skin and are one of the most common causes of skin infections in the U.S. (7) The bacteria also live harmlessly in the nasal passages of roughly 30 percent of the U.S. population. These people are sometimes called “staph carriers” or persons who are “colonized” with staph organisms. Staph organisms can cause infection when they enter the skin through a cut or sore. Infection can also occur when the bacteria move inside the body through a catheter or breathing tube. The infection can be minor and local (for example, a pimple) or more serious. (8)

Though MRSA is generally associated with healthcare institutions, it can also occur in persons who have had no contact with a healthcare facility. These types of MRSA infections are classified as community-acquired MRSA (CA-MRSA) and are presenting to hospital emergency departments and outpatient clinics in increasing numbers. In addition, patients with CA-MRSA who are admitted to a healthcare facility can be the source for organisms that can be spread to other hospitalized patients, and such spread has been well documented. Many such infections have also occurred among athletes who share equipment or personal items (such as towels or razors) and among children in daycare facilities who are in very close contact with one another throughout the day. (9) By some estimates, more than half of all skin infections now treated in emergency rooms are caused by MRSA. (10)

How does someone contract MRSA?
MRSA is most often contracted while a patient is in the hospital. Transmission of MRSA organisms can occur from skin-to-skin contact with someone who has MRSA on their skin, by hands of healthcare personnel who pick up organisms on their hands from a colonized patient and then care for another patient without washing their hands between the tasks, by contact with items such as computer keyboards or surfaces such as bedrails that have the
organisms on them, and through insertion of devices such as catheters or breathing tubes that bypass the body’s natural defenses.

The risk for the spread of CA-MRSA is highest where people with poor hygiene are associating in close quarters such as prisons, homeless shelters, locker rooms and daycare centers.

How do we clean rooms used by MRSA infected patients?
Using a EPA registered disinfectant with a MRSA rating clean thoroughly using friction, all surfaces in the patient room, paying particular attention to high touch  surfaces. Be sure to follow contact precautions in addition to universal precautions, and wash hands thoroughly, when you finish cleaning.

References:

1 www.nlm.nih.gov/medlineplus/print/ency/article/007261.htm
2 http://www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html
3 http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html
4http://www.nlm.nih.gov/medlineplus/print/ency/article/007261.htm
5 www.cdc.gov/od/oc/media/pressrel/r061019.htm
6 Siegel JD, Rhineheart E, Jackson M, Linda C; Healthcare Infection Control Practices Advisory Committee.
“Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006.” Available at

http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.

7 http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html
8 http://www.nlm.nih.gov/medlineplus/print/ency/article/007261.htm
9 http://www.nlm.nih.gov/medlineplus/print/ency/article/007261.htm
10 Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA; Emergency ID Net Study Group. (2006). Methicillin-Resistant S. aureus Infections among Patients in the Emergency Department, New England Journal of Medicine, 355,666-674.

Suggestions for Infection control procedures for free-standing imaging centers and hospital radiology departments

The cleanliness of free-standing imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other acquired infections. The following are 11 simple procedures to implement that can prevent the spread of these infections.

1. Have a written infectious control policy to include MRI cleaning procedures as well as the cleaning schedule and have it posted throughout the center.

2. Implement a mandatory hand washing / hand sanitizing procedure between patient exams for technologists and any others who come into contact with patients.

3. Clean the MRI tables, inside the bore of the magnet and any other items that come into contact with a patient. Infection control experts recommend this be done between each patient.

4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.

5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the pads should be replaced.

6. Regularly check all padding material with an ultraviolet (black) light and make sure that any biological material detected on the pads can be removed.

7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.

8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is compromised.

9. Promptly remove body fluids, and then surface disinfect all contaminated areas.

10. If a patient has an open wound or any history of MRSA/other infection:

a. Gloves and gowns should be worn by all staff coming in contact with the patient. These barriers must be removed before touching other areas not coming in contact with the patient, i.e. door knobs, scanner console, computer terminals, etc.

b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already being performed between every patient. For patients with any known infectious process add 10-15 minutes onto the scheduled scan time to assure there is enough time to thoroughly clean the room and all the pads.

11. All furniture should be periodically cleaned. Ideal surfaces are those that are waterproof and wipeable. Infection control experts recommend this be done between each patient.