Analysis of antiseptics
New technologies will not eliminate the need for strong hand-washing protocols, experts say.
Wound-tracking is increasingly reliant on data and analysis. That's one of the reasons Medline is joining forces with WoundRounds and its maker, Telemedicine Solutions, to analyze which practices deliver the best results.
“We're looking at wound care management and risk assessment solutions to prevent skin breakdown, close wounds faster, and lower that risk of infection,” says AJ Ford, product manager for advanced wound care and biologics at Medline. “It's a new way for us to approach efficiencies in patient care and improve health economics.”
It's also indicative of a wider trend in infection control that will likely mean more surveillance, better communication and more integration of some acute-care techniques in skilled nursing.
No ignored mistakes
While long-standing hand washing and needle protocols are known to work, momentary lapses still put thousands of patients at risk every year. Infection control experts say both philosophical and technical changes will help make the fight against superbugs less vulnerable to human error.
The disinfectant, sanitary, medical waste management and wound care markets continue to evolve, with one eye on today's biggest problems (C. Diff, MRSA, CRE) and the other on emerging threats (such as Ebola).
J. Hudson Garrrett, Ph.D., vice president of clinical affairs for PDI, is excited about programs that challenge the culture. He's working with facilities in Georgia and Tennessee to implement TeamStepps, a healthcare management approach created by the Department of Defense and the Agency for Healthcare Research and Quality.
Garrett says the system encourages compliance by creating an atmosphere where infection control and other mistakes aren't ignored. A secretary who sees a nurse placing a catheter without gloves could report that to a third party and effect change without fear of retribution. This can also get more staff members involved in infection control, whether they're C-suite professionals, wound care specialists or on-site pharmacists.
“We have to take what we know and make people accountable,” Garrett says. “It's about championing change all the way to the bedside component.”
That includes tracking residents' exposure to infectious diseases. Upon an outbreak of a contagious infection — whether it's the flu or something more exotic, like Ebola — it is critical to identify who might have been in contact with the contagion and which equipment might require disinfection.
Using an RTLS (real-time location system) such as the NoWander from PointRF greatly expands tracking capabilities. RTLS is relatively new to long-term care settings.
Staff can pull customized reports for individuals, revealing their historic location data and whom they've had contact with. Authorization to enter certain areas also can be regulated.
“You can identify those who have a high risk of contracting the infection and monitor their location as well,” says Ahuva Goldshmidt, PointRF's marketing coordinator. “It's very effective and at the same time not intrusive. It could be a life saver.”
Impacting the future now
Controlling future infections depends on what happens today.
The Obama administration this fall launched a multi-year plan to develop the next generation of tests, antibiotics and vaccines for infectious diseases. A related report from the president's science and technology advisers also called for improved surveillance of antibiotic-resistant bacteria, increasing the effectiveness of existing antibiotics, and developing new ones.
Antibiotic resistance is especially troubling in the presence of medical devices.
“Once you start to put residents on antibiotics or central lines and put a hole in their body, that's when those residents get into trouble,” says Garrett.
In a hospital, a unit nurse might be specifically assigned to check patient health progress and recommend removal of devices like Foley catheters when no longer needed. But with lower staffing ratios, long-term care facilities might overlook that risk factor, or others like it.
They can instead put technology to use with automatic alerts that work with electronic medical records to remind doctors to order device removal, says Silvia Munoz-Price, M.D., Ph.D., an enterprise epidemiologist studying infection control for the Froedtert & Medical College of Wisconsin. Another alternative is to institute policies that allow certain nurses to remove the devices based on published guidelines.
Munoz-Price advocates for better coordination of efforts between hospitals and the post-acute settings, noting that knowing where infections start can help to battle them communitywide. She's spent much of the past few years studying carbapenem-resistant Enterobacteriaceae transmission and found that long-term care facilities often miss — and fail to segregate — carriers.
“As we expand our surveillance to LTC facilities, we're going to realize all these areas for improvement,” she says. “But we know there are not as many resources or as much fancy equipment to decrease infections rates.”
For facilities with ongoing outbreaks, Munoz-Price suggests using chlorhexidine baths. The long-acting antiseptic is applied daily to ICU patients to reduce the presence of bacteria on their skin. Though it shouldn't be used on all patients, Munoz-Price said it could be a good strategic tool for facilities with continuing MRSA or VRE problems. It has been proven to decrease transmission of CRE, and central-line and bloodstream infections.
The Centers for Disease Control and Prevention's CRE toolkit suggests chlorhexidine for residents who are dependent on healthcare personnel for activities of daily living, who are incontinent, who have wounds with hard-to-control drainage, and who are on ventilators.
A facility using a bulk liquid form needs to have a plan for mixing and applying, and train staff and families to understand that the product should not bubble. The addition of sudsing agents undermines chlorhexidine's efficacy. A wipe form with emollients is available but costs more.
Jan Harris, director of environmental health and safety for SHARPS Compliance Inc., says resident buy-in is also critical to stopping accidental needle pricks.
Long-term care settings with residents who administer their own daily injections for diabetes or other chronic conditions traditionally have not provided an in-room option for safe disposal.
“The housekeepers are the ones who are getting needle sticks now,” says Harris. “It puts the employees at risk, and it puts the organizations at risk of lawsuits.”
Small containers that can be provided to residents as a service and mailed back by a wellness director make it easy for patients to comply with sharps guidelines and provide a new layer of safety.
A one-use spill kit is also gaining traction among SHARPS' customers, Harris says. In the rare case of falls, staff in those facilities sometimes grab any old mop to wipe up blood or other fluids and then fail to dispose of messes properly, Harris adds.
SHARPS' kit includes a mop, personal protection equipment and a second-generation quaternary solution. After clean up, the whole package can be stuffed into the bucket and mailed away for medical waste disposal.
Quicker kill times
When it comes to surface disinfection, the quest for faster kill times is unending, according to Steven McNabb, vice president of marketing for Medline's environmental services and interiors division.
Many current formulations are highly effective against airborne and surface agents. But if a product's kill time is five minutes and it dries faster than that, it won't deliver promised results.
Earlier this year, Medline introduced MicroKill One, an alcohol-based quaternary that kills gram-positive, gram-negative and multi-drug-resistant bacteria and non-enveloped organisms like norovirus in one minute.
McNabb says he's seeing a move away from spray-based applications, which might trigger respiratory reactions, in favor of flip-top bottles or wipes.
McNabb says peracetic acid is comparable to bleach but offers less surface damage. Some companies are experimenting with iodine-based solutions to see if its efficacy on skin translates to hard surfaces.
Metal ion solutions are becoming popular due to their good health rating, and they can be used on food prep surfaces.
Metals and natural ingredients are also increasingly popular.
Molnlycke expanded its silver dressing line to develop Mepitel Film IV AM, a new silicone product impregnated with silver and chlorhexidine acetate and designed for fragile skin.
In November, Medline planned to roll out a manuka honey dressing that releases into the skin for seven days to absorb drainage. At 4-by-4 inches, it's ideal for pressure and diabetic ulcers or skin tears common in long-term care, McNabb says.
In Garrett's eyes, new products and electronic surveillance will not matter if staff isn't educated on the basics of infection control or doesn't have time to follow guidelines. As facilities develop the ability to record data with the help of devices, he wants Medicare and Medicaid to “step up” and fund more data monitoring for numbers-driven interventions.
Until that happens, he says the best bet is still to focus on core practices.
“If you do the right things every time, you won't have these outbreaks,” he notes.