Logic tells us that textiles in the healthcare setting can easily be a source of cross-contamination, putting patients, their visitors, and staff at risk for acquiring an infection. However, it has only been in recent years that textiles have been given the attention merited as a potential source of hospital-acquired infections (HAIs).
John Mazzaccaro, Vice President of Sales and Marketing, Curtain Care Plus, offered insight as to why it has taken so long for textiles to be taken seriously as a source of transmission of pathogens causing HAIs. “Textiles on curtains, furniture, and other fixtures have long been the elephant in the room that no one wants to talk about. Soft surfaces do not fall into defined classes that currently have clear guidelines for frequency, method, and disinfectant application.”
He added that standards for isolation cleaning do not specifically call textiles, such as privacy curtains, into the practice of terminal room cleaning, with facilities having to make such determinations themselves, leading to wide variances in practices. “Best practice is being redefined with the pressure of reducing HAIs. I don’t think anyone would question that cleaning textiles is common-sense best practice,” said Mazzaccaro.
Mazzaccaro believes that published scientific literature has played a role in identifying textiles as a medium for transfer and growth of active microbe colonies tied to HAI infections. “The other factor is the recent attention on air quality as a proven and known transmission point. When shaking a curtain slightly in a well-lit room, it becomes alarming to see the extreme amount of dust that is circulated, including large amounts of skin cells and spores,” added Mazzaccaro. “With privacy curtains occupying more than 500 square feet of hands-on surface in a typical double-room occupancy, and going through hundreds or thousands of touches over months or years, there is no doubt that the microbes infesting them play a role in HAI transmission.”
Mazzaccaro explained how Curtain Care Plus’s solution works to reduce HAIs. “The Hand Shield defines a handhold area that allows easier movement while transforming this area into a wipeable, nonporous surface that remains machine washable.”
It saves time and money, while facilitating a method to reset the microbe count to zero between patients. The efficacy of the product is related directly to the disinfectant chosen by the cleaning team, making 6- to 8-log reductions possible and practical with no new cleaners, products, or extraordinary steps. (“Log reduction” is a mathematical term used to show the relative number of live microbes eliminated from a surface by disinfecting or cleaning.) Just add the curtains to your high-touch cleaning schedule, and even your ATP testing schedules, to prove the effectiveness.”
Mazzaccaro referred to a recent article in Healthcare Purchasing News (“Ounce of prevention, pound of cure,” March 2017, www.hpnonline.com/ounce-prevention-pound-cure/) highlighting one early adopter of the Hand Shield that experienced a facility-wide Clostridium difficile sustained index improvement of more than 70 percent.1 “Sysosset Hospital is one of 70 hospitals now standardized on the Hand Shield. The ATP testing on our non-porous Hand Shield surface consistently shows levels of 500+ on soiled curtains, and, without exception, zero after treatment with cleaning solutions like 10 percent bleach or hydrogen peroxide.”1
Curtain Care Plus’s Hand Shield is available as either a permanently affixed solution that can be wiped daily in seconds or as a disposable version that can be used in conjunction with all existing privacy curtains.
Keil Merrick, President, On the Right Track, also credits published scientific literature and the rise in C. diff with bringing recognition to textiles as a potential source of HAIs. “Recent research points towards high-touch surfaces in a patient room as a focus point for transferring infection. This has renewed the effort to clean the soft surfaces in the room, and textile curtains certainly are a part of that program. Increasing C. diff rates in the past three years, which is primarily transferred via hand to surface contact, has renewed the focus on all high-touch surfaces in the room, not just the bed rails and food trays, which are traditionally the top touched surfaces.”
from On the Right Track
Merrick declared that On the Right Track’s Holistipure disposable curtain is guaranteed to be rid of HAIs, because a new curtain is used on every curtain change. “This eliminates the risk of a curtain being hung that was not properly cleaned, above 160 degrees, to eliminate the risk of infection. In a patient room, the privacy curtain is the most touched soft surface2 away from the bed. The curtain is touched over 60 times a day by the patient and all the various healthcare workers who come in and out of the room. Most hospitals have no way to verify the curtains are clean.”
Merrick noted, “Stamford Hospital in Connecticut made the decision to replace all cubicle and shower curtains in their facility with disposable curtains to help reduce the spread of infections.”
Tietex International, Ltd., is a global manufacturer of stitchbonded, non-woven fabrics developed for a variety of markets, including healthcare. Mike Hardegree, Vice President, Strategic Business Development, explained how Proton Hygienic Microfiber cleaning towels provide superior deliverance of disinfectants. “It is well known that traditional cotton and standard microfiber cleaning towels rapidly and significantly bind quaternary (quat) ammonium compounds and other disinfecting solutions. This ionic binding results in a sub-lethal dose of disinfectant being delivered to the surface. Proton Hygienic Microfiber is compatible with disinfectants, so full efficacy is delivered, the disinfectant solution’s advertised kill rate is achieved, and HAIs are reduced.
Hardegree noted that Tietex’s Proton Hygienic Microfiber towel can play a role in thwarting antimicrobial resistance. “Sub-lethal disinfecting solution (due to quat binding) creates disinfectant-resistant pathogens. Disinfectant-resistant pathogens create biofilm to protect themselves. Proton Hygienic Microfiber delivers full disinfectant efficacy, then works synergistically with the disinfectant by removing (not killing) pathogens, dead or alive, at log 3 and removing biofilm at log 4.
Gene Burke, MD, former Executive Medical Director and Vice President for Clinical Effectiveness, Sentara Healthcare, spoke with experience on behalf of Cupron regarding their antimicrobial patient gowns and linens. “Hospitals are looking for continuously active technologies to complement the work of their nursing and cleaning staff. Patient gowns and linens are among the most frequently touched and contaminated surfaces in the patient environment, and Cupron’s self-sanitizing linens are a practical way to improve patient safety.
“Cupron’s patient gowns and bed linens have copper particles permanently embedded into the fibers, providing broad-spectrum antimicrobial activity for the life of product. The continuously self-sanitizing textiles reduce contamination surrounding the patient, therefore interrupting transmission and reducing the risk of infection.”
Burke talked about Sentara Health’s experience with Cupron’s copper-impregnated textiles. “In 2014, Sentara Health, a 12-hospital system in Virginia and North Carolina, conducted the world’s largest trial on the impact of antimicrobial textiles and hard surfaces on HAIs. The trial took place at Sentara Leigh Hospital,3 a 250-bed community hospital in Norfolk, VA. Half of the rooms had copper linens and hard surfaces, and the other half were unchanged. The copper rooms had 83 percent fewer cases of C. diff infection, and 78 percent fewer HAIs due to multidrug-resistant organisms or C. diff, and relative to the baseline period. We observed no changes in rates of HAI in the unmodified rooms.
“In 2015, Sentara expanded the trial to account for confounders and found that rates declined 21 percent and 24 percent, whereas rates at two control hospitals increased between 41 percent and 88 percent. Based on these results, Sentara expanded deployment of copper linens and surfaces across all 12 hospitals.”
Burke noted that, in 2016, in two other clinical trials of Cupron Medical Textiles alone, a double-blinded crossover trial established a 29 percent drop in HAI-related events.4 “In an earlier trial of the textiles, a 24 percent reduction in HAI rates was demonstrated.”
Making beds and tables safer
Mattresses, not surprisingly, can also be a source of C. diff infection. Bruce Rippe, CEO, Trinity Guardion, commented, “Healthcare settings have experienced outbreaks of C. diff and other infections that have been traced back to textiles and soft surfaces such as patient mattresses. In addition, clinicians and staff are becoming increasingly aware that soft surfaces, such as polyurethane-coated mattress covers/skins, are extremely challenging to disinfect, because of their physical nature and because there are no EPA-cleared disinfectants designed for use on these surfaces. Even bleach products will damage polyurethane.”
Rippe described how Trinity Guardion’s Patient Protection Systems work to reduce contamination and transmission of pathogens, including C. diff, safely and efficiently. “Reusable Trinity Guardion Patient Protection Systems are designed to protect each new hospital-bed occupant from the residual infectious contamination of all previous patients. They also protect mattresses from the biome of the current patient by blocking microbes and particles from passing inward toward the mattress surface.”
“The barcoded mattress and pillow covers are designed to resist staining and undergo up to 150 rigorous CDC-recommended high-heat laundry cycles (after each patient discharge) that eliminate pathogens such as C. diff,” noted Rippe. “They are more economical, efficient, and effective to use than the multi-step mattress-disinfection process defined by hospital-bed manufacturers, and they constitute a compliant, traceable, alternate equipment program when used as instructed. The fabric permits moisture transfer away from the skin and has pliable four-way stretch to allow for pressure distribution. It works with foam, static air, and low air-loss mattresses.
Rippe cited two published studies examining use of Trinity Guardion’s Patient Protection Systems. The first, performed in a bariatric unit of a Midwestern hospital, “proved that the recommended Trinity Guardion laundry process provides a higher level of disinfection than the typical manual mattress-wiping process used in this and other facilities.5 The second study was conducted in two Midwestern long-term acute-care hospitals, one with 75 beds and the other with 25. Both reduced their hospital-acquired C. diff rates by approximately 50 percent. If we assume a conservative cost of $7,385 per case, the savings was about $140,000.”6
Operating room tables are another source of infection. With one in twenty patients affected with an HAI everyday — and 31 percent of them attributed to SSIs — Jennifer Barber, Senior Product Specialist at Ansell, says greater focus is being placed where patients undergo surgical procedures.
“Some hospital systems are still using reusable linen sheets in the operating room, which allow strike-through contamination of blood and body fluids, virus and bacteria,” said Barber. “Disposable, impervious linens are a better choice for preventing cross contamination, however independent testing shows that significant bacterial transfer from a contaminated operating room table to the patient contact surface does occur, even with disposables. To address this, Ansell offers a unique and clinically superior choice that provides complete protection against bacterial migration. SANDEL STAT-BLOC Table Linens are the only impervious linens to provide an antimicrobial layer proven 99.9 effective against MRSA, CRE and E. coli. Ansell linens are available individually or in a custom kit with various components designed to address infection control and room turnover.”
On the horizon
Clearly, there is a lot going on in the field of textiles, both disposable and reusable. What more can we expect to see in the near future?
Merrick, On the Right Track, offered, “Over the last three years, we have witnessed a shift towards disposable cubicle curtains. The healthcare market is frustrated with textile curtains that are expensive to acquire, require constant cleaning, reach end of life after 40 washings, and often don’t match the curtain in the room next door, making the hospital look disheveled. Disposable curtains eliminate these frustrations while guaranteeing the curtain you are hanging is infection free.”
Mazzaccaro, Curtain Care Plus, observed, “I see a trend in simplifying processes and products as the greatest focus on improving clinical environments. New facilities have clearly taken this approach, and supply chains are taking this approach to the products and services they choose to introduce. Innovation that takes advantage of minimized SKUs, additional training, and processes will continue to prevail.”
References
- Cantrell S. Ounce of prevention, pound of cure: small changes can reap big rewards. Healthcare Purchasing News. 2017;3:26-37. http://digital.hpnonline.com/editions/z38o/0A148ky/1703-HPN/html/index.html?page=28.
- Huslage K, Rutala WA, Gergen MF, et al. Microbial assessment of high-, medium-, and low-touch hospital room surfaces. Infect Control Hosp Epidemiol. 2013 Feb;34(2):211-212.
- Sifri CD, Burke GH, Enfield KB. Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens. Am J Infect Control. 2016 Dec 1;44(12):1565-1571.
- Marcus EL, Yosef H, Borkow G, et al. Reduction of health care-associated infection indicators by copper oxide-impregnated textiles: Crossover, double-blind controlled study in chronic ventilator-dependent patients. Am J Infect Control. 2017 Apr 1;45(4):401-403.
- Hooker EA, Allen S, Gray L, et al. A randomized trial to evaluate a launderable bed protection system for hospital beds. Antimicrobial Resistance and Infection Control 2012;1:27. http://www.aricjournal.com/content/1/1/27.
- Hooker EA, Bochan M, Reiff TT, et al. Decreasing Clostridium difficile health care-associated infections through use of a launderable mattress cover. Am J Infect Control. 2015 Dec 1;43(12):1326-30. Epub 2015 Oct 21.
Susan Cantrell
Susan Cantrell is Infection Prevention Editor for Healthcare Purchasing News.
