KEEPING YOUR HOSPITAL SAFE From Antibiotic Resistant Bacteria
Antibiotic resistant bacteria seem to be winning the battle. As bacteria evolve to evade antibiotics, infections that were once easily cured are becoming deadly. According to Dr. Margaret Chan, director general of the World Health Organization, “things as common as strep throat or a child’s scratched knee could once again kill.”
“We are losing our first-line antimicrobials,” Chan said in a keynote address at a conference on combating antimicrobial resistance. Antibiotic resistant pathogens once relegated to intensive care units and nursing homes are increasingly found in communities, schools and gyms worldwide. This means that the bad germs are coming into hospitals with the patients. Because the infections are so difficult to treat, prevention of exposures to and transmission of the bacteria is paramount.
A July, 2011, review article in the Journal of Infection Control and Hospital Epidemiology (ICHE) by Jonathan A. Otter, PhD, and colleagues states: “Studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare- associated infections. However, recent studies have demonstrated that several major nosocomial (hospital acquired) pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them, and can be transferred to the hands of healthcare workers.” The germs are transmitted via healthcare worker hands onto everything the worker touches: patients, uniforms, linens, equipment, etc.
And although hospitals continue their efforts to improve infection control, standardized practices for soft surface bacterial management are inadequate compared with those for hand hygiene and environmental surfaces cleaning. New strategies to decrease bacterial burden on textiles are needed.
Soft surfaces constitute 90% of the patient care environment. Healthcare textiles such as scrub uniforms and lab coats are highly mobile carriers of contamination in the hospital setting, as healthcare workers move from patient to patient, frequently throughout the day. Not surprisingly, contaminated clothing, curtains and linens have been implicated in several reports as the source of infections.
CLOTHING COMPARED TO TOILETS AND SINKS
Recently presented research reveals that Staphylococcus aureus and the community-acquired “Superbug” Methicillin-resistant Staphylococcus aureus (CA-MRSA), a potentially deadly bacterial infection that is resistant to antibiotic treatment, is transferred on clothing and other fabrics used in healthcare facilities, homes, schools, sports teams and prisons. The research concludes that “clothing and household linens play a significant role in the spread of infectious diseases.”
“Our findings document the role of textiles in the spread of infectious diseases, like MRSA,” says Elizabeth Scott, PhD, co-director of the Simmons Center for Hygiene and Health in Home and Community from Simmons College in Boston, Mass.
“We wash our hands frequently throughout the day, but we do not change our clothes. We touch our clothing constantly and people move around a great deal during the day. The data is clear—clothing acquires, retains, and can potentially transmit bacteria.” adds Dr. Scott.
In a ranking of sites and surfaces in the home, based on their risk of transmission, hands are the most likely surface to transmit infection while floors, walls, and furniture were the least likely. Surprisingly, clothing and linens share a ranking with known harbingers of bacteria: toilets and sinks.
While healthcare laundering is generally successful in getting healthcare textiles clean, the March, 2011, Journal of Hospital Medicine documents another important issue —how quickly “clean” uniforms get contaminated. In fact, Marisha Burden, M.D., and colleagues found that “bacterial contamination occurs within hours of donning newly laundered short-sleeved (scrub suit) uniforms. After 8 hours of wear, no difference was observed in the degree of contamination of (scrub suit) uniforms versus infrequently laundered white (lab) coats.”
Even if garments start the shift clean, they become colonized with bacteria quickly and continually spread it throughout the patient environment. Reporting in ICHE in March of this year, researchers Gonzalo L. Bearman, MD, MPH, Richard Wenzel, MD, MSc, and colleagues from Virginia Commonwealth University conclude that “An extension of a horizontal strategy includes apparel bioburden reduction with passive, textilebased antimicrobial technologies.”
THREE KEY FEATURES
A group of new textile technologies is making it possible to do just that. But which one is the right one?
Thomas J. Walsh, MD, FACP, director of Cornell University’s transplantation-oncology infectious diseases program has presented four research posters on the new textile technologies. Dr. Walsh explains, “Bacteria are highly adherent organisms. Look for a fabric that is designed to repel most fluids that could get on the textile, such as blood, diarrhea and vomit.”
Fluid repellency stops organisms from sticking to fabrics. As contaminated fluids are repelled, there are fewer of them on the on the fabric. This decreases the exposure time that the antimicrobial needs to kill the germs.
Fluid repellency not only reduces bioburden on the garment and keeps the bioburden down throughout the shift; it also serves as a passive, physical barrier to protect the wearer from unexpected sprays and splashes of blood and bodily fluids.
“The fabric should also allow water vapor to be wicked away from the skin, so it's not uncomfortable to wear. Comfort is important in end-user acceptance of any new technology.”
Dr. Walsh continues, “The second important mechanism of action is the possible direct antimicrobial effect of the antimicrobial agent imbedded into the fabric. Sometimes antimicrobials are successful in the lab and then disappointing in the real world. Before you invest in a fabric technology, be sure the product has had its performance verified with published clinical data that reflect real life and use conditions.”
MADE TO LAST
With acquisition cost premiums of 50%–100% more than untreated textiles; the new healthcare textiles bring their benefits with a price tag. However, they may have an edge with extended performance and technology durability, enhanced textile quality and reduced maintenance costs.
Data from the 2008–09 North American Comparative Operating Revenues and Expense Profile for the Healthcare Textile Maintenance Industry indicate average usage per item for scrub uniforms at about 36 uses. Says Glen Phillips, the lead compiler of the study, “In dealing with uniform and textile programs, it’s a common mistake to look at purchase price only. Especially with technical textiles, you should find a product that preserves its performance longer than untreated products so you offset the higher acquisition cost with lower product replacement, maintenance and processing costs. Look for data documenting at least 50 healthcare launderings.”
ABOUT THE AUTHOR Todd Thyssen is currently the Director of Environmental Services at Maricopa Integrated Health System in Phoenix Arizona. Todd was previously employed for over 5 years at the Mayo Clinic Phoenix Campus. He has been in the Health Care Environmental Service industry for over 15 years in various Director capacities for both in-house and contract services.