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New technologies have potential to prevent HAIs
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Curtis J. Donskey, MD, and colleagues at the Louis Stokes Cleveland VA Medical Center had a novel idea to prevent some infections in their facility.
During influenza season, patients entering the hospital coughing and sneezing can use one of the many available touchscreens to check in.
“Dozens of people in the course of the day will be touching the same screen and they are very seldom practicing hand hygiene after doing that. And what we asked is if we could come up with some automated way to decontaminate the screens with each use — that could be a useful technology,” Donskey, an infectious disease physician at the hospital and professor of medicine at Case Western Reserve University, told Infectious Disease News.
The idea inspired the creation of an automated device that uses ultraviolet C light as a disinfectant to clean the touchscreens. A prototype of the device was designed by a scientist and then tested by Donskey. In his experiments, Donskey found that the UV-C device, which was designed to automatically scan the touchscreen after patient use, reduced the transmission of viruses from contaminated screens to fingertips in simulations.
The UV-C touchscreen cleaner is just one of many new technologies that have been developed and tested recently to prevent health care-associated infections (HAIs).
‘One jumbo jet’s worth of people’
Although the prevalence of HAIs in hospital patients in the United States decreased from 4% in 2011 to 3.2% in 2015, they remain a significant issue for patients and health care facilities.
Each year, about 2 million Americans contract an HAI and between 75,000 and 100,000 die from one, Michael G. Schmidt, PhD, professor of microbiology and immunology at the Medical University of South Carolina, told Infectious Disease News. Broken down, that means almost 300 Americans may die every day from an HAI.
“If one plane, a jumbo jet, crashed each day in the United States, would anybody fly? The answer is no. That is precisely the number of U.S. citizens who die each day from a health care-associated infection. One jumbo jet’s worth of people,” Schmidt said.
Additionally, he noted the large financial burden, observing that HAIs may cost taxpayers an estimated $150 billion per year, according to a study published in the Journal of Medical Economics.
“Imagine what we could do if we just cut that rate by 10%,” Schmidt said. “What could we do with $15 billion?
New technologies
Different types of technologies aimed at decreasing the risk for HAIs have emerged in recent years, Hilary M. Babcock, MD, MPH, president of the Society for Healthcare Epidemiology of America and professor of medicine at Washington University School of Medicine, told Infectious Disease News.
“These technologies definitely have the potential to transform care for our patients,” she said.
Many of the newer technologies use environmental decontamination to prevent the transmission of pathogens, Donskey said. Efforts have focused on developing novel disinfectants and delivery methods, no-touch devices and antimicrobial surfaces.
Bleach and quaternary ammonium disinfectants are the standard cleaning products used in hospitals. However, quaternary ammonium does not inhibit Clostridioides difficile, and bleach — while effective — can damage surfaces and irritate some patients, according to Donskey. Peracetic acid-based disinfectants have been developed as a modified solution and have been found to be effective at destroying spores and less harmful to surfaces, he said.
Because wiping down surfaces mechanically is not efficient for disinfecting irregular surfaces or an entire room, new delivery methods have been investigated, Donskey said. For example, electrostatic spraying devices might allow for more rapid and effective decontamination, he said.
Moreover, no-touch technologies are gaining traction, the most common of which are UV devices, according to Donskey. Many different UV devices have been created to decontaminate patient rooms and equipment, such as CT tables, tablets, keyboards and stethoscopes, and have demonstrated efficacy in reducing pathogens. One study published in The Lancet showed that adding UV-C light to standard terminal cleaning strategies reduced the likelihood that patients would acquire the same infection as the previous patient by 30%.
Antimicrobial surfaces also have been shown to be useful in helping rid hospital rooms of pathogens, Schmidt said. One study demonstrated that placing copper surfaces on significant touch points in the patient care environment decreased the rate of HAIs by 58%, he noted.
Many more technologies have demonstrated the ability to prevent the spread of pathogens, including novel sink drain covers, electronic hand hygiene monitors — including voice-based monitors that remind clinicians to sanitize their hands — antimicrobial catheters and antimicrobial textiles, such as surgical scrubs, hospital curtains and bed linens.
“All of these technologies are intended to prevent a wide range of infections, from common bacterial pathogens, such as C. difficile and MRSA, to fungal infections, such as Candida auris, that may be associated with contaminated surfaces,” Donskey said.
Implementation within hospitals
The move to implement new technologies in hospitals has been gradual, but more and more facilities are using them, especially UV room decontamination devices, Donskey said. In fact, a survey of health care facilities in the U.S. and 11 other countries showed that, in 2018, 37% of facilities reported using UV light for environmental cleaning.
Babcock said most infection preventionists are aware of the new technologies. The companies that manufacture them will often exhibit them at hospitals and conferences. Hospitals will consider the devices and their claims for prevention and purchase them if they are well suited for their specific needs, she said.
“One of the challenges for a lot of these technologies is to show a direct link between the use of that device and an actual decrease in infections in patients. A lot of these kinds of technologies clearly do decrease the amount of bacteria on a surface, but it can be difficult to prove that using this kind of device or technology can actually decrease infections in patients,” Babcock said.
Plus, not every hospital is in need of these types of new technologies.
“If a hospital has already done a lot of work with preventing infections after surgery then maybe they don’t need a special dressing to prevent this problem in their patients,” Babcock said.
Whether the new technologies have a significant benefit compared with emphasizing standard infection control measures is also up for debate, Donskey said. A great deal of effort goes into introducing any new technology into a hospital. Costs go up, and training health care workers to use them can be time consuming, he said. Hospitals may see a comparable reduction in infections by investing the same amount of time in improving standard infection control strategies than they would in implementing a new technology, he noted.
Regardless, the No. 1 thing that physicians and patients can do to prevent HAIs is wash their hands whenever they go in and out of a hospital room, Schmidt said.
“Simple things like practicing good hand hygiene make all the difference in the world at reducing the rate,” he said.
Infection prevention mostly relies on health care providers doing things correctly while providing care to patients, Babcock said.
“HAIs kill more people than HIV and breast cancer combined,” Schmidt said. “If we had tools like UV light, copper and hand hygiene monitors to alleviate breast cancer and HIV, we’d be out there cornering the market to end those diseases.” – by Alaina Tedesco
- References:
- Alhmidi H, et al. Am J Infect Control. 2018;doi:10.1016/j.ajic.2017.09.032.
- Anderson DJ, et al. Lancet. 2017;doi:10.1016/S0140-6736(16)31588-4.
- Chiotos K, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.172.
- Gerba CP, et al. Am J Infect Control. 2016;doi:10.1016/j.ajic.2015.10.013.
- Haque M, et al. Infect Drug Resist. 2018;doi:10.2147/IDR.S177247.
- Magill SS, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1801550.
- Marchetti A, Rossiter R. J Med Econ. 2013;doi:10.3111/13696998.2013.842922.
- Salgado CD. Infect Control Hosp Epidemiol. 2013;doi:10.1086/670207.
Disclosures: Babcock and Schmidt report no relevant financial disclosures. Donskey reports receiving research funding from Clorox, Avery Dennison, PDI and GOJO.