By Linda Lybert
There are dozens of types, textures, and materials that comprise the surfaces that exist within the healthcare environment. They can be as varied and different as imaginable – from plastic, rubber, textiles, stainless steel, epoxy, resin, wood, carpet, tile, linoleum, marble and more. Patients, healthcare personnel, visitors, and staff interact with these surfaces and in many ways t they can serve as barriers for safe, effective care and inhibit infection prevention efforts by supporting the spread of pathogens and microbes that cause infection and illness. These foundational issues within our healthcare facilities and the surfaces that make them up have not been addressed. Existing and ongoing research show surfaces can be active transmitters of microbes when devices, equipment and people interact with them during the patient-care process.
Experts often evaluate the causes and develop solutions based on their area of expertise, including materials science, epidemiology, infection prevention and control, microbiology, textile science, chemical engineering, environmental services, occupational health, and more. To find sustainable solutions that promote the safety and integrity of the surface itself as well as minimize the role they can play in spreading microbes and other contaminants requires a clear understanding of all aspects of the problem from a multidisciplinary group of professionals working on the same issue from differing points of view. There is not a single solution to this problem, therefore it requires input, discussion, and consensus among many different competencies.
Successful sustainable solutions will be found when experts come together and share their knowledge, understanding, and insights. Experts and advocates that must be included in the discussion in a quest to find solutions come from many healthcare sectors including manufacturing, research, academia, technology, frontline healthcare professionals, as well as governmental and regulatory agencies. All have very different understandings of the problem and all can contribute critical facts and valuable insight that will lead to effective and sustainable solutions.
A cutting-edge collaboration of world renowned experts began in 2015 at the first Healthcare Surfaces Summit. This group of experts who are passionate about this issue gathered with the goal to gain a clear understanding of the complex and far reaching issue of infection control as it relates to surfaces.
Approximately 50 people were in attendance. The collaboration began with each professional expert giving a 10-minute lightning talk answering the same three questions:
• Based on your area of expertise describe the surfaces issue and how and why they support the spread of microbes that cause deadly infections?
• What are the hurdles to successfully reducing or mitigate the spread of infection via surfaces?
• What needs to happen immediately?
Each presentation provided a different perspective of the problem that others had not considered. A rich, broad discussion took place with all participants, and a mission statement created for the Summit.
“Reduce preventable infections through the collaboration of industry, academia, science, regulatory, and service sectors by interrupting the transmission of surface related pathogens in healthcare in support of community health.”
Additionally, four areas of focus for initiative work were identified based on the information presented:
• Standards and Utilization
• Surface Disinfection Compatibility
Each participant selected one group to work in. There is a focus on build bridges between silos of expertise, so all groups had representatives from all areas of competence.
At the conclusion of the Summit, each initiative group provided the larger group with an overview of their mission and listed specific projects they would focus on for the remainder of that year. They are as follows:
Mission: Prove the connection between surfaces and HAIs
• Show that surfaces cause infections clearly
• Which is the rate limiting step- where to apply product
• What products work
• Sea of change with CDC recognizing environmental role and importance
Standards and Utilization:
Mission: Implement evidence based best practices for people process and technology to assess and eliminate surface contamination and evaluate interventions designed to disrupt pathogen transmission.
• Interaction with various surfaces – what, how, when, where
• Best practices - what currently exist
• Monitoring and training - research and read current programs identify what is successful
• Process evaluation
Devices (detection/monitoring) & Technology
• Performance standards
• Detection limit, sensitivities
• Programs for pathogen detection kits/systems
• Programs for disinfection technologies
• Material suitability
• Harmonization of antimicrobial claims
• Best practices for cleaning and disinfection
• Design standards
• Testing requirements to establish surface disinfection compatibility
Mission: Review, Create and Disseminate critical information for healthcare stakeholders to reduce transmission of surface related pathogens
• Wipe down time out campaign
• Review surface educational programs and provide additional data and information
• Surface performance data - based on R&D and Standards
• Antimicrobial vs. Bactericidal, Microbial surfaces
The work of the Summit is done throughout the year by each of the four Initiative groups. Sponsorship funds and grants are used to support this work with the remaining amount going toward the Annual Summit where groups report back to the larger group on their success, hurdles to success and plan for the next year.
The Healthcare Surfaces Summit is not an educational conference. There are many excellent professional organizations that provide fantastic annual conferences that we highly recommend and support. The Summit is a roll-up-your-sleeves, get involved to develop effective sustainable ways to reduce infections, recommending evidence based best practices, develop new standards, recommend policy and code changes. Provide and support educational programs that provide data and detailed information about surfaces.
In March 2017, the original advisory board became the board of directors and officially adopted bylaws. The Healthcare Surfaces Summit Inc. became a non-profit, 501c3 organization.
Board of Directors members are:
• Jacqueline Butler, MLT (ASCP), CIC
• Douglas Erickson, FASHE, CHFM, HFDP, CHC
• Caroline Etland, Director of Education, Research and Professional Practice at Sharp Chula Vista Medical Center, San Diego
• Dr. Charles Gerba, University of Arizona
• Dr. Matthew Hardwick, President, and CEO of ResInnova Laboratories
• Darrel Hicks, BA, MREH, CHESP, Certified Expert Trainer
• John LaRochelle, Facilities Offer Development and Deployment, Sodexo USA
• Linda Lybert, President of Healthcare Surface Consulting and Founder of the Healthcare Surfaces Summit
• Dr. Amber Hogan Mitchell, Dr.PH, MPH, CPH International Safety Center, President, and Executive Director
• Dr. Rodney Rohde, Ph.D., MS, SV, SM, MB (ASCP) Chair and Professor of Clinical Laboratory Science Program at Texas State, Associate Dean for Research in the College of Health Professions
• Dr. William Rutala, Director of Hospital Epidemiology, Occupational Health and Safety Program University of North Carolina Hospital and Research Professor for the Division of Infectious Diseases at University of North Carolina School of Medicine
• Dr. Syed A. Sattar, M.Sc., Dip. Bact., Ph.D. RM(CCM) FAAM Professor Emeritus of Microbiology, University of Ottawa, Chief Scientific Officer CREMCO Laboratory
• Glenda Schuh, Consultant in Infection Prevention and Occupational Health, a member of APIC. IPAC-Canada, IFIC
• Keith Sopha, President of Canadian Association of Environmental Management and founder of CleanLearning
• Pamela Vaccaro, R.N. CIC, Director of Infection Prevention and Environmental Services at North Oaks Health System
An advisory board has also been created members are:
• Shari Soloman Esq., President of Clean Health Environmental LLC.
• Dr. Curtis White, Ph.D., Chief Technology Consultant and President of White IEQ Consulting and the CEO and CTO of Nano Safe Coatings.
The infrastructure is now in place and fundraising underway to support the ongoing initiative work. On August 22-23, 2017 in Arlington, Texas, the second Healthcare Surfaces Summit was held with seven sponsors: Sappi, PDI, International Safety Center, Healthcare Surface Consulting, zBioscience, E-Mist and Munnworks.
The keynote speaker, Mary Millard, an HAI survivor presented "The Devastation of Life with a Superbug Infection" telling her story of the nightmare infection she continues to live with.
Mary acquired her infection during a cannula insertion while she was on an Extra Corporeal Oxygenation (ECMO) machine. She survived a second open heart surgery that was required to clean out the infection, adding an additional month to her already month-long hospital stay. She continues to live with a variety of complications today as a result of a surface acquired infection.
The statistics are staggering -- 1 out every 25-people entering the hospital for care will acquire an infection. Antimicrobial resistance, super bug infections, surfaces that are difficult if not impossible to clean are all important issues. The World Health Organization estimates that by 2050, 10 million people will die as a result of superbug infections. It will take an ongoing collaboration of many professionals to truly have an impact.
The Healthcare Surfaces Summit is unique, as it calls attention to the issue of surfaces which is a complex daunting problem and avoided as a result. Most professionals are overwhelmed by the number of surfaces and are completely unsure of where to start so they use different disinfectants and cleaning processes on surfaces that are impossible to clean.
The Healthcare Surfaces Summit has taken a collaborative approach knowing that all areas of expertise are absolutely necessary to be able to fully understand and address all aspects of the surfaces problem.
The second Summit featured the addition of new board members and sponsors. A new segment was also added to the agenda, the Manufacturer Spotlight. Manufacturers with new innovative products or ideas were given a room to set up a display and each gave a 10-minute presentation. Several new products that have not yet gone to market were presented followed by networking time and discussion with board members and Summit participants. Valuable insight was received providing manufacturers with an opportunity to refine technology to meet critical needs.
New and innovative products often come to market without any discussion with key decision makers or experts in the industry. They have the ability to provide sound solutions and innovative ideas but often miss one critical aspect that may need to be addressed. The Summit provides the opportunity to meet with key decision makers that will provide insight into areas often not addressed. Input and feedback can be valuable and critical to the success of products.
Linda Lybert is president of Healthcare Surface Consulting and founder of the Healthcare Surfaces Summit.