Real-time, measurable technology helps to reduce HAIs
HOSPITAL
FFT Hospital: Thompson HealthPROBLEM
Increased hospital-onset Clostridium difficile (C.diff) cases”SOLUTION
Technology using UV-C, combined with prevention bundles, contributed to the reduction of HAIsVENDOR
Steriliz LLC
Clostridium difficile (C. diff) has become the most common microbial cause of health care-associated infections in U.S. hospitals. They contribute to almost half a million infections among patients annually, resulting in approximately 29,000 deaths and costing $4.8 billion each year in excess health care costs. Thompson Health in Canandaigua, NY, was not immune to this debilitating, often fatal infection and saw its incidence of hospital-onset cases rising in late 2015 and continuing to climb in early 2016.
In spring 2016, they hired me, a seasoned board-certified infection preventionist, as the hospital’s Director of Infection Prevention. After early assessment of facility risks, and in collaboration with leadership, C. diff reduction was identified as an immediate priority.
Gap analysis
A gap analysis helped identify the current situation at the facility, recognize internal gaps from guidelines and evidence- based practice, and identify the desired future state.
Opportunities were identified in several areas: Evidence-based policies and procedures, antimicrobial stewardship, C. diff -testing guidelines, environmental cleaning and disinfection, surveillance and overall need for education. Given the vast gaps identified, I — in collaboration with nursing leadership — realized a structured design was needed to tackle this large project.
It takes a village
Embracing a robust C. diff-reduction program requires a multidisciplinary approach with engaged, empowered staff to be successful. Realizing this, Elizabeth C. Alexander, Director of Medical/Surgical and ICU Nursing, initiated a Do-It Group (DIG) program. DIGs work together to solve a specific problem using a four-step, problem-solving method: Define, Outline, Implement, Track. In July of 2016, the DIG was formed to focus on infection prevention, nursing, environmental services, laboratory, pharmacy and leadership.
The group focused on a collaborative grassroots approach to align with basic infection-prevention practices. It was divided into subgroups focused on the opportunities identified, including evidence-based policies and procedures; surveillance, focusing on real-time alerts and notifications; nurse- driven protocol for C. diff– stool sampling; antimicrobial stewardship; and environmental cleaning and disinfection.
Beyond basic prevention strategies
UV-C has been used for decades in many different areas of environmental disinfection. Today, ultraviolet “robots” provide a powerful tool for sanitizing air and environmental surfaces. I led a DIG subgroup involved in guiding FFT Hospital to take the leap in utilizing new technology to fight against HAIs. I felt strongly that in a day of evidence-based medicine, value-based purchasing and the drive toward delivering high-reliability health care, technology choices should be carefully researched. Critical features identified in FFT’s search for a UV-C solution were:
- Dose – the need for dose-based performance to achieve virus, bacteria and spore eradication
- Time – the need for efficient/rapid room turnover to ensure throughput is not adversely affected
- Measurement – the ability to measure that the dose set on the device is actually delivered to the targeted areas
This led FFT to select the R-D Rapid Disinfector by Steriliz. The R-D is the only UV-C solution that can directly measure and report the exact dose delivered to an area, which it does via patented wireless sensors. FFT also chose the R-D based on other features, such as real-time job status via browser-enabled devices, utilization-data availability, and pause-and -reposition functionality.
Proactive not reactive
Historically, FFT Hospital’s approach to C. diff was a reactive one. The DIG identified the need to change to a more proactive approach.
Guidelines and risk-stratified interventions were created to address C. diff -facility burden related to increased prevalence, cluster and outbreak. The hospital introduced a proactive cleaning and disinfection approach to cover all in-patient areas called a “clean sweep” room-by-room cleaning of an entire unit. Knowing that any amount of C. diff cases on a unit increases the risk for horizontal transmission, a clean sweep is triggered for all units identified with an increased hospital-onset rate or increased overall CDI patient burden.
FFT Hospital EVS leaders also created a daily, ongoing UV-C-utilization program. Using reports generated from the R-D system, all facility areas are tracked and UV-C’d on a regular basis. This includes not only all clinical areas, but also visitor bathrooms, public areas, medication rooms, offices, etc.
Can novel UV-C technologies contribute to HAI deduction?
Without question. In 2016, FFT Hospital saw a dramatic 90-percent reduction in clinically significant C. diff as compared to the pre- and post-intervention period. Similar success has continued in the first quarter of 2017.
Thompson Health’s mission statement is, ‘to continuously improve the health of the residents and communities of the Finger Lakes and the surrounding region.’ Our novel approach to UV-C disinfection, using the R-D Rapid Disinfector, is just one of many examples of how we continue to achieve our mission and to deliver optimal healthcare.
