Andy Armenta: A New Discipline on the Horizon?

When it comes to infection control in the patient care setting, there are many stakeholders responsible for cleaning and disinfecting all the medical equipment. The question arises, how many of these devices slip through the cracks, and what can we do about it?

Even though there are cleaning procedures in every end-user manual, some of the equipment is not being cleaned as frequently as the manufacturer suggests. How many times have we all heard of outbreaks occurring in hospitals across the nation? There is plenty of media coverage. We hear of infected surgical devices, or anesthesia machines or whatever equipment is suspected as the source.

Any device that comes near or in direct contact runs the risk of an environmental transmission to the patient as well as the staff. It has been proven there are some microorganisms that are resistant to alcohol or hydrogen peroxide based solutions. How can we possibly know to use bleach in these instances?

Many of us in the healthcare technology management (HTM ) arena will eventually catch a bug from this dirty equipment. This happens because we don’t always wash our hands in between working with these devices. Moreover, how many other staff outside our service support trade forget to wash their hands? This is something to ponder when we hear of 700,000 infections and 23,000 deaths occurring annually. How many of these were a direct result of environmental transmissions?

The power of percentages says there are a few thousand that were most likely to occur as a direct result of staff or dirty equipment as being the source of transmission. There was a study done on sterilized devices as being the source of transmissions. How can that possibly happen if these devices were sterilized? Just last year in the UK, they made it a regulation that sterilizer compartments must be frequently tested with color metric protein swabs to validate proper sterilization has taken place.

We know that antibiotics are becoming more and more ineffective to treating infections in patients. What happens to the patient’s germs while staying in the hospital? They get thrown into the room or wherever the patient gets transported. How can we even contend with germs in our environmental surroundings? We know environmental services (EVS) crews are combating this through disinfecting, but how much of their jurisdiction is with the medical equipment? It is not much.

We are losing the battle of keeping the environment free of bacteria, viruses, or even fungus, especially on the medical equipment. How can we take ownership and even deal with the cleaning and disinfecting aspect when we put the responsibility on the end user? That’s their job and not ours, right? We are not the EVS crew, either. They clean the environment and have a lot to do with environmental conditions, right?

There is a huge disconnect in this infection control arena, and I have spent years honing in on the technical aspects in order to help find a position for HTM to intervene. We can help resolve this dilemma in our hospitals by adopting and learning the devices that help monitor the environmental conditions that are the direct cause of transmissions. If we can understand the test devices, then we can learn to understand the transmission patterns.

Understanding the transmission patterns is not too difficult, but it takes a little bit of time and strategy. Understanding the high-touch locations on medical equipment takes time. There are hard surfaces, waterborne locations, and sometimes airborne from all the equipment designed with fans and compressors.

ATP meters are great little devices. Put one of these in the hands of a biomed and compare the difference of how the EVS team or the infection control department utilizes them. They mainly stick to the qualitative end of the spectrum. But a biomed knows both qualitative and quantitative method because of our makeup. It is embedded in us to conduct our testing and troubleshooting in this manner. Your eyes will open when you realize after a while why the disconnect is prominent.

Once you get past this, then you might realize a good performance improvement measure for the coming year. Providing monitoring and surveillance of how well end users clean and disinfect their medical equipment may just prove to be the forefront of a major movement towards facilities combating hospital acquired infection, and surgical site infection if you get creative and more into this new discipline.

We have the potential to save a whole lot of lives and heartache by teaching facilities how to handle the technologies associated with controlling the environment. Try comparing your ICU’s ECG monitor non-invasive blood pressure (NIBP) start button with your emergency department’s NIBP start button. This may open your eyes to new avenues of discipline needed in the patient-care environment.

I encourage you to get involved with healthcare-associated infections and surgical site infection concerns and our expertise carves this path. We can make a huge difference in this area of need. Your administration might even love the idea! New challenges and discoveries await. And when you hit those obstacles (because there will be as every new discipline has) give me a ring. I may have just the workaround for you!

Andy Armenta is vice president of service operations at the Microbial Genomics Research Council.

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