Closing the Gap Between Environmental Services and Clinical Research

September 20, 2012

By George Clarke
But he hasnt got any clothes on!

Its blunt, I know, but its how I feel about the continuing vulnerability of patients to healthcare-associated infections (HAIs).

Case in point: Earlier this year, the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC) brought together thousands of infection preventionists, nurses, vendors and other professionals seriously interested in learning how to be more effective in their commitment to reduce preventable HAIs and ensure a safe patient environment. People came from many countries to learn about the latest research presented by healthcare leaders and a number of world-renowned experts dedicated to infection prevention.

The scenario reminded me of Hans Christian Andersens story, The Emperors New Clothes. But in my version of the story, the tailors were researchers and so many of the attendees appeared to be so enamored with the research presented that they failed to recognize that the Emperor the patient, if you will continued to stand naked against the onslaught of HAIs.

To be clear, Im a researcher myself and my comments are not intended to diminish the value of research. Organizations such as APIC, the Society of Healthcare Epidemiology of America (SHEA), and the Association for the Healthcare Environment (AHE) do a great service to the healthcare community by bringing researchers to their conferences.

But at some point, there comes a time when research needs to be turned into effective action or patients will continue to be vulnerable to HAIs. For example, look at the value of handwashing and the use of personal protective equipment (PPE) and all we know about them. Yet, why is it so difficult, besides the obvious cost obstacle, for hospitals to require staff, visitors and family to follow proper hand hygiene and PPE protocol? Research has shown the efficacy of proper hand hygiene so why dont hospitals simply say, No handwashing plus no PPE means no visit. For more than 150 years we have known that proper hand hygiene is one of the paramount measures to reduce infections in patients.
At the 2012 APIC conference, pundits and professionals alike were heard quoting 12-year-old statistics associated with annual HAI rates again. Weve heard them time and again: 1.7 million infections; sixth leading cause of death; 99,000 deaths; $35 billion all of this for 12 years now. Hasnt enough research been done over the past 12 years for the healthcare community to ask: When will we see the HAIs mortality decline?

Will the Emperor ever get his clothes? 

In his APIC presentation, Disinfection and Sterilization: From Benchtop to Bedside, William Rutala, PhD, MPH, CIC, stated: There is increasing evidence to support the contribution of the environment to disease transmission, and that we pick pathogens up at the same level by touching the environment as we do the patient. Unless we inactivate or remove these microbes, they are going to be present in a patient room for a long time.

If hospital administrators and the infection prevention community truly embrace the evidence related to pathogens on patient care environmental surfaces and the need to remove or inactivate them, why isnt there more indication of this? Where is the collaboration between APIC and AHE that was heralded last year at AHEs conference?

Could it be that APIC and other clinicians in healthcare fail to recognize and admit that there is a science to cleaning and disinfecting and that environmental services (ES) performs both the 1) clinical function of removing and inactivating/killing HAI producing microbes and 2) a practical function of cleaning? 

In one of the APIC sessions, researchers reviewed the science behind environmental contamination of patient rooms and its role in the spread of antibacterial-resistant bacteria to healthcare workers and between patients. Afterward, one of the sessions co-presenters, AHE executive director Patti Costello, brought focus to the dilemma when she asked of the audience (and I paraphrase), Now what? We have all this information, what are we going to do with it?

The fact is, like Ive said, research findings like those shared at APIC are necessary, for they help expose not only areas needful of consideration but present practical and efficacious resolution. Research is necessary, and we should regard it with great esteem, but as Ms. Costello said, were not going to make great strides until we actually begin applying the research.

To me, one of the easiest and most cost effective ways we as an industry can affect change in reducing preventable HAIs is to recognize the critical role that ES, the first line of defense, plays in mitigating the risk of HAIs. And yet ES departments are being hobbled at every turn.

Instead, were seeing a proliferation of costly disinfection machines that achieve their intended function only after ES staff completes their assigned tasks. These devices were everywhere at APIC, and they range in price from $80,000 to $124,000. How many infection prevention or ES staff can be hired for $124,000?

In my version of The Emperors New Clothes, research and best intentions are turned into action not solitary initiatives that must have collaborative support to succeed, but enterprise-wide action involving every department including the C-suite, every employee and, of course, ES.

But when it comes to the battle against HAIs, it simply shouldnt have to be that it is only in a fairy tale where the patient lives happily ever after.

George Clarke is CEO and founder of Chicago-based UMF Corporation, innovator and specialists in environmental hygiene. For more than 10 years, Clarke has been an aggressive advocate of raising standards in the battle to reduce healthcare-associated infections (HAIs). He holds more than 30 patents both issued and pending, including those for his line of high performance micro-denier textiles under the brand names PerfectCLEAN® and Micrillon®. For clients, his PerfectCLEAN® Environmental Hygiene System, which comprises high-performance products and specialty training, has been simultaneously instrumental in reducing rates of infection while raising patient satisfaction scores. Clarke is a graduate of the University of Toronto.