Guidelines for Evaluating New Technologies for Infection Control

December 1, 2010

By Mark Stibich, PhD

Some people enjoy evaluating new technologies and sometimes it is part of their job description and they are overwhelmed by all the possibilities of products to review. Often the first person to evaluate a new technology or solution for an infection control-related problem is the infection preventionist (IP). If an IP had time to thoroughly evaluate new technologies and approaches to infection control, that would be fantastic but the reality is that the IP is often swamped with other work and the evaluation of new technologies, with potential life-saving benefits to patients, unfortunately joins a long list of other "to-dos." Even more challenging, if an IP believes a new technology would help, often he or she must become an internal advocate for that technology. The task of presenting the technology to administrators and other medical staff falls on him or her, adding yet another project to an overworked IP.

This article provides a brief guideline for evaluating new infection control technology. After reviewing the following factors, IPs should be able to determine what questions to ask about a new technology and be able to compare potential solutions. This will also allow an IP to address the likely concerns about new technologies, making presenting the new solution to administrators and other staff easier. For the purpose of this guideline, well consider "new technology" to be anything from a new type of disinfectant to a hand hygiene monitoring system to a room decontamination device (and everything in between).

Guidelines for Infection Control Technology Evaluation

Establishing Efficacy

Establishing the efficacy of a new infection control technology may be challenging. Because of the nature of infection control, randomized studies of new technologies may be difficult and, in some circumstances, unethical because of the need to suspend other improvements during such a study. Each hospital or facility also has unique circumstances that may or may not reflect the data available. That leaves it up to the individual infection control department to evaluate the data available on a new technology.

Estimating the impact of a new technology will involve looking at the impact of similar technologies in other settings as well as reviewing the literature. It may be that other technologies accomplished a similar result, but were unpractical for wide-spread implementation. For example, technologies used in high-incidence or outbreak situations show the impact of various approaches to infection control, but may not be practical for daily use. If a technology emerges that has the same success, but can be used more routinely, the prior technologies can be used to help evaluate it.

- Impact on operations: Will the technology significantly delay patient admissions or other procedures? Is the technology practical enough for continuous use throughout a facility?

- Ease of use: How long will training take? What level of professional is needed to operate the new technology? Is routine maintenance needed?

- Cost per use: What is the cost per use? Are there consumables such as chemicals that must be ordered and stored?

- Patient/staff acceptance: How will patients and/or staff perceive the technology? Could it help drive patients to the facility?

- Environmental impact: Are toxic materials used in the manufacturing or use of the technology? Does the technology produce waste each time it is used? If any waste is produced, how is it disposed of? What is the cost of that disposal process? Are there any risks associated with the waste? Does the technology have a "green" certification?

- Hidden costs: Are there any hidden costs to using the technology? Is there a cost per use? Does the technology depend on other materials or processes being in place?

- PR benefit: Could the technology be leveraged into a public relations campaign for the facility? Does it address concerns that the public and media have expressed?

- The "Grandma" test: If you grandmother was in the hospital, would you want this technology used?

- Excitement factor: When implementing a new technology, it helps greatly if there is some excitement, or "buzz" around. This will help gather support for the technology and ease the transition to using the new technology.

- Material compatibility: Is the new technology compatible with existing materials? Is there known damage that occurs when the technology is used?

- Operator safety: Does the technology have safeguards in place to protect the operator? Is any routine exposure to chemicals involved?

- Operator level: What level of expertise does the operator need to have? Will there be problems within the housekeeping staff such as union issues or job classifications?

- Patient acceptance: If a patient heard about the technology, what would he or she think? Would the patient be supportive, skeptical or indifferent?

- Supplier support: Is the supplier easy to communicate with? Can the supply keep up with the demand (especially if consumables are used)?

- Storage: What type of storage space does the new technology require? Are there consumables that would need to be stored?

- Mobility: How portable is the technology in a busy hospital setting?

- Assurances: Does the technology have a monitoring or other system to provide dose assurance? How can you be sure it is working correctly?

- Instructions: Instructions should be easily understandable to people whose first language is not English. Can the instructions for the technology be easily understood? Have efforts been made to make the instructions simple and clear?

- Supplier support and technology durability: What level of support does the supplier offer? Do they offer experts to assist with implementation and monitoring the use of the new technology?

- Warranty: What is the warranty on the technology? What does it cover and how long does it last? Do you have assured "up time" in which the company will provide you with replacement technology within a certain time period? This is important if you are considering making a new technology part of the routine protocols in your facility.

Making the Case for New Technology

Once an IP finishes his or her evaluation and decides that a new technology shows promise, she cannot stop there. It often falls on the ICP to present that new technology to management, both within infection control and throughout the facility. Here are some topics that are sure to come up in that discussion:

- Cost-Benefit: Establishing the cost-benefit of new technology is always a challenge. When looking at the cost-benefit, youll need to establish the cost per use of the technology as well as the potential benefit. The benefit, of course, is ultimately the reduction of infections. An August 2010 report from AHRQ puts the following values on healthcare associated infections: $43,000 in additional care and 19.2 additional length of stay. Keep in mind that those 19.2 days represent unprofitable bed days for your facility and should be valued at around $800 per day. Therefore the total cost of an infection is, on average, $43,000 plus a lost profit of $15,360. Of course, some of the $43,000 will be passed through to insurers and/or Medicare/Medicaid (though the amount is becoming less and less). The bottom line in estimating the cost-benefit of a new technology is figuring out how many infections must be prevented in order to "break-even" and then thinking about the probability of achieving that level of reduction. Simply take the annual cost of the new technology (including labor, consumables and other costs) and divide it by the cost of an infection. The result is the number of infections the new technology would have to reduce in order to pay for itself.

- Infection reduction: The other question most frequently asked, is "how many infections will the new technology prevent?" In the case of new technologies, this data may not be available. What may be available is case studies, comparisons to similar technologies and other data that will indicate the potential impact of the technology on the infection rate. It will be up to the IP to make the case based on the data available for the expected infection rate reduction if the new technology is implemented.

Perhaps the most compelling and exciting news is that new technologies exist which meet all of these criteria for example, some types of room disinfection technologies exist which are fast, effective at eliminating deadly micro-organisms, and affordable. Being the person to present a cost-effective and microbiologically effective method for disinfecting the hospital environment and improving patient safety will make the IP look like a superhero and we all have time for that.

As Xenex Healthcare Services chief scientific officer, Mark Stibich, PhD, oversees research, product development, facility assessments, protocol design and operator training. He holds a doctoral degree from the Johns Hopkins University School of Public Health and a masters in health science, also from Johns Hopkins. He was a faculty member of the UCSD School of Medicine and is currently a consultant with Columbia University.