INFECTION PREVENTION AND CONTROL
Figure 8: A graphic representation of the results of the CLEEN study.
pieces of equipment are responsible for large numbers of patient deaths, then the current situation is likely to be perpetuated. The new HTM
04-01 addendum4 recognises, for the first time, the importance of the periphery of the water system as an area requiring specific expertise, training, and competence. There is a mutual benefit of closer working relationships
between NHS procurement personnel and manufacturers – at the moment there is no feedback in the system. This creates a problem – through no fault of their own, NHS procurement personnel may not appreciate the risks, differences in solutions, or what the right criteria might be, to help prevent infections from a product. Secondly, choice of item may then become solely based on cost – this may disadvantage better designs which may have a slightly higher purchase cost, but which will be recouped very rapidly via their clinical benefits. This lack of feedback not only starves manufacturers of vital information to improve their products, but also prevents those choosing the products from being able to make an informed decision. For example, to many individuals there is no way to be able to distinguish between outlet design for a clinical handwash station. Thus, rather than being predicated on patient safety, choice is often purely driven by price. However, there are significant differences, for example, between water outlets in terms of risk to patient. Where initial purchase price is the main selection criterion, safety standards may inadvertently be reduced if the safer outlets are slightly more expensive. Such small differences in purchase cost are readily recouped should a slightly more expensive improved design result in one less infection (a single Pseudomonas infection on ITU is estimated to cost at least £15,000) during its lifetime of use.
Dr Simon Pybus
As a network of healthcare facilities, the NHS has a tremendous untapped resource of staff using products, whose feedback can provide vital information to manufacturers to improve product design and improve patient safety. In this modern era, where individuals continually feed back on almost every product available why cannot this be the case for something as vital as healthcare products?
Ward level decontamination A recent study has shown ward level decontamination to be ineffective and dangerous, with infections being reduced by a third when additional dedicated cleaning is provided – see Figure 8 for an explanation of the CLEEN Study.8 Ward level decontamination of equipment is also time- consuming, and takes trained staff away from their prime function. This is important, as there is a global shortage of trained nursing and medical staff. Anything which can relieve them of these tasks, and perform to a higher standard, will not only prevent the spread of AMR, but will also more widely improve outcomes by allowing staff time to be spent on direct patient care. Unfortunately, even common cleaning practices can
exacerbate the problem of AMR. A recent outbreak report describes how floor scrubbers spread a highly resistant pathogen throughout a hospital.9
These machines were
not designed for healthcare settings. Processes need to be dissected to identify the risks for AMR pathogen transmission.
Dr Simon Pybus is a specialist registrar in medical microbiology and infectious diseases in Glasgow. He holds the Graham Ayliffe Training Fellowship, funded by the Healthcare Infection Society, working with ARHAI Scotland and NHS Scotland Assure, with his work focused on infection prevention related to the healthcare built environment.
Figure 9: The blue trays are used for administration of drugs. On some wards up to 120 trays a day may be used, requiring decontamination at ward level. Washing the trays with water has resulted in water and wastewater-borne infections in patients. Alternatively, disinfectant-impregnated wipes may be used, but this is also often performed poorly, due to inadequate space (no segregation between dirty and clean), and insufficient time. An automated solution would provide benefits.
Figure 10: A floor scrubber. These pieces of equipment (not brand specific) have been implicated in the spread of AMR and outbreaks in healthcare facilities. Some of these floor scrubbers are robotic, going under the generic title of Autonomous Mobile Robots, sharing the same acronym AMR, which would appear to be prophetic.
October 2024 Health Estate Journal 43
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