When patients are admitted into a hospital room that has been prepared for a new patient, they anticipate the room has been properly disinfected and is free from harmful pathogens known to cause healthcare-associated infections (HAIs). As practitioners in infection control and prevention, we know that despite the use of strong disinfectants and rigid protocols for cleaning and disinfection; oftentimes, pathogens are left behind on surfaces. From InfectionControlToday.com - https://www.infectioncontroltoday.com/print/8291 The study team at Promise Hospital includes (from left) Victor R. Lange, infection preventionist; Joseph Baran Jr., MD, infectious diseases; and Peter C. Juan Jr., director of laboratory services. By Victor Lange, MSPH, CRC, ICP, JD(c)
When patients are admitted into a hospital room that has been prepared for a new patient, they anticipate the room has been properly disinfected and is free from harmful pathogens known to cause healthcare-associated infections (HAIs). As practitioners in infection control and prevention, we know that despite the use of strong disinfectants and rigid protocols for cleaning and disinfection; oftentimes, pathogens are left behind on surfaces. HAIs are a major cause of patient morbidity and mortality. Often the main source of these pathogens is the patient's own endogenous flora. Yet, researchers have projected that approximately 20 percent to 40 percent of HAIs are associated with cross -ontamination by way of contact contamination from the hands of healthcare personnel who have touched contaminated patients or contaminated environmental surfaces.1 Several studies discuss the strong role environmental contamination plays in the transmission of methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus species.(1) Nosocomial transmission of norovirus, Clostridium difficile, and Acinetobacter spp can come from environmental contamination.(1) These pathogens can survive on environmental surfaces for long periods of time. The hospital environment is well recognized as an increasingly important source of healthcare-associated infection; yet the environment in which the patient spends the most time, the hospital bed and pillow, are often overlooked when it comes to finding the source. So, at our facility, we decided to investigate patient pillows. Over a five-week period, swab cultures (n=100) were obtained from reusable vinyl covered pillows to determine if pathogens remained on the pillow post environmental services disinfection with a commonly used quaternary ammonium solution. The vinyl surface of the pillow was swabbed with a sterile, polyester-tipped applicator and placed in a sterile tube of sodium chloride solution. The tube was vortexed and swab discarded. Soybean-Casein Digest Agar plates were inoculated with 100 microliters of the eluate and incubated at 360 degrees C for 72 hours. Pathogens were identified according to established industry practices. We found that the patient-ready, decontaminated reusable vinyl covered pillows in use at our hospital were in fact contaminated with pathogenic bacteria. Thirty eight (38 percent) of the 100 disinfected patient ready pillows cultured were contaminated with infection causing pathogens including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Enterococcus faecalis (E faecalis), Escherichia coli (E coli), Providencia stuartii (P stuartii), Yeast, Coagulase-negative Staphylococci (CNS), Klebsiella pneumoniae (K pneumoniae), Bacillus species, Gram-positive Cocci and Diptheroids (95 percent CI, P < .016). Three pillows were found to harbor more than three pathogens on each pillow and 15 pillows had more than two pathogens on each pillow. Reusable patient pillows pose a cross-contamination risk. Variability in disinfection technique, pillow condition, and the effectiveness of disinfectant make it difficult to completely clean and disinfect the pillow. Cross-contamination may occur from the pillow to the patient, from the pillow to the healthcare worker to patient, and from the patient to the pillow. Clear and rigorous guidelines should be established for decontamination of patient beds and pillows. Outbreak investigations should include assessment of pillows and mattresses. At our institution, this finding led us to make a temporary switch to disposable pillows. We are currently reviewing other options such as a barrier pillow cover with and without antimicrobial protection. Victor Lange, MSPH, CRC, ICP, JD(c), is director of infection control at Promise Hospital in San Diego.
1. Weber D, Rutala W, Miller M, Huslage K, Sickbert-Bennet E. Role of hospital surfaces in the transmission of emerging healthcare-associated pathogens; norovirus, Clostridium difficile, and Acinetobacter species. American Journal of Infection Control, 2010 Jun; 35 (5 Suppl 1) S25-33.
AND a 38% decrease in direct costs This independent research was just released at the APIC2018 Conference in Minneapolis. The study involved SleepAngel pillows in an ICU environment in the Kingdom of Saudi Arabia. I will update the post with the link to the study and the poster when I have a public link to share: What is the impact of introducing barrier pillows into a tertiary care hospital in Saudi Arabia? Bassel Molaeb, MPH, CIC, FAPIC - Infection Control Director, Al-Moosa Specialist Hospital
Background: There is substantial evidence indicating that pillows contribute to the cross-transmission of pathogens and this is attributed to the variability in disinfection technique and the pillow condition and construction. On the other hand, the costs of pillow laundry and replacement are always overlooked. This study discusses the impact of introducing barrier pillows into a tertiary care hospital in Saudi Arabia on cost and incidence density of multidrug-resistant Acinetobacter baumannii (MDR-ACB) in the intensive care unit (ICU).
Methods: Barrier pillows were introduced to replace regular pillows in the hospital. The differences in purchase cost in addition to laundry costs in the pre-intervention (November 2016 to April 2017) versus the post-intervention (May 2017 to October 2017) phases were compared. All infection prevention practices were maintained the same in ICU and the incidence density of MDR-ACB was reviewed and analyzed during the study period. The overall cost savings and the decrease in MDR-ACB incidence density in ICU were analyzed using Z-test and p-value of less than 0.05 was considered statistically significant.
Results: The intervention resulted in 38% cost reduction (p-value<0.05) with the elimination of laundry costs. In addition, a significant 58% decrease in the MDR-ACB incidence density was observed during the post-intervention phase as compared to the pre-intervention phase.
Conclusions: Substantial cost savings are achieved by introducing barrier pillows since they are reusable and require standard surface cleaning only thus making laundry obsolete. Barrier pillows reduce replacement frequency because they are durable and decrease infection risks since no fluids and contaminants can enter the inner of the pillow due to the barrier filter protection and presence of a completely welded seam. The decrease in the MDR-ACB incidence is noted after introducing the barrier pillows although there were no major changes in the infection prevention practices in ICU during the post intervention phase.
Barrier pillows, cost reduction, incidence density
Why we need to limit the exposure to respiratory viruses for children with asthma Great post from Medscape.com on June 4, 2018 by Veronica Hackethal, MD https://www.medscape.com/viewarticle/897604 Children with moderate to severe asthma exacerbations who are also infected with respiratory viruses, and especially respiratory syncytial virus, influenza, and parainfluenza, are at increased risk of not responding to asthma treatments, according to results published online today in Pediatrics . The results come from the largest study of its kind and suggest children with moderate to severe asthma exacerbations may need a different workup and more intense management. About 60% to 80% of asthma exacerbations are triggered by respiratory pathogens, but until now, researchers haven't known exactly which pathogens cause the problem. "This is the first time we've been able to disentangle the risk of non-response to asthma treatment with the presence of specific viruses — specifically, influenza and rhinovirus. The more than 20-per-cent higher absolute risk of treatment failure in flu cases is very significant," senior author Caroline Quach, MD, said in a press release. Quach is chair of the Quebec Immunization Committee, chair of the National Advisory Committee on Immunization of the Public Health Agency of Canada, and affiliated with McGill University and the University of Montreal. The results also highlight the importance of prevention, using the influenza vaccine. The authors encouraged easy access to vaccination at the point of care in asthma, respiratory, and general pediatric clinics. "These kids should get their flu shot and they should get it systematically — it's worth it," study coauthor Francine Ducharme, MD, from the University of Montreal, Quebec, Canada, said in the news release. "We now know that if these kids get the flu the risks are very high that emergency treatment for an asthma attack will fail," she added. "Instead of having an overall 17-per-cent risk of treatment failure, with flu their risk rises to almost 40 per cent." To evaluate the effect of respiratory viruses on asthma exacerbation severity and treatment, researchers analyzed data from the DOORWAY (Determinants of Oral Corticosteroid Responsiveness in Wheezing Asthmatic Youth) study. DOORWAY was designed to evaluate treatment failure after standard therapy with inhaled bronchodilators and systemic corticosteroids. The trial enrolled 958 children with moderate to severe asthma exacerbations, who were seen at one of five Canadian emergency departments between 2011 and 2013. During the study, researchers tested nasopharyngeal fluids for the presence of respiratory viruses and atypical bacteria and measured asthma exacerbation severity using the standardized Pediatric Respiratory Assessment Measure. Treatment failure was defined as hospital admission, emergency department stay longer than 8 hours, or asthma relapse. Overall, 61.7% of children tested positive for at least one respiratory virus, with rhinovirus most prevalent, and 16.9% of children experienced treatment failure. Testing positive for any respiratory pathogens was not linked to more severe asthma exacerbations. However, children who tested positive had an 8.2% absolute higher risk for treatment failure compared with children with negative tests (20.7% vs 12.5%; 95% CI, 3.3% - 13.1%). Among children infected with nonrhinovirus pathogens, the absolute risk for treatment failure was 25.4% (95% CI, 19.8% - 31.0%), which was a 13.1% adjusted risk difference compared with those with no pathogen infection. By specific viral type, the risk for treatment failure was 21.4% (95% CI, 14.1% - 28.7%) for respiratory syncytial virus, 37.5% (95% CI, 17.8% - 57.2%) for influenza, and 46.7% (95% CI, 20.4% - 73.0%) for parainfluenza. The adjusted risk differences for each virus were 8.8% for respiratory syncytial virus, 24.9% for influenza, and 34.1% for parainfluenza. In contrast, children who tested positive for rhinovirus, which causes the common cold, were not at increased risk for treatment failure. The study did not include children with mild asthma exacerbations, so results may not necessarily apply to less severe cases. The study was supported by the Canadian Institutes of Health Research. One or more authors reports donations, grants, and/or advisory board membership from one or more of the following: Boehringer Ingelheim, Merck Canada, GlaxoSmithKline, Novartis, Merck, Sanofi Regeneron, AstraZeneca, Sage Products LLC, and AbbVie. Pediatrics . 2018;142(1):e20174105. Full text