Dr. Mark Stibich

In the beginning was the mop; in the middle was the mop; and, we still have the mop. The basic tools used to clean rooms, even hospital rooms, haven’t evolved a great deal over the past decades. This lack of evolution is unfortunate because the bacteria and viruses that cleaning destroys have evolved quite a bit. It is now understood that the environment plays a critical role in infection control in healthcare and other settings, such as cruise ships. What is needed now are new tools to allow environmental services (EVS) workers to attain a total room clean without creating additional burden or adding to turnover time. Moving Goalposts In the healthcare setting, the original job of the cleaning team was to make the hospital room look good. Emphasis was placed on efficiency and turning over rooms quickly. Rooms were expected to be fully ready for the next occupant in 38 minutes or less, which is a challenging feat by anyone’s standards. As researchers learn more and more about how the environment can contribute to infections, that goal is changing. At recent conferences, the term “pathogen-free room” has been suggested as the new goal of the environmental services team. This, of course, is a necessary and noble goal: to make certain that the environment cannot harm the patient. Of course, it is also a challenging goal: to make certain that no infectious bacteria or viruses are left behind in a room. Unfortunately, one thing was forgotten when this goal was created; the cleaning team wasn’t given any more time or any new tools to accomplish the goal of the “pathogen-free room.” The same efficiency standards are in place, but the stakes have changed. The resources are the same, but the goalposts have been moved far away. Room Cleaning: A Matter of Life and Death The average person who cleans a hospital room today must be familiar with an alphabet soup of bacteria: MRSA, VRE, CRE, C. diff, MDRO, GNR, NDM-1, etc. For some of these organisms, there is essentially no treatment for the infection they cause. CRE, for example, has been described as a “nightmare bacteria” by the Centers for Disease Control and Prevention (CDC). To make matters worse, these organisms can also be resistant to the average disinfectant, forcing the use of bleach, which damages surfaces and can create a harmful environment for personnel. “Housekeepers” are rapidly becoming disinfection experts. Room cleaning has truly become a matter of life and death. Acute care hospitals are leading the charge to create safer environments. Environmental service directors sit on the infection control committee and are seen as an essential component of patient safety. Recent changes in reimbursement now link these infections directly to payments to the hospital by Medicare, Medicaid and private insurance. We know it is critically important to disinfect every hospital room, every time — what is needed are new methods and tools for accomplishing that goal. No Touch Disinfection No touch disinfection is a category that is rapidly emerging in the hospital environmental cleaning space and will likely expand into other areas in the near future. The category is so new that there are a wide variety of names for it: room disinfection, automatic disinfection, total room cleaning and more. Hospitals seem to be settling on the term “no touch disinfection” to describe a number of different technologies that automate the disinfection of rooms and equipment. There are essentially three main technologies used for no touch disinfection: hydrogen peroxide vapor, mercury-vapor lamps and pulse xenon lamps. The first uses a familiar disinfectant — hydrogen peroxide — and applies it in a vapor or mist throughout the room. The next two use different methods to produce ultraviolet light in the germicidal spectrum. Mercury vapor lamps produce germicidal ultraviolet in a narrow spectrum around 253.7 nanometers, while pulsed xenon produces ultraviolet that covers the entire UV germicidal spectrum (from 200-280 nanometers). Each technology, based on the published literature, takes a different amount of time to accomplish the goal of disinfection of bacterial spores — for example, the most difficult organism typically found in hospital rooms, C. diff. with hydrogen peroxide vapor taking at least 2.5 hours per room, mercury ultraviolet taking at least 50 minutes and pulsed xenon taking at least 15 minutes total. All of the technologies work, but each has a different profile in terms of the total disinfection and the total time required for disinfection. Recently, the Association for Professionals in Infection Control (APIC) came out with new guidelines for the control of C. diff. These guidelines include references to “no touch disinfection” systems and examine the role of these new technologies in infection prevention in the hospital. These guidelines show the acceptability of “no touch disinfection” in hospitals. It should be anticipated that these technologies will be coming to nursing homes, cruise ships and other markets in the near future. Real-world Expectations In order for any of these systems to protect patients and reduce infection rates, it must integrate into real-world situations without excessive costs or disruption of patient flow. In a busy hospital, a disinfecting system that is too slow, complex to use or is costly will not be used often enough to have a meaningful impact on hospital-acquired infection (HAI) rates. No touch disinfection systems do not operate themselves. Someone has to move the devices around the hospital and operate them. Who that person is will be a very important consideration in choosing a no touch disinfection system. Some of the no touch disinfection systems can be operated by a housekeeper and others require a more in-depth technical training. Look for a system that has been designed specifically for use by the EVS team — easy to transport and easy to use. Results Matter Most importantly, evaluate and consider the demonstrated impact the no touch disinfection systems are having on hospital infection rates. As these new technologies are deployed in real-world settings, the hospitals that deploy them may or may not report on the

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Dr. Mark Stibich

Chief Scientific Officer and Co-Founder of Xenex Healthcare Services

Articles by Dr. Mark Stibich

The Evolution of Cleaning: New Advances in Disinfection Technologies

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