The use of decontamination technologies became more prevalent during the COVID-19 outbreak. The increased choice of tools and suppliers means that NHS Trusts and healthcare providers need to assess which technology best fits their overall IPC strategy.
In this article we explore what criteria should be used to evaluate decontamination options, when looking to achieve enhanced levels of pathogen reduction, and when it might be right to select each technology. Read on to find out more, or select the section of most interest:
- Why IPC remains critical
- Managing infections today
- What are decontamination technologies?
- Where do decontamination technologies fit in the strategy?
- Assessing decontamination solutions
- Supporting a whole hospital approach
Why does IPC remain critical for patient outcomes?
The importance placed on effective infection prevention and control in healthcare environments has never been higher – with its visibility and focus significantly heightened during the pandemic. Preventative infection control plans were a core part of the response to the COVID-19 outbreak. However, the need to assess, plan, implement and measure effective infection prevention and control strategies is not a new concept.
In the mid-19th century Dr Ignaz Semmelweis, a Hungarian physicist, first linked the concept of cleanliness with germs and health. Building on the work of Louis Pasteur, Joseph Lister later introduced preventative practices which significantly impacted post-operative infection rates. The terms ‘hospitalism’ or ‘ward fever’ were used to refer to people who died in hospital despite successful operations – known today as ‘hospital-acquired infections.’¹
How are we managing infections today?
Despite the significance placed on prevention and control of hospital-acquired infections, it is still a challenge many organisations are grappling with. In July 2022, it was estimated that the proportion of people in hospital with COVID-19 who caught it post-admission could have been as high as 24%².
The term hospital-acquired infections (HCAIs) includes many different pathogens, with some of the most common being methicillin-resistant staphylococcus aureus (MRSA), clostridium difficile (C. difficile) and escherichia coli (E. coli).
The number of hospital-onset cases of MRSA, has been relatively stable since 2013/14³. The rate observed in 2022/23 rose slightly from 0.7 to 0.8 per 100k bed days⁴.
For E.coli, the rate has remained relatively stable since 2012. Although, in FY 2022/23 the rate slightly increased from 21.5 to 22.2 per 100k bed days⁴.
C. difficile saw a more noticeable increase in 2022/23 from 16.3 to 18.3 per 100k beds⁴.
Despite our best efforts, and enhanced processes initiated during the COVID-19 outbreak, these core infections remain difficult to prevent in hospital settings. The UK Health Security Agency highlights in its annual report that ‘it is imperative to uphold or intensify control measures within hospitals, while simultaneously, increasing focus on healthcare interventions within the community and strengthen the collaboration between hospital and community infection control teams.’
Decontamination technologies
Decontamination tools and technologies may already form part of your
overall IPC strategy. Depending on the pathogens being targeted, and known outbreaks of an area, a strategy will be formed in stages from routine cleaning, which will vary in frequency depending on area and known pathogens, to additional cleaning using agents such as disinfectants and finally the introduction of automated technologies as a dynamic cleaning stage.
Decontamination is a term used to describe the combination of processes that ‘removes or destroys contamination so that infectious agents or other contaminants cannot reach a susceptible site in sufficient quantities to initiate infection, or other harmful response⁵.
Although the first two stages may be sufficient in many scenarios, additional technologies will take decontamination to the next level. Many of the tools have been available for some time, including Ultraviolet Light and Hydrogen Peroxide Vapour. However, their execution methods have become more sophisticated – often enhancing performance, such as reducing cycle length to lower the impact on patient flow or introducing automation to decrease the labour required to operate the service.
More recently we’ve seen Hypochlorous Acid become a more reliable part of IPC plans – which is safe for the staff and patients, the environment and for disposal. However, as with all disinfectant options there are pros and cons. The efficacy of Hypochlorous Acid has been challenged when stored over a period of time. However, recent developments have improved its stability and overcome many of these concerns.
When should decontamination technologies be used?
As we’ve highlighted, decontamination solutions should form part of an overall IPC strategy in a phased, targeted plan – considering a whole hospital approach which includes water, ventilation and services.
Removing the bio-burden is still critical to get the most positive impact from any automated solution. When determining if an automated solution is required, you should consider:
- What are the pathogens we’re trying to remove. Is there a known issue?
- What are our areas of high risk – theatres, ICUs, bathrooms?
- Do we have any known patient infections/outbreaks?
By using a RAG rating traffic light approach you can determine which scenarios require higher levels of resources and where those resources will have the biggest impact in the most efficient and optimised way.
Priority areas can be given Functional Risk categories from FR6, which has a minimal infection and perception risk to FR1 which has a high infection and perception risk. Recording numerical values for priorities can help establish where to focus resources:
- Areas of significant importance – carry implications for health, safety, and hygiene
- Areas of strategic importance
- Areas not considered of significant importance – low health, safety and hygiene risk.
Assessment criteria
So, if as part of your IPC strategy you have determined that decontamination solutions are required, such as Ultraviolet Light technologies or Vapour Producing technologies, how should you assess the right tools for your organisation?
The following framework allows you to determine suitability:
- Efficacy – do you know what pathogen you’re targeting and how does the device perform in the removal of these target pathogens?
- Speed – how long will a room/area be out of action while the device is in operation? Does this have a strategic impact e.g. affect the flow of patients?
- Ease of use – is it a simple, easily replicable disinfection process? Do your teams have the skills and capabilities or is there a training requirement?
- Validation – will you be able to obtain the proof the device has done its job after an application? What assurance do you need and can it provide this?
- Storage and transport – is the device safe and easy to store and move around the site?
- Safety – what are the risks of operating the device and how are they mitigated?
- Servicing and repairs – are parts and servicing readily available to minimise disruption due to machine breakdown? Do you need a service agreement – and how long are you tied into that contract for?
- Material compatibility – will the disinfection process damage the fabric of the building or the equipment in the room?
- Cost – what is the total cost of the automated room disinfection service? Consider the cost of the device, its consumables and the labour required to deliver the service.
By weighting the importance of each of these metrics to your organisation and rating the performance of each (score x weighting), you can deliver a quantitative score for comparison. It will highlight where one tool outperforms another, based on your own assessment, and allow you to present the findings internally for approval.
Looking to implement a whole hospital approach?
Sodexo Health & Care routinely reviews, evaluates, and uses the right decontamination tools for our clients’ needs. Our Protecta solution is an evidence-based standard that provides infection prevention processes and technologies, alongside the implementation of the new National Standards, to keep healthcare spaces clean and safe.
Delivering soft and hard FM services, we provide a whole hospital approach – a complete environment, cleaning and decontamination solution.
Click here to find out more about Protecta.