NHS Quality conference - Tom Lister
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“Does environmental decontamination enhance patient safety, or create an operational nightmare?” From his experience of working with hospitals around the globe, Tom will evaluate several peer-reviewed studies as well as discuss emerging decontamination technologies to open a discussion as to whether environmental decontamination does bring a benefit to patients, or whether it is a prohibitively challenging process.
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NHS Quality conference - Tom Lister
- 1. Does Environmental Decontamination Enhance Patient Safety or Create an Operational Nightmare?
- 2. Disclosures: I am currently employed by Hygiene Solutions 2
- 3. Discussion Points: 1. The Positive impact of decontamination a. Addenbrooke’s Data b. Leeds Data 2. The negative impact of decontamination a. Time constraints b. Operational constraints 3. Decontamination Technologies 4. A Risk-Based Approach 3
- 4. Addenbrooke’s Data Ref: Impact of cleaning and other interventions on the reduction of hospital-acquired Clostridium difficile G.J. Hughes et al 4 70 60 50 40 30 20 10 0 2004 2005 2006 2007 2008 2009 2010 2011 Patient episodes per month
- 5. What interventions were there? 5 Cephalosporins banned (1997) 70 60 50 40 30 20 10 0 Hand hygiene campaign Enhanced cleaning programme N2 opens with daily MDT patient review Ciprofloxacin banned Deep clean programme formalised with single dedicated decant facility Hydrogen peroxide fumigation Deep clean programme expanded and wards decanted Deep clean programme on Care of Elderly wards started 2004 2005 2006 2007 2008 2009 2010 Patient episodes per month Enhanced cleaning programme N2 opens with daily MDT patient review Ciprofloxacin banned Cephalosporins banned (1997) KK33 ooppeennss Hand hygiene campaign Cleaning interventions Other interventions Deep clean programme formalised with single dedicated decant facility Hydrogen peroxide fumigation Deep clean programme expanded and wards decanted Deep clean programme on Care of Elderly wards started
- 6. Periods of relative stability: 6 70 60 50 40 30 20 10 0 2004 2005 2006 2007 2008 2009 2010 Patient episodes per month
- 7. Break points and confidence intervals: 7 0 10 20 30 40 50 60 70 80 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 2002 2003 2004 2005 2006 2007 2008 2009 2010
- 8. Significant interventions: 8 0 10 20 30 40 50 60 70 80 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 2002 2003 2004 2005 2006 2007 2008 2009 2010 Enhanced cleaning programme Deep clean programme on Care of Elderly wards started Deep clean programme expanded and wards decanted Hydrogen peroxide fumigation
- 9. Ref: Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high clostridium difficile infection incidence E.L. Best et al 9 Leeds Data
- 10. • Reduce environmental contamination • Reduce infection • Enhance Quality of life for patients • Reduce patient stay – up to 11 days for C. Diff case¹ • Reduce cost of patient care – up to US$60,000¹ ¹ US Journ of Clin Microb 1 0 Positive Impact of Decontamination
- 11. The negative impact of decontamination: Time constraints Exit block from ED? Only able to be carried out in vacated rooms What do we do in bay scenarios? 11
- 12. Evaluation of technologies: Hydrogen Peroxide Vapour (HPV) Ultra Violet (UV-C) 12
- 13. Deprox HPV Strengths High level efficacy Multiple applications Weaknesses Down time Operational complexities 1 3 H₂O₂
- 14. Uvo Decontamination: • Strengths • Rapid decontamination – suited to high-pressure environments • Self calibrating spectrome monitoring – known efficacy • Intelligent processing – no over-exposure • Bay decontamination • Weaknesses • Line of site technology 1 4
- 15. RAG Cleaning System: • RED –High risk Infectious patients from single side rooms • AMBER – Lower risk infectious patients • GREEN – Non- Infectious patients 15
- 16. 16 Clean Equipment In Dirty Equipment In Sink Equipment Cleaning Area Deprox Decontamination Area Decontaminated Equipment Out Storage before transportation to wards
- 17. Thank you. tom.lister@hygienesolutionsuk.com 07880 400 953