New weapons in infection control and prevention
Healthcare-acquired infections (HAIs) are an ongoing challenge for hospitals and health systems, racking up billions in costs. According to the Centers for Disease Control and Prevention, roughly one in 25 patients has at least one HAI at any given time. Reports of deaths from antibiotic-resistant “superbugs” linked to reusable duodenoscopes made headlines in recent years and led to a U.S. Senate investigation that found serious shortcomings in cleaning practices involving the scopes.
Thorough cleaning and disinfection of environmental surfaces are critical to effective infection control and prevention, but traditional cleaning programs often fall short. Newer technologies, such as ultraviolet light and real-time locating systems, are putting new teeth in the war on HAIs and helping hospitals and helping increase room turnover time.
UV light adds a level of disinfection above routine cleaning and sterilization and is often used in rooms following discharge of patients with multidrug-resistant organisms to prevent transmission to an incoming patient. ECRI Institute included UV-C LEDs — a newer option that emits light in the “deep UV” range, which is most useful for killing germs — in its 2017 list watch list of emerging technologies.
Hand hygiene monitoring
There are also technologies to enhance hand hygiene, which is one of the best ways to prevent the spread of infection both inside and outside of the hospital. Real-time location systems, for example, integrate sensors with dispensers to detect usage.
Brett McGreaham, senior product manager at Versus Technology, told Healthcare Dive, “When a staff member enters or exits a patient room, we look to see if they’ve used a soap or sanitizer dispenser—either a smart hand hygiene dispenser containing RTLS technology, or a regular dispenser with a small device attached.”
“We use contextual-based movements of staff to determine if healthcare workers have washed their hands before and after patient care.”
Senior product manager, Versus Technology
Versus’ clients have seen hand hygiene increase by up to 300%, with one reporting a 12% decrease in HAIs, McGreaham added.
“Most hospitals do some monitoring of hand hygiene compliance,” says Susan Casey Bleasdale, medical director of infection control at the University of Illinois Hospital & Health Sciences System and spokesperson for the Infectious Diseases Society of America. “There are different applications to help you collect and monitor that data that are portable, so you can give someone an i-Pad or an i-Phone or some something to make those observations and then it collates that.”
RTLS can also be used to retrace the steps of an infected individual to determine who they came into contact with and where, and to reduce cross-contamination of equipment.
Think of it as a sort of indoor GPS. Newtown, PA-based CenTrak’s RTLS system is installed in about 800 U.S. hospitals, though not all of them are using it for infection control. “Many are using it at the asset management level where you’re preventing soiled assets from coming into contact with the patients, and an alert will be sent to prevent that from happening,” says Adam Peck, vice president of marketing at CenTrak.
Data mining is yet another way that hospitals are tackling the HAI problem. These programs, some of them proprietary, link to a hospital’s data feed to identify patients with multidrug-resistant organisms or other infections so that they can be isolated or target trends and associations of different infections within the facility. Studies show there is quicker notification of outbreaks and transmission, Bleasdale says.
UIC uses both hand hygiene monitoring and data mining and is planning to add UV light, but on a limited basis. “The cost does not allow you to have one unit for each room, so we are going to use it initially focused in rooms where patients have had multidrug-resistant organisms,” Bleasdale tells Healthcare Dive.
One technology that’s getting lots of attention is rapid diagnostics. These tests can identify a specific bacterium within 24 hours, compared with the usual three to five days, and identify antibiotic-resistance patterns using genetic markers. This allows facilities to identify resistant organisms early, both for treatment and isolation, and determine if any associations or transmissions occurred.
“For rapid diagnostics, you need to not just have the technology itself. It needs to be integrated into a systems where someone is responding to the information quickly and can get that to someone quickly.”
Susan Casey Bleasdale
Medical director of infection control, University of Illinois Hospital & Health Sciences System
Both academic and community hospitals are starting to use rapid diagnostics because of increased efficiencies in the microbiology lab, Bleasdale sats. “The process of getting those up and running is cost, but there’s definitely evidence that there’s a cost benefit to using rapid diagnostics because it’s earlier and more directed therapy and potentially shorter admission times and better outcomes.”
Providers are also using new tools to cut down on surgical site infections. For example, St. Louis-based health IT startup Epharmix offers an automated communication system that reminds post-op patients to fill prescriptions for antibiotics and body wash and report signs of infection.
Choosing the right technology
Deciding what technologies to invest in should start with a good cost analysis, Bleasdale says. Hospitals need to determine the cost of the technology itself, the impact on workflow and how effective it is likely to be in decreasing infections.
“Any time a facility is going to decide to implement new technology, they need to evaluate what are their current infections, what are the gaps, what is their performance, what do they need to work on and then what are the technologies out there that can help improve their performance that would justify the cost of adding new technologies,” she says.
Reducing infections is not just a safety issue. It can also affect a hospital’s bottom line. Under Medicare and Medicaid, hospitals are penalized for being in the bottom quartile on certain quality measures, including some that relate to HAIs. “Decreasing your infections and improving your performance related to other centers has the potential to give you a large amount of cost savings,” Bleasdale says.