- Written by J. Darrel Hicks
It has long been thought that environmental cleanliness was the key to curbing the spread of cross-contamination. That’s not to minimize the meticulous hand washing by healthcare workers.But once hands are clean, they can quickly become contaminated if the environmental surfaces are not clean and disinfected.
The mission of the Environmental Services Department should be to create a clean, safe environment where patients can get well and go home. But, you may be overlooking a dirty little problem: the cubicle (or privacy) curtain. Have you considered the possible link between these curtains and healthcare associated infections (HAI’s)? If you have not, perhaps you should. When a patient is admitted to a hospital room, the furniture (including the bed) has been cleaned and disinfected; clean linens are on the bed; the rest room is spic and span and sanitized, too; yet, the privacy curtain that is within 24” of their bed has not been changed for weeks or months. The curtain might even have visible blood or other “unknown” spots/stains that makes one wonder, “Is it clean or not?”
Doctors, nurses, patients, housekeepers and everybody else grabs the cubicle curtain to open or close it. Sometimes with gloves, most of the time without gloves. Sometimes they open the curtain with clean hands, and sometimes with hands soiled with Staphylococcus aureus, MRSA, C-diff, VRE or e-coli. Yet the curtain stays from one sick patient to the next, to the next, to the next…
In 1993, there were less than 2,000 reported cases of MRSA. In 2005, there were an estimated 94,000 cases and 18,650 deaths due to MRSA.
Hospitals are required to be in compliance with the Federal requirements set forth in the Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid payment. CMS (Centers for Medicare/Medicaid Services) is a Federal agency overseeing the government’s insurance program.
Since 2008, CMS is no longer reimbursing hospitals for patients who acquire an infection during their stay. Hospitals will experience a negative economic impact due to HAI’s not being reimbursed by CMS. New standards, which force the medical institution to pay for treating HAI’s, have made prevention and reduction of HAI’s a primary concern.
Cubicle curtains have been known to cause HAI’s1 2, 3, 4, 5. In a study published in the November 2008 issue of “Infection Control and Hospital Epidemiology” it was discovered, 42% of hospital privacy curtains were contaminated with, vancomycin-resistant enterococci (VRE), 22% with MRSA and 4% with Clostridium difficile (C-diff). Then the clean hands of hospital workers were cultured after they opened/closed the curtains and the organisms had transferred to clean hands or gloves. The conclusion: healthcare- associated pathogens left on curtains are transferred to hands and could potentially lead to HAI’s.
Since the exposure of this phenomenon, some hospitals have begun to use anti-microbial curtains in an effort to impede the spread of HAI’s. A potential problem with that solution is that a lethal dose of antimicrobials isn’t delivered and can make organisms more resistant, which is an even larger problem.
Barnes-Jewish Hospital, St. Louis, Missouri, concluded during a study that treating curtains daily with hydrogen peroxide may decrease gram-positive infections, however results are confounded by other infection prevention activities. Hydrogen peroxide seems to have no effect on gram-negative organisms and fungi.
Neely et al (1999) concluded that spraying with 3% hydrogen peroxide was an inexpensive and safe way of spot-disinfecting fabrics in the laboratory6 and “may limit the spread of potentially pathogenic antibiotic-resistant bacteria.”
In my opinion, a better solution would be to change the bed curtains following each contact isolation. This should become a part of the discharge/transfer protocol for contact isolation rooms.
I hear you say, “In the first place, I don’t have the staff for that. And, second, I don’t have enough curtains to do an exchange. Third, who is going to pay for the cleaning of these curtains (labor, utilities, etc.)?” I will suggest two possible answers or solutions to your dilemma.
1. Install disposable cubicle curtains in your patient’s room. The features of this curtain over a conventional curtain are:
- Safety-reduce cross contamination and HAI’s; reduce worker’s comp issues by reducing injuries; eliminate stress on back, neck and shoulders; eliminate cross contamination risks for ladders in and out of isolation rooms; assure a clean/refreshed curtain each change.
- Time savings-reduce changeover time to less than 10 seconds per panel (usually 2-3 panels around each bed); compact packaging allows stocking product in nursing units to eliminate wait time; anyone (including nursing) can change the curtains with this system which results in faster patient admissions; compatible with current ceiling track’ auto release system reduces maintenance calls.
- Money savings-can be charged to each nursing division and stocked to a par level by Central Storeroom personnel; reduce worker’s comp issues by reducing injuries (the elimination of one fall from a ladder by one of your staff could pay for curtains for a year!); reduce FTE’s/labor cost associated with changing, laundering, etc.; eliminate acquisition cost of current curtains if you don’t have the necessary 30% overstock needed to implement frequent changes; stock a single SKU and reduce storage costs; faster curtain changes allows for patient admissions (improving patient throughput from the ER); eliminate one more possible source of HAI’s due to soiled curtains remaining in the room from one sick patient to the next.
- Increase Patient Satisfaction & Regulatory Compliance-faster patient admissions; maintain patient privacy with consistent curtain length in every room; no torn or yellow mesh at the top of the curtain; no mismatched curtains; no waiting on curtain changes; eliminate HAI’s due to soiled curtains.
If I have piqued your interest in disposable curtains, check out photos and information on ICP Medical’s Rapid Refresh™ (R2) Compliance System at www.icp-med.com.
2. The second possible solution is a more traditional fabric curtain utilized in a 2-piece cubicle curtain system. The system I like best is the “Simply 66 Snap System” by the Cubicle Curtain Factory.
Here’s how it works:
Simply 66 is the ultimate infection control cubicle curtain whose attributes also include its functionality, time and money saving characteristics and ease of installation. If a patient or member of the hospital staff soils a small section of a conventional cubicle curtain, health codes require that the Environmental Services or Housekeeping staff remove the entire cubicle curtain for laundering and hang a replacement curtain. This requires most hospitals to keep a stock of replacement cubicle curtains. Many times two complete sets are purchased for each existing track. This practice is extremely expensive for hospitals to maintain.
With a Simply 66 cubicle curtain snap panel system, one size fits all. This is the case since snap panels have been engineered to allow each 66” W x 66” section to be added or removed one at a time to the antimicrobial curtain mesh. The maintenance staff simply needs to find a clean-snap panel and snap it on. By removing only the soiled panels of a curtain system for cleaning, laundering costs are greatly reduced. During the panel replacement process, staff can load a cart with many snap panels and change out soiled panels on several floors in just one trip to the curtain storage room, thus saving the staff time and the facility money. Ladders are not required to change the panels because the snap system on each curtain is engineered to be approximately 72 inches from the floor. This is accomplished by varying the length of the antimicrobial curtain mesh to accommodate various ceiling heights.
The disadvantage of this program over the disposable curtain is you will still have the acquistion cost for changing over your current curtain system, need to purchase 30-100% replacement curtains (depending on the high turnover of isolated patients) and laundering of the curtains.
You can see photos of the Simply 66 curtain system and get more information at Phoenix Textiles website: http://www.phoenixtextile.com/ c-3079-simply-66.aspx.
In conclusion, a comprehensive approach to changing cubicle curtains is necessary to reduce the numbers and frequency of hospitalacquired infections. Collaboration between infection prevention/control practitioners and the Environmental Services Department is essential in breaking the chain of infection. Who knows, the life you save may be your own, or that of your loved one. References:
- “Contamination of Hospital Curtains with Healthcare- Associated Pathogens”, Infection Control and Hospital Epidemiology, Nov. 2008, Vol. 29, No. 11; Floyd Trillis, III, BS; Elizabeth C. Eckstein, RN; Rachel Budavich, BS; Michael J. Pultz; Curis J. Donskey, MD Conclusion: Hospital privacy curtains were frequently contaminated with pathogens, and these organisms could be acquired on hands. Further research is needed to evaluate strategies to minimize the risk for patient-to-patient transmission of pathogens from contaminated organisms.
- Klakus J, Vaughan NL, Boswell TC. Methicillin-resistant Staphylococcus aureus contamination of hospital curtains. Journal of Hospital Infection 2008; 68:189- 190. Conclusion: Curtains are frequently handled both directly before and after examination of patients by healthcare workers, and are probably an overlooked vehicle for MRSA transmission within hospitals.
- Das I, Lambert P, Hill D, Noy M, Bion J, Elliott T. Carbapenemresistant Acinetobacter and role of curtains in an outbreak in intensive care units. Journal of Hospital Infection 2002; 50: 110- 114. Results: The curtains surrounding the patients’ bed were the predominant source with comparatively high counts of organisms found. Conclusion: …the environment, particularly curtains, in the clinical setting is an important but overlooked source of outbreaks.
- Palmer R, Bacterial contamination of curtains in clinical areas. Nursing Standard 1999, Sep 29- Oct 5; 14(2): 33-5. Results: Of the 28 curtains sampled, all plates yielded bacteria, 22 of the 28 yielded, Staphylococcus aureus. Conclusion: …in light of the evidence from this small-scale study, it appears that curtains are a potential source of infection.
- Huang R, Mehta S, Weed D, Price CS, Methacillin-resistant Staphylococcus aureus survival in hospital fomites. Infection Control Hospital Epidemiology 2006 Nov; 27 (11):1267-9. Conclusion: MRSA survived for 9 days on a cloth curtain.
- Neely AN, Maley MP. The 1999 Lindberg award. 3% hydrogen peroxide for the gram-positive disinfection of fabrics. Journal of Burn Care Rehabilitation, 1999 Nov-Dec; 20(6); 471-7. Conclusion: Spraying with a 3% hydrogen peroxide is…a simple procedure that may limit the spread of potentially pathogenic antibiotic-resistant bacteria.
(Reprinted with permission by Executive Housekeeping Today.)
Quick Rinse - News From Around The World
Laundry Inks $23.7 Million Military Hospital Contract
SAN ANTONIO, Texas — Division Laundry & Cleaners process over 16 million pounds of linens yearly for hospitals and hotels. San Antonio Military Medical Center (SAMMC) recently awarded the family-run business a 5-year, $23.7 million contract for laundry services.