Services in hospitals by external companies: Requirements and issues from the perspective of hygiene. Düsseldorf, 11 April 2013.
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1 Services in hospitals by external companies: Requirements and issues from the perspective of hygiene Düsseldorf, 11 April 2013 Walter Popp
2 Services by external companies Laundry Kitchen CSSD Cleaning Doctors surgeons Anesthesia Occupational medicine Occupational safety Recruitment agency eg nurses Pharmacy Medical technology Hairdresser, pedicurist Folie Autor
3 Services by external companies Where Price Quality Laundry Hospital Kitchen Hospital Taste? CSSD Hospital, resident doctor Cleaning Hospital, resident doctor Bad quality Doctors - surgeons Hospital Anesthesia Resident doctor Postoperative control? Occupational medicine Hospital, resident doctor Occupational safety Hospital, resident doctor Recruitment agency eg nurses Hospital, resident doctor Pharmacy Hospital Medical technology Hospital? Hairdresser, pedicurist Hospital Folie Autor Infectious risks?
4 Folie Autor
5 Minimum Is a hygiene plan available or written procedures? Is the procedure described correctly? Folie Autor
6 Folie Autor
7 > 20 cfu, at least 2x cfu, at least 1x Folie Autor
8 Folie Autor > 100 cfu
9 > 20 cfu, at least 2x cfu, at least 1x Folie Autor
10 Folie Autor
11 Staph. aureus MRSA MRSA Patient Abklatschuntersuchungen: 9 x MRSA 3 x Staph. aureus Folie Autor
12 MRSA on ICU Inves n n MRSA n not in MRSA room Environment rooms Environment 14 days later anteroom Staff > hall Environment 2 months later Folie Autor
13 Hamburger Modell (1978) (hospitals) REFA (nursing homes) Cleaning in m 2 /h (Recommendation) Patient s room Toilette / bathroom Hall Neumann / Henning Lutz (nursing homes) (ward) Folie Autor
14 Folie Autor
15 Cleaning as usual: 2-3 hours daily in morning, especially floors and sanitary rooms. No disinfectant. Cleaning in study design: One additional cleaner on ward daily for 8 hours. Frequent cleaning of hand contact areas. Folie Autor
16 Folie Autor
17 Investigation committee of Bremische Bürgerschaft (Bremen state parliament) - Recommendation Also before the outbreak, there were hints to deficits in cleaning. But they were not recognized as it should have been done. In highly sensitive areas, there should be permanently assigned cleaning staff. Folie Autor
18 Folie Autor
19 Typical problems in responsibility of nurses cleaners service assistants Making cupboards and shelfs empty before cleaning. Medical products like ECG, perfusors, ventilation machines, incubators. Refill dispensers. Cleaning of contaminations out of regular cleaning times. Reprocessing of beds on wards: - Rooms - Hall Patient beds are medical products. Folie Autor
20 Folie Autor
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22 Typical problems of cleaning staff in service companies - Language problems - Frequently leaving job - Bad training - High workload (m 2 ) - Missuse of disinfectants and cleaning agents if used in parallel Folie Autor
23 Folie Autor Carling und Bartley: Am J Infect Control 2010, 38, S41
24 Folie Autor
25 Folie Autor
26 Misleading recommendations of the past (Daschner, Rüden, ) No routine disinfection of sanitary rooms on normals wards. No routine disinfection of patient touch surfaces on normal wards. No routine disinfection of floors on ICUs. No disinfection of incubator during patient change. No disinfection of baby s changing table during patient change. No routine disinfection of toys. Folie Autor
27 Folie Autor
28 Folie Autor
29 Additionally: Prevent contamination of cloths: No redipping of cloths in cleaning solution minimise redipping of cloths in disinfectant solutions. Cloths for reuse have to be washed thermically or chemothermically by washing machines dry them in a dryer If washing of cloths is not possible, single-use cloths have to be used. Buckets have to be cleaned thoroughly after end of work shift. Folie Autor
30 Single-use cloths in buckets, ready to use Compatibility of cloths and disinfectant (VAH) Loss of efficacy with time and by drying out (VAH) Contamination of cloths standing out (VAH) Growing of gram(-) bacteria in bucket, biofilms (VAH) If Quats: chemothermical reprocessing of buckets (Bode) Manual reprocessing is enough if aldehydes or alcohol (Bode) No restriction re disinfectants (Merz) Folie Autor
31 Investigation Buckets for disinfectants during use 56 buckets of cleaning staff 50 buckets of other staff groups Disinfectant solutions investigated 250 probes investigated Bacteria positive n=9 N=6 gram(-) bacteria Gloves of cleaning staff 27 gloves 13 in use, 14 not in use between shifts 2 disinfectants used 6 gloves with pathogenic bacteria, 4 of them in use: Staph. aureus, enterobacteriae Folie Autor
32 Preliminary conclusions Permanent staff on ICUs and in OTs. Quantification of time needed for cleaning of specific areas, also including hygienic issues increase of technology on ICUs in last years! Cleaning evidence based. Training according to TRBA 250 and HygMedVO. Folie Autor
33 Multiresistant bacteria Growing problem: Repeated outbreaks of same strain even after months breaks! Air disinfection and more intensified cleaning might increase! Essen: RKI concentration and time Air disinfection VAH concentration and time Mostly successful Folie Autor
34 What the patient can see Hand hygiene (disinfection, jewelry ) Wound dressing Cleaning of rooms Isolation of patients (cleaning of beds) Folie Autor
35 Folie Autor
36 Patient can make an opinion on what is going on in his/her room but not in the operating theatre! Deliver good cleaning practice in the room! Folie Autor
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