Forced Warm Air - Bair Huggers - and Airborne Contaminants

Am J Infect Control. 2010 Nov 20. [Epub ahead of print]

Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room.

Albrecht M, Gauthier RL, Belani K, Litchy M, Leaper D.

Augustine Biomedical and Design, Eden Prairie, MN.

Abstract

BACKGROUND: Forced-air warming (FAW) is widely used to prevent hypothermia during surgical procedures. The airflow from these blowers is often vented near the operative site and should be free of contaminants to minimize the risk of surgical site infection. Popular FAW blowers contain a 0.2-μm rated intake filter to reduce these risks. However, there is little evidence that the efficiency of the intake filter is adequate to prevent airborne contamination emissions or protect the internal air path from microbial contamination buildup.
METHODS: Five new intake filters were obtained directly from the manufacturer (Bair Hugger 505, model 200708D; Arizant Healthcare, Eden Prairie, MN), and 5 model 200708C filters currently in hospital use were removed from FAW devices. The retention efficiency of these filters was assessed using a monodisperse sodium chloride aerosol. In the same hospitals, internal air path surface swabs and hose outlet particle counts were performed on 52 forced-air warming devices (all with the model 200708C filter) to assess internal microbial buildup and airborne contamination emissions.
RESULTS: Intake filter retention efficiency at 0.2 μm was 93.8% for the 200708C filter and 61.3% at for the 200708D filter. The 200708D filter obtained directly from the manufacturer has a thinner filtration media than the 200708C filter in current hospital use, suggesting that the observed differences in retention efficiency were due to design changes. Fifty-eight percent of the FAW blowers evaluated were internally generating and emitting airborne contaminants, with microorganisms detected on the internal air path surfaces of 92.3% of these blowers. Isolates of Staphylococcus aureus, coagulase-negative Staphylococcus, and methicillin-resistant S aureus were detected in 13.5%, 3.9%, and 1.9% of FAW blowers, respectively.
CONCLUSION: The design of popular FAW devices using the 200708C filter was found to be inadequate for preventing the internal buildup and emission of microbial contaminants into the operating room. Substandard intake filtration allowed airborne contaminants (both viable and nonviable) to penetrate the intake filter and reversibly attach to the internal surfaces within the FAW blowers. The reintroduction of these contaminants into the FAW blower air stream was detected and could contribute to the risk of cross-infection. Given the deficiencies identified with the 200708C intake filter, the introduction of a new filter (model 200708D) with substantially lower retention efficiency is of concern.

CDC New Guidance: Options for Evaluating Environmental Cleaning

From http://www.infectioncontroltoday.com/   Decemver 21, 2010

The Centers for Disease Control and Prevention (CDC) has released guidance for programs to optimize the thoroughness of cleaning of high-touch surfaces. The guidance recommends a two-level program administered by infection preventionists and coordinated and maintained through environmental services professionals.



The document, “Options for Evaluating Environmental Cleaning,” was prepared by Alice Guh, MD, MPH, of the Division of Healthcare Quality Promotion in the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, and Philip Carling, MD, of Carney Hospital and Boston University School of Medicine in Boston. Assistance in document preparation was provided by Brian Koll of Beth Israel Medical Center in New York; Marion Kainer and Ellen Borchers from the Tennessee Department of Health in Nashville, Tenn.; and Brandi Jordan of the Illinois Department of Public Health in Chicago.
The document notes, “In view of the evidence that transmission of many healthcare-acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high-touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients. Since dedicated resources to implement objective monitoring programs may need to be developed, hospitals can initially implement a basic or Level I program, the elements of which are outlined below. Some hospitals should consider implementing the advanced or Level II program from the start, particularly those with increased rates of infection caused by healthcare acquired pathogens (e.g., high Clostridium difficile infection rate). All hospitals that have successfully achieved a Level I program should advance to Level II.”
The document continues, “At present, the objective monitoring of the cleaning process of certain high touch surfaces (e.g., the curtain that separates patient beds) beyond those outlined in the attached checklist is not well defined. Additionally, there is no standard method for measuring actual cleanliness of surfaces or the achievement of certain cleaning parameters (e.g., adequate contact time of disinfectant) or for defining the level of microbial contamination that correlates with good or poor environmental hygienic practices. As our understanding of these issues evolve and a standardization of assessment in these respective areas can be developed and practically implemented, hospitals that have obtained a high compliance rate with surface cleaning as outlined in the Level II program are encouraged to advance their efforts in optimizing environmental hygienic practices.”
http://www.cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html

Webinar on Antiseptics

The slide deck for this presentation is available at http://www.workingtowardzero.com/

In celebration of Perioperative Nurse Week, Nov. 8-14, the Association of periOperative Registered Nurses (AORN) is offering free to its members a series of "Chasing Zero" Webinars, funded through the AORN Foundation by a grant from CareFusion.
The Webinar, "Chasing Zero: Skin Antisepsis," will be held on Nov. 11, 2010, at 2 pm MT. The speaker is Maureen P. Spencer, RN, MEd, CIC. The Webinar will discuss the rationale and steps for preoperative skin preparation, selection of antiseptic agents, the safe handling of flammable skin preparation materials, and other best practices in infection control. This webinar will award one contact hour upon completion of Webinar evaluation.

Working Toward Zero Infections - Methodist Wiilowbrook Hospital in Houston

http://www.infectioncontroltoday.com/news/2010/12/methodist-willowbrook-hospital-achieves-zero-infection-rate.aspx

Methodist Willowbrook Hospital in Houston reports that it has not recorded a healthcare-acquired infection (HAI) in the top three at-risk areas for 14 consecutive months.
The 251-bed hospital, part of the Methodist Hospital System, achieved a zero infection rate in ventilator associated pneumonias, central line bloodstream infections, and urinary catheter infections. Hospitals nationwide have been charged with reducing the number of hospital-acquired infections and other preventable injuries as a result of the Institute of Medicine’s patient safety initiatives. Published studies show that there are 1.7 million infections in hospitals annually, resulting in almost 100,000 deaths a year—most in the above three categories.
"Once thought unattainable, Willowbrook has set a new gold standard by sustaining zero infections in all three categories for this period," said Dr. Charles Denham, chairman of Texas Medical Institute of Technology and co-chair of multiple national programs at the National Quality Forum. "High performance care occurs at the intersection of great leadership, safe practices that deliver predicable outcomes, and implementation of technologies. It all starts with leadership, and the extraordinary success of Methodist Willowbrook Hospital makes it a role model for our nation."
Some of the things Willowbrook did to lower infection rates include working collaboratively with its nursing staff to develop an electronic tool within the electronic medical record that alerts nurses when specific patient care tasks should be performed. For example, it alerts the nurse on the number of days a urinary catheter has been in place and to review for continued need.
"If a patient has a stroke, the nurse is focused on hundreds of critical tasks to ensure the patient is recovering appropriately. The removal of a simple catheter could easily be overlooked, and early removal is key to reducing the chance of a urinary tract infection," says Dr. Patrick Woods, emergency department medical director and chief of quality and patient safety at the hospital. "Having a committed and talented staff assisted by technology has been a key to success at Methodist Willowbrook Hospital."
Another key to the hospital’s success is a system called electronic rounding, which is the daily review of key indicators by the hospital’s quality department. The quality team reviews the chart of every patient who is at risk for any of the three infection areas to ensure appropriate action has been taken, or, collaborating with the clinical team if the plan needs to be changed, Woods says.