Pressure Increases in the War on Bugs
There has been a flood of new products and a rush by companies to get new infection control products on the market since last summer, when the Centers for Medicare and Medicaid Services (CMS) passed a rule it will no longer reimburse healthcare facilities for preventable hospital-acquired infections (HAIs) starting in October 2008.
CMS said it will no longer reimburse hospitals for the treatment of preventable errors, injuries and infections that occur in their facilities. In particular, Medicare no longer will reimburse hospitals for treatment related to falls, mediastinitis infections following heart surgery, urinary tract infections resulting from improper use of catheters, pressure ulcers, or vascular infections that result from improper use of catheters. CMS said it will likely include other hospital-acquired conditions to the list in the future.
CMS officials hope the move saves lives and millions of dollars annually. The implication for hospitals is they will have to absorb the additional treatment costs. Hospitals will also likely conduct more prescreening tests to assess the condition of patients during admission, including whether they are MRSA carriers.
Centers for Disease Control (CDC) estimates HAIs affect more than 1.7 million U.S. patients annually and cause about 99,000 deaths. The largest number of specific infections are urinary tract (32 percent), followed by surgical site infections (22 percent), pneumonia lung infections (15 percent) and bloodstream infections (14 percent). The CDC reports the fatalities from these inflections include 35,967 deaths from pneumonia, 30,665 from bloodstream infections, 13,088 from urinary tract infections, 8,205 from surgical site infections, and 11,062 from infections of other sites.
Healthcare is looking to technology for ways to reduce these numbers, including the use of new whole-room sterilizers and silver-based coatings on medical equipment.
New weapons in the arsenal
The traditional hospital cleaning methods of wiping down surfaces and mopping floors is now being outclassed by new systems for whole-room sterilization, which can kill all bacteria, viruses and spores, even under tables, in ceilings and small crevasses in a room. In 2007, two new systems come onto the market: STERIS Corp. released the VaproSure system and Biomist Inc. introduced the NAV-CO2 system.
“There is a problem with hospital-acquired infections in the U.S. and it needs to be addressed,” said James Bowden, M.D., MBA, FAAFP, chief medical officer for Holston Valley Medical Center, Kingsport, TN, part of the Wellmont Health System. “There are about 1.7 million hospital-acquired infections each year, and it costs hospitals about $30 billion a year to treat these infections... We have a problem.”
He says his hospital, as well as its whole healthcare system, was looking for new ways to cut the number of these infections and turned to technology for the answer. STERIS Corp. began selling its VaproSure whole-room sterilizer to hospitals last summer and the first orders went to Wellmont Health System, Lake Hospital System and the VA Boston Healthcare System.
Dr. Bowden says the VaproSure system has been used in an implementation phase since January to determine how to best use it at Holston Valley Medical Center. The hospital is conducting a thorough clinical study of the device's effectiveness by swabbing several locations in a room for cultures. The swabs are taken before, after and at several intervals after the sterilization. The hospital so far has been very happy with the results.
“It removes all spores, bacteria and viruses,” Dr. Bowden said. “We are finding there is nothing there — nothing grows.”
He says VaproSure was used in industry prior to healthcare, so it is a new, but proven technology. The hospital plans to eventually sterilize all its rooms using the device.
Rooms are first prepared by sealing all windows, doors and electrical outlets so particles cannot enter or leave during the process. The VaproSure machine is wheeled in and the computer programmed for the duration of the sterilization, which begins after staff has left the room and sealed the door. It uses Vaprox Sterilant to create a dry hydrogen peroxide gas, which fills the room for about eight hours, then the machine turns off and the peroxide breaks down into harmless oxygen and water vapor.
Dr. Bowden says the hospital is also attempting to find the best way to use the device and what process works best. While it is effective at killing all germs in a room, he says the time the process takes makes the room unavailable for about 12 hours. The hospital also wants to use the device in its ICUs, but that will take a lot of coordination and preplanning to completely clear out an active ICU for 12 or more hours.
“We want to create the safest hospital environment possible,” Dr. Bowden said. “We are working out the protocols now. It's not a complex process, but it is time consuming.”
Holston Valley Medical Center plans to publish its findings on the effectiveness of VaproSure based on its ongoing study. The hospital also wants to find what it considers the optimum use of the device — whether it should be used for all rooms, or just for high-risk rooms where infections are likely, such as those of known MRSA carriers.
“What we hope to pass on to other hospitals is if this truly makes a difference in reducing hospital-acquired infections,” Dr. Bowden said, but so far feels, “This is the way to.”
Biomist's NAV-CO2 system uses liquid carbon dioxide as a propellant to spray a fine alcohol mist, temporarily displacing oxygen by an envelope of rapidly expanding CO2 gas. The CO2 renders the vapor nonflammable. The maker says the system has been used in Asia for the past 10 years, but is only about two-years old in the U.S. Biomist first targeted food processing plants, but began selling the system to Veterans Administration hospitals a year ago.
Formulating a battle plan
Wellmont Health System, along with the Novant and Adventist systems, formed the Safest Hospital Alliance. The group is experimenting with technology like VaproSure to develop thorough, best practice infection control strategies they implemented in all their hospitals.
“We are working toward making error-free templates for infection control,” Dr. Bowden said.
Whatever strategy a hospital adopts, Dr. Bowden said they need four components to work. These include utilizing technology, making sure appropriate processes are in place, ensuring staff is compliant with those processes, and making sure all staff — from dieticians and case workers though surgeons and radiology technicians — are aware of and engaged concerning the policies.
“You can't just throw technology out there — the whole show has to take place,” Dr. Bowden said.
- The Steris Vaprosure device uses hydrogen peroxide gas to completely sterilize all surfaces in a sealed room.