nhs quality conference - tom lister
DESCRIPTION
“Does environmental decontamination enhance patient safety, or create an operational nightmare?” From his experience of working with hospitals around the globe, Tom will evaluate several peer-reviewed studies as well as discuss emerging decontamination technologies to open a discussion as to whether environmental decontamination does bring a benefit to patients, or whether it is a prohibitively challenging process.TRANSCRIPT
Does Environmental Decontamination
Enhance Patient Safety or Create an
Operational Nightmare?
Disclosures:
I am currently employed by Hygiene Solutions
2
Discussion Points:
1. The Positive impact of decontamination
a. Addenbrooke’s Data
b. Leeds Data
2. The negative impact of decontamination
a. Time constraints
b. Operational constraints
3. Decontamination Technologies
4. A Risk-Based Approach
3
Addenbrooke’s Data
Ref: Impact of cleaning and other interventions on the reduction of hospital-acquired Clostridium difficile G.J. Hughes et al
4
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2010 2011
Patie
nt epis
odes p
er
month
What interventions were there?
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0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2010
Patie
nt epis
odes p
er
month
Enhanced cleaning
programme
Enhanced cleaning
programme
N2 opens with
daily MDT
patient review
N2 opens with
daily MDT
patient review
Ciprofloxacin
banned
Ciprofloxacin
banned
Cephalosporins
banned (1997)
Cephalosporins
banned (1997)
K3 opensK3 opensHand hygiene
campaign
Hand hygiene
campaign
Cleaning interventions
Other interventions
Deep clean
programme
formalised with single
dedicated decant
facility
Deep clean
programme
formalised with single
dedicated decant
facility
Hydrogen
peroxide
fumigation
Hydrogen
peroxide
fumigation
Deep clean
programme
expanded and
wards decanted
Deep clean
programme
expanded and
wards decanted
Deep clean
programme on
Care of Elderly
wards started
Deep clean
programme on
Care of Elderly
wards started
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2010
Patie
nt epis
odes p
er
month
Enhanced cleaning
programme
Enhanced cleaning
programme
N2 opens with
daily MDT
patient review
N2 opens with
daily MDT
patient review
Ciprofloxacin
banned
Ciprofloxacin
banned
Cephalosporins
banned (1997)
Cephalosporins
banned (1997)
K3 opensK3 opensHand hygiene
campaign
Hand hygiene
campaign
Cleaning interventions
Other interventions
Deep clean
programme
formalised with single
dedicated decant
facility
Deep clean
programme
formalised with single
dedicated decant
facility
Hydrogen
peroxide
fumigation
Hydrogen
peroxide
fumigation
Deep clean
programme
expanded and
wards decanted
Deep clean
programme
expanded and
wards decanted
Deep clean
programme on
Care of Elderly
wards started
Deep clean
programme on
Care of Elderly
wards started
Periods of relative stability:
6
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2010
Patie
nt epis
odes p
er
month
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2010
Patie
nt epis
odes p
er
month
Break points and confidence intervals:
7
0
10
20
30
40
50
60
70
80
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2002 2003 2004 2005 2006 2007 2008 2009 2010
Significant interventions:
8
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60
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80
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2002 2003 2004 2005 2006 2007 2008 2009 2010
Hydrogen peroxide
fumigation
Deep clean programme
expanded and wards decanted
Enhanced cleaning programme
Deep clean programme on Care
of Elderly wards started
Ref: Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high clostridium difficile infection incidence E.L. Best et al
9
Leeds Data
• Reduce environmental contamination
• Reduce infection
• Enhance Quality of life for patients
• Reduce patient stay – up to 11 days for C. Diff case¹
• Reduce cost of patient care – up to US$60,000¹
¹ US Journ of Clin Microb
1
0
Positive Impact of Decontamination
The negative impact of decontamination:
Time constraints
Exit block from ED?
Only able to be carried out in vacated rooms
What do we do in bay scenarios?
11
Evaluation of technologies:
Hydrogen Peroxide Vapour (HPV)
Ultra Violet (UV-C)
12
Deprox HPV
Strengths
High level efficacy
Multiple applications
Weaknesses
Down time
Operational complexities
1
3
H₂O₂
Uvo Decontamination:
• Strengths
• Rapid decontamination – suited to high-pressure environments
• Self calibrating spectromemonitoring – known efficacy
• Intelligent processing – no over-exposure
• Bay decontamination
• Weaknesses
• Line of site technology
1
4
RAG Cleaning System:
• RED –High risk Infectious patients from single side rooms
• AMBER – Lower risk infectious patients
• GREEN – Non-Infectious patients
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Dirty Equipment In
Sink
Equipment Cleaning Area
Clean Equipment
InDeprox
Decontamination Area
Decontaminated Equipment Out
Storage before transportation to
wards
