Services in hospitals by external companies: Requirements and issues from the perspective of hygiene Düsseldorf, 11 April 2013 Walter Popp
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 2 2 11.04.2013 Autor
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 3 3 11.04.2013 Autor Infectious risks?
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Minimum Is a hygiene plan available or written procedures? Is the procedure described correctly? Folie 5 5 11.04.2013 Autor
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> 20 cfu, at least 2x 40-100 cfu, at least 1x Folie 7 7 11.04.2013 Autor
Folie 8 8 11.04.2013 Autor > 100 cfu
> 20 cfu, at least 2x 40-100 cfu, at least 1x Folie 9 9 11.04.2013 Autor
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Staph. aureus MRSA MRSA Patient Abklatschuntersuchungen: 9 x MRSA 3 x Staph. aureus Folie 11 11 11.04.2013 Autor
MRSA on ICU Inves n n MRSA n not in MRSA room Environment 140 9 2 rooms Environment 14 days later 140 6 1 anteroom Staff > 60 4 1 hall Environment 2 months later 140 0 0 Folie 12 12 11.04.2013 Autor
Hamburger Modell (1978) (hospitals) REFA (nursing homes) Cleaning in m 2 /h (Recommendation) Patient s room Toilette / bathroom Hall 65 40 150 144-188 69-84 317-581 Neumann / Henning 170-220 90-180 300-500 Lutz (nursing homes) 110-140 (ward) 70-90 300-400 Folie 13 13 11.04.2013 Autor
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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 15 15 11.04.2013 Autor
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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 17 17 11.04.2013 Autor
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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 19 19 11.04.2013 Autor
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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 22 22 11.04.2013 Autor
Folie 23 23 11.04.2013 Autor Carling und Bartley: Am J Infect Control 2010, 38, S41
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Misleading recommendations of the past (Daschner, Rüden, 2000-2002) 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 26 26 11.04.2013 Autor
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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 29 29 11.04.2013 Autor
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 30 30 11.04.2013 Autor
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 31 31 11.04.2013 Autor
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 32 32 11.04.2013 Autor
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 33 33 11.04.2013 Autor
What the patient can see Hand hygiene (disinfection, jewelry ) Wound dressing Cleaning of rooms Isolation of patients (cleaning of beds) Folie 34 34 11.04.2013 Autor
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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 36 36 11.04.2013 Autor