Infection prevention
commented Pat Cattini. “The New Hospitals Programme is asking for 100% single rooms and that means that there’s going to be a lot of water outlets to clean, flush and maintain. Of course we need our water outlets; we need to provide water for hand hygiene and for personal hygiene – particularly mouth care, which we’ve been hearing so much about during this conference. “The evidence is that water is still the best
thing to deal with norovirus and C.difficile. So, we don’t want staff to not have access to water – although I would argue that, for many things, alcohol hand rubs are the gold standard. However, we do need to start thinking differently.
“What about the products of the future? …
We know that there are at least two companies now producing hypochlorous acid products, which can be used as a hand disinfectant, which they claim to be effective against C.difficile and norovirus. “So, it may be that we have an alternative to
hand washing basins for clinical staff. We need to understand and balance our risks, and we need to think very carefully,” she commented. In another new building, recently opened at
the Trust, it was found that there were excess hand wash basins – resulting in some not being used on a regular basis. This may increase the potential risks associated with waterborne infection and ‘dead legs’. Hence, the IPC team proposed a derogation for the next build which would reduce the number of outlets. This included removing the handwash basin from the patient bed space (in response to the Fucini paper)4
and from the clean utility room.
A retrospective analysis of 552 ICUs, by Fucini et al, found that sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection The Estates team flagged this as a
‘derogation’ from the HBN and were concerned about proceeding without authorisation. There was also a concern that staff would be unhappy with no sink in the bedroom and anxiety around the fact that there was no sink availability in the drug room to cope with a chemotherapy spill. The request was presented and approved by the Trust’s executive team and endorsed by the New Hospitals Programme. Risk assessments were undertaken to ensure
the appropriate mitigations were in place and additional training provided for staff on water hygiene, so that they fully understand the reasons for caution with water outlets. The Trust is also planning a trial of a novel product based on hypochlorous acid hand sanitiser, which could have the potential to reduce the need for water outlets in the future. “We asked to take out the clinical handwash basin in the patient’s bedroom, leaving a sink that could be used for hand washing of soiled hands in the patient’s bathroom. That would be the patient’s sink that they wash, shave and brush their teeth in,” Pat Cattini explained. “We also asked for no hand wash basin in
the clean utility/drug preparation rooms. You shouldn’t have wash basins in a pharmacy setting where you are preparing drugs. Too
often we see a counter where nurses are expected to prepare IV medication – often the space is very tight and cluttered, and there’s a handwash basin nearby. “We also suggested that we put no handwash basins in the clinical consulting room as, in those settings, alcohol rub is sufficient.” She further highlighted concerns over water coolers and fountains within haematology and cancer settings. The potential benefits of the project include: l Reduced patient infection risk from water outlets and drain splashes.
l Reducing the cost of treating patient infection – extra bed days, extra antibiotics, and mortality.
l Reduced installation costs of unnecessary sinks.
l Reduced ongoing maintenance cost for cleaning (about £1,000 per year).
l Reducing the additional cost of six-monthly water sampling in augmented care.
l Reducing the cost of filters where outlets are positive (£30-45 each)
The IPC team linked in with the New Hospitals Programme expert, Dr. Michael Weinbren, for advice and support. They presented an options appraisal which was accepted by the Trust prior
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