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Friday, October 27, 2017

Acquired Infections vs Acquired Illness

It’s relatively hard to go a day without seeing some form of media article about hospital acquired infections (HAIs).  Hospitals and Infection Preventionists are being pushed to prevent HAIs so as not to lose out on funding (and of course not to harm patients).  At virtually every tradeshow or conference I attend and speak with Infection Preventionists, I hear “Do you kill X or Y?”  or “How fast is the contact time?” over and over…..ad nauseam.

Depending on the person or the conversation, I have been known to challenge the concept of focusing only on efficacy or speed.  In fact one of my favorite lines is “I don’t care what the product says it will kill or how fast it will kill it, if the staff don’t like using it (or are scared of using it), you can be guaranteed they won’t.” It’s the truth.  I’ve seen it.  I’ve talked with staff who are concerned for their health due to the perception they have of the disinfectant product that has been chosen and they feel forced to use.

The truth is, in the race to ensure we rid every surface of as much as we can in order to minimize the spread of HAIs we have forgotten one important thing.   We have forgotten to consider the balance between efficacy and safety.   It’s relatively easy to go online and find a recipe to make a “safe” disinfectant.  From a chemical engineering perspective it’s also pretty easy to create a disinfectant that will kill everything….assuming we’re not concerned with occupational safety or materials compatibility.  Finding the balance and creating a product that has a pretty broad-spectrum efficacy along with a great safety profile is another thing altogether. 

A recent study published in AJIC investigated health problems associated with disinfectant product exposure and concluded that the PAA-based disinfectant chosen because of its product label effectiveness to reduce C. difficile was directly associated with mucous membrane and respiratory health effects.   The results were based on a survey completed by healthcare workers as well as air monitoring in units that utilized the disinfectant in question.  It was found that there was a higher prevalence of work-related wheeze and watery eyes among users of the disinfectant product.  It was also found that in one unit where the highest level of chemicals was found in the air that there was a higher prevalence of health effects among both product users and non-users.  The researchers also compared the prevalence of asthma among the healthcare workers in the hospital to reported values for the US adult population and found that the prevalence was significantly higher.  The recommendations of the study were to ensure that healthcare workers concerns about occupational illness are taken seriously and to implement controls to reduce exposure to cleaners and disinfectants in order to provide a safe working environment while still protecting patients from HAIs.

The long and the short is that everything we do in life needs to be balanced and that many of our choices will require a trade-off.  In the case of choosing disinfectants, the difficulty being you may be choosing between the health and well-being of a patient over a healthcare worker or vice versa.  When looking at our disinfection needs remember it’s not just about what a product kills or how fast it kills.  We need to consider the safety of the staff that have to use it.  If there is a potential health concern, then what controls need to be put in place such as additional PPE such as respirators or only cleaning 1 or 2 rooms per shift with the product in question.   Alternatively are there changes in cleaning protocols that can be used such as twice daily cleaning (e.g. morning and afternoon) to help keep the pathogen load in the environment lower?  

As I learned today, perhaps we need to use a “Beginner’s Mind” when trying to come up with solutions to the problems we have.  We often look to the experts to come up with a solution, but according to Zen Master Shunryu Suzuki “In the Beginner's Mind there are many possibilities. In the expert's mind there are few." 

Bugging Off!


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