Providence Healthcare
leverages technology to improve outbreak notifications By Emily Dawson istorically, when an outbreak was declared at Providence Healthcare’s long-term care home, staff and volunteers would have to scramble to manually call the families or Substitute Decision Makers for all 288 residents who live in the close-knit, active community. “When evaluating the efficacy of manual calls, we noted a few barriers to providing consistent, accurate and timely notifications,” says Aurora Wilson, Providence’s manager of Infection Prevention and Control (IPAC). “The process was time-consuming and took clinicians away from care during critical moments in an out-
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break situation. We also found the communications were inconsistent, as we would have clinical and non-clinical staff – and sometimes volunteers – making these calls. The call process definitely added to stress and frustration of staff amidst an outbreak.” Now, an automated mass-calling system has been implemented for whenever there’s an outbreak at the Cardinal Ambrozic Houses of Providence long-term care home. During an outbreak, Providence notifies families and Substitute Decision Makers for several reasons: to keep other residents and visitors safe by minimizing the spread of infection through awareness; to maintain orga-
Join us for the 2019 conjoint conference of the International Federation of Infection Control and Infection Prevention and Control Canada.
Quebec Convention Centre, Quebec
For registration and information: www.ipac-canada.org Tel: 1-866-999-7111 or 204-897-5990 Email: info@ipac-canada.org
Automated mass calling project team members gather in the Houses of Providence. Clockwise from top left: Pat Colucci, Aurora Wilson, Shiva Nadarajan, Jube Walker, and Maggie Bruneau. nizational transparency; and to help everyone make informed decisions about visiting. When an outbreak is declared, the system allows the IPAC staff to select the affected unit, and it then uploads the contacts to the automated dialer’s portal and initiates the communications. If a call is answered or goes to voicemail, families hear a standardized script with the outbreak details. The system is programmed to repeat the call when there is no answer. “The automated calling system leaves the staff to care for the residents and implement outbreak measures. For families, the system offers a standardized message that’s clear and concise. The message also directs them to a hotline if they have additional questions,” says Wilson. “There is room to grow and spread this system to Providence Hospital, and to have outbreak messages translated into different languages. Those would certainly be our end goals.” Wilson and her team presented the project at the GTA IPAC Education Day in late 2018 and it generated buzz among other long-term care providers.
“I admit I had some nerves on the first live auto call. But what I share with people is that there have been no glitches. It’s surprisingly simple, it works, and it’s leveraging technology, which is the way the healthcare system’s heading,” she says. A robust report is immediately available after the automated call. It tracks the number of people reached, whether it was a live pick-up or voicemail, out-of-service numbers, no answer or busy lines. After a recent respiratory outbreak affecting two units in the home, the system generated 64 calls, of which 78 per cent were answered (live or voicemail), 15 per cent went unanswered or reached a busy line, and seven per cent had invalid numbers. The call is followed by an e-mail blast to families as an added layer of communication to ensure that everyone is reached. “One unintended, positive outcome is the opportunity to improve our record-keeping. The system tracks invalid phone numbers, so we’re able to clean-up our database, or seek updated contact information, as we go,” H Wilson adds. ■
Emily Dawson is…at Unity Health Toronto? 18 HOSPITAL NEWS FEBRUARY 2019
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INFECTION CONTROL 2019
International Infection Control Conference rom May 26-29, 2019, a historic education conference will be held in Québec City. This will be the first conjoint conference of the International Federation of Infection Control (IFIC) and Infection Prevention and Control Canada (IPAC Canada). Held at the impressive Québec Convention Centre, the conference is expected to attract 700 infection prevention and control professionals worldwide. An international Scientific Program Committee has developed an inspiring and creative education program. Attendees will have their choice of sessions including current issues in antibiotic resistance and immunization; cleaning and disinfection; hand hygiene; and the One Health Initiative. They will also have the opportunity to network with other attendees from around the world, developing relationships and learning how others approach and manage similar challenges.
real patient will set the tone for the conference.
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WHO ARE INFECTION PREVENTION AND CONTROL PROFESSIONALS?
Of primary importance to the theme of the conference is the Voice of the Patient. Attendees will be urged to ‘think outside the box’ when advocating for patient care, such as issues in unusual care settings, data collection, and patient engagement in their own care. The experienced story of a
Molly Blake RN BN MHS CIC is President of the Infection Prevention and Control Canada. She is an Infection Prevention and Control Professional in Winnipeg MB.
www.hospitalnews.com
An Infection Prevention and Control Professional (ICP) is an individual who is employed with the primary responsibility for policies, procedures, and practices that impact the prevention of infections. Integral competencies to the role include knowledge of infectious disease processes, microbiology, routine practices and additional precautions, surveillance, principles of epidemiology, research utilization and education. An ICP should be Certified in Infection Control (CIC®). We invite healthcare professionals from all settings to join us in Québec City for the 2019 IFIC/IPAC Canada Education Conference. For more information, visit www.theific.org or H www.ipac-canada.org. ■
Infection Prevention and Control Canada (IPAC Canada)/ Prévention et contrôle des infections Canada (PCI Canada) IPAC Canada is a national, multidisciplinary, voluntary professional association uniting those with an interest in infection prevention and control in 20 chapters across the country. It is committed to the wellness and safety of Canadians by promoting best practice in infection prevention and control through education, standards, advocacy and consumer awareness.
International Federation of Infection Control With members from nearly 50 countries, IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare-associated infections worldwide. By being part of a network, IFIC members share experiences and publications and collaborate in improving infection prevention and control globally.
Terrie Lee RN MS MPH CIC FAPIC is President of the International Federation of Infection Control. She is an Infection Preventionist in Charleston, WV.
FEBRUARY 2019 HOSPITAL NEWS 19
INFECTION CONTROL 2019
SickKids-led research team uncovers a drug that disarms life-threatening bacteria By Vanessa Blanchar lostridium difficile (C. diff) is an antibiotic-resistant ‘superbug’ that causes life-threatening diarrhea and colitis (inflammation of the colon). It typically affects people who have recently received both medical care and antibiotics. C. diff causes disease by secreting a fleet of toxins that enter and destroy the cells of the colon. A team led by Dr. Roman Melnyk, Senior Scientist in the Molecular Medicine program at The Hospital for Sick Children (SickKids), that includes Hanping Feng, PhD, professor in the Department of Microbial Pathogenesis at the University of Maryland School of Dentistry (UMSOD), and Jacques Ravel, PhD, associate director, Institute for Genome Sciences (IGS) at the University of Maryland School of
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Medicine found a drug that can block the effects of the three deadly C. diff toxins without affecting healthy gut bacteria. This means a more focused and successful treatment of C. diff compared to current antibiotic treatments that can’t target these toxins. The U.S. Centers for Disease Control and Prevention listed C. diff at the top of the list of the 18 antibiotic-resistant threats in the U.S. There is an urgent need for therapies that prevent the symptoms of this disease without disrupting the healthy gut bacteria. C. diff continues to become increasingly more widespread and difficult to treat with traditional means. The team screened thousands of small-molecule drugs to determine if any of them could block the effects of the three deadly C.diff toxins
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20 HOSPITAL NEWS FEBRUARY 2019
without affecting the gut bacteria. They discovered that a drug called Niclosamide, approved in 1982 for use against human tapeworm infections, protected human colon cells from all three C. diff toxins by preventing their uptake into cells. The team’s findings were published in Nature Communications on Dec. 7.
This discovery could have profound impact on patient care. If these findings translate to humans, this would be the first drug to treat C. diff that is able to block all toxins to prevent disease and disease recurrence without affecting the gut bacteria. By repurposing an existing drug, new treatment can come to market sooner
THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION LISTED C. DIFF AT THE TOP OF THE LIST OF THE 18 ANTIBIOTIC-RESISTANT THREATS IN THE U.S. “C. difficile, commonly thought of as a disease of the elderly, is increasingly being seen in children,� says Melnyk, who is also an Associate Professor in the Department of Biochemistry at the University of Toronto. “When we embarked on this work, we knew that we needed to find a drug that was safe for humans. Recognizing that it can take over a decade to get a new drug to the clinic, we focused our efforts on old drugs that were already approved for human use.�
and it can be taken orally because it is an oral pill. The team will continue to conduct trials to further investigate whether Niclosamide represents a model for non-antibiotic drugs against toxin-producing infectious diseases. This work was supported by a grant from the Canadian Institutes of Health Research. It is an example of how SickKids is making Ontario Healthier, Wealthier and Smarter H (www.healthierwealthiersmarter.com). â–
Vanessa Blanchar is a Senior Communications Specialist at The Hospital for Sick Children (SickKids). www.hospitalnews.com
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INFECTION CONTROL 2019
Infection prevention is in your hands By Anne MacLaurin ealthcare-associated infections (HAIs), or infections acquired in healthcare settings, are the most frequent adverse event in healthcare delivery worldwide. Every year, 220,000 Canadian patients – approximately one in nine – will develop an infection during their hospital stay, and an estimated 8,000 of those patients will lose their lives (Zoutman et al., 2003). Complicating the problem is that many HAIs are caused by antimicrobial-resistant organisms (AROs). Without harmonized and immediate action, the world is facing a post-antibiotic era in which common infections could once again be deadly (WHO, 2015). AROs could lead to infections that are difficult, if not impossible, to treat. Action needs to happen on multiple levels to prevent the emergence of antimicrobial resistance, and special care must be taken to protect the most vulnerable populations. Patients are placed at risk of acquiring an infection each time they enter the healthcare system with an open wound or a suppressed immune system, when they require surgery or have an invasive device inserted, and from a myriad of other ways that are seemingly innocuous to the unaware. To better understand the magnitude of the problem, take the case of one senior who ping-ponged throughout the healthcare system and later died from a HAI: Herbert Strasser, a very active 72-year-old, collapsed at his home in Belleville, Ontario on the morning of August 3rd. One minute he was standing at the door drinking coffee, and the next minute he was literally a paraplegic lying on the floor. He was rushed to the local hospital and then on to Kingston General Hospital (KGH). Strasser was diagnosed with a disc decompression, requiring urgent sur-
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WITHOUT HARMONIZED AND IMMEDIATE ACTION, THE WORLD IS FACING A POSTANTIBIOTIC ERA IN WHICH COMMON INFECTIONS COULD ONCE AGAIN BE DEADLY. gery. He spent 10 days recovering before being transferred to a rehabilitation centre. He was there five days before being sent back to KGH for symptoms of a urinary tract infection. He stayed overnight in the ER, and was then transferred back to the rehab centre. Once back at the rehab centre, Strasser continued to deteriorate and after several days was sent back to KGH where it was determined he was septic from an abscess that had developed at the surgical site on his back.
22 HOSPITAL NEWS FEBRUARY 2019
He received antibiotics, an incision and drainage and was reassured that a very close eye would be kept on this infection. Over the next several days he lost his appetite, developed a severe thrush in his mouth and suffered episodes of chills and shakiness. Strasser desperately wanted to be transferred back home to be closer to his family. The doctors agreed he was stable and “there was nothing being done at Kingston that couldn’t be done at Belleville.” He was transferred
late one evening without pertinent transfer records; they were to follow. A physician-to-physician report did not occur and within 24 hours Strasser became quite ill with various issues. Prior to transfer a very important antibiotic for the spinal abscess was accidently discontinued. Within six hours of being transferred as a “stable” patient, Strasser tested positive for C. difficile. He was severely dehydrated, the thrush in his mouth persisted to the point where eating and drinking had become painful. Strasser was transferred to the ICU, where tragically he died on September 19th. Post mortem it was determined that the spinal abscess had not resolved, it had in fact crept up from the base of his spine to his neck and the infection was literally disintegrating his neck. The C. difficile was so severe his colon was macerated and the thrush in his mouth had extended all the way down his throat. Several healthcare improvements have since been made. At KGH, protocols were initiated to identify patients at high risk for C. difficile; transfers are limited on weekends and off hours; and physicians give doctor-to-doctor reports. The Belleville hospital made positive changes to medication reconciliation as well as communication between physicians. The rehab facility also made changes to address communication and nursing staff issues.
REDUCING hais Currently, there is not a consistent approach across provinces/territories or even within some provinces for how infections are defined, measured, or reported. The Canadian Patient Safety Institute is supporting a number of pan-Canadian initiatives to implement standardized surveillance definitions and leading a public awareness campaign – STOP! Clean Your Hands www.hospitalnews.com
INFECTION CONTROL 2019 Day – aimed at helping to change behaviours around cleaning your hands to help prevent infection. Under the leadership of Infection Prevention and Control Canada (IPAC Canada), in collaboration with the Association of Medical Microbiology and Infectious Diseases Canada (AMMI Canada) and the Canadian Patient Safety Institute, standardized surveillance definitions for HAIs in acute care and long term care have been identified. The nationwide adoption and application of these definitions will impact how infections are defined, measured and reported and ultimately reduce infections. Senior leaders are called upon to endorse, promote and use these case definitions within their jurisdiction, facility and/or network. In addition, the Public Health Agency of Canada, the Canadian Nosocomial Infection Surveillance Program, the Canadian Institute for Health Information, AMMI Cana-
da, IPAC Canada and the Canadian Patient Safety Institute are working in collaboration to identify potential strategies for national surveillance of HAIs. Good surveillance data and information is essential for improvement. The group seeks support to facilitate the collection, analysis and reporting of HAI surveillance data across Canada. Ultimately, this data will serve to reduce infections, like the HAI that ended Strasser’s life. As front line healthcare workers, there is something you can do right now to help prevent the spread of HAIs. Proper hand washing serves as the foundation to prevent HAIs: in Canada, the Canadian Patient Safety Institute promotes STOP! Clean Your Hands Day each year to foster engagement and participation. Improving the implementation of evidence-based practice in order to make patient care delivery safer depends on behaviour change (Michie et al, 2011), and events like these help provide the
tools and resources to encourage that behaviour change. STOP! Clean Your Hands Day highlights the dangers in not cleaning your hands, not only in healthcare, but also in our communities. If we are going to defeat HAIs, we should report them, honour the memory of those they affect, and face the problem with clean hands.
STOP! CLEAN YOUR HANDS DAY Cleaning your hands is one of the best ways to stop the spread of infection. In a Canadian Hand Hygiene audit the national compliance rate for hand hygiene was 78.3 per cent (CPSI, 2014). Current data estimates that compliance rates by province range from 48 to 90 per cent. Each year, thousands of healthcare providers in sites across Canada join the fight against the spread of infection by participating in STOP! Clean Your Hands Day – led by the Canadian Patient Safety Institute, in conjunc-
tion with the WHO’s SAVE LIVES: Clean Your Hands campaign. The day is celebrated annually on the fifth day of the fifth month, representing five fingers on each hand. The WHO slogan for May, 5, 2019 is “Clean care for all – it’s in your hands”. Calls to action have been created, targeted to each of these audiences: • Health workers: “Champion clean care – it’s in your hands” • Infection Prevention and Control leaders: “Monitor infection prevention and control standards – take action and improve practices” • Health facility leaders: “Is your facility up to WHO infection control and hand hygiene standards?” • Patient advocacy groups: “Ask for clean care – it’s your right” Planning is now underway to celebrate STOP! Clean Your Hands Day across the country on Monday, May 6, 2019. Visit www.handhygiene.ca to H learn how you can participate. ■
Anne MacLaurin is a Senior Program Manager with the Canadian Patient Safety Institute, leading the infection prevention and control national strategy.
www.hospitalnews.com
FEBRUARY 2019 HOSPITAL NEWS 23
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INFECTION CONTROL 2019
Face-to-face with infection prevention and control By Michael Oreskovich nfections are the most common kind of complication for hospitalized patients, responsible for thousands of deaths each year according to the Public Health Agency of Canada. Since their prevention is fundamental to patient safety and the recovery process, Runnymede Healthcare Centre has taken steps to strengthen its partnerships with patients and families by increasing access to the hospital’s infection control experts. Patients and families have always been able to rely on Runnymede’s infection prevention and control (IPAC) team to be there when they need support. In addition to providing in-person consultation upon admission, the team also arranges for pa-
I
tient- and family-focused IPAC education at key points through the year, including at Canadian Patient Safety Week and IPAC Week events. But in late 2017, a new series of meetings was launched that took the team’s engagement with patients and families to a new level. Bimonthly Patient Family Engagement Committee meetings are held on every floor at Runnymede to give patients and families a chance to meet with hospital staff, and the IPAC team always takes part. “One of our goals is to increase our patients’ and families’ access to the IPAC team so they can share information about infection control and raise awareness about how important it is,” says Raj Sewda, VP of clinical operations and quality, chief
Setting a New Standard for Non-Antimicrobial Soap Performance There has been limited innovation in handwashing, with the largest advances being the advent of foam formulations and improved skin compatibility, i.e., mild formulations. However, there haven’t been major formulation advances in skin cleansing (i.e., removal of dirt, bodily fluids, microorganisms, etc.), the primary function of handwashing. GOJO has developed improvements in non-antimicrobial soap performance by optimizing the skin cleansing properties without sacrificing skin compatibility or aesthetics. PURELL HEALTHY SOAP™* with CLEAN RELEASE™ Technology sets a new standard for soap performance. • Remarkably mild formulation is gentle on skin • Contains no antimicrobial active ingredients or harsh preservatives1 • Removes more than 99% of soil and germs.1-3 PURELL HEALTHY SOAP™* with CLEAN RELEASE™ Technology is a superior non-antimicrobial handwash ideal for a high frequency hand hygiene environment such as healthcare.
To learn more on this new innovation from GOJO visit www.PURELLSOLUTION.ca *Cleans & Moisturizes 1. Does not contain an antibacterial soap active ingredient. 2. Augustine Scientific, Newbury OH, Ex Vivo Soil Removal Analysis, August 5, 2017. 3. BioScience Laboratories, Inc.; Bozeman, MT, Study# 170398-101, Evaluation of In-Vivo Germ Removal, July5, 2017.
26 HOSPITAL NEWS FEBRUARY 2019
THESE FACE-TO-FACE MEETINGS HAVE GIVEN THE IPAC TEAM A NEW FORUM FOR ENGAGING PATIENTS AND FAMILIES DIRECTLY ABOUT INFECTION PREVENTION. nursing executive and chief privacy officer at Runnymede. “The conversations we have at these meetings with patients and families have the potential to save lives.” These face-to-face meetings have given the IPAC team a new forum for engaging patients and families directly about infection prevention. “The best way to help patients and families understand the importance of infection prevention is through in-person education,” says Catherine Fitzpatrick, Runnymede’s director of flow, quality, pharmacy and privacy. “We see that when this happens, they’re more likely to adopt safe practices.” An example of this is with Runnymede’s annual flu shot campaign. Every September, the IPAC team raises patients’ and families’ awareness about vaccine safety, explains the risks associated with not getting the flu shot, and takes the time to listen and address their questions and concerns. Importantly, the team also gives patients an opportunity to consent to receive their flu shot at Runnymede, and advises family members on where they can go for vaccination. The efforts appear to be having a measurable impact. As of January 2019, 71 per cent of patients at Runnymede received the flu shot. According to a 2018 Public Health Agency of Canada report, this is nearly double the national rate for adults. (It helps that the hospital’s staff lead by example: since 2015/16, Runnymede has placed first or second among its peer hospitals in the Greater Toronto Area (GTA) for staff vaccination.)
The meetings also provide patients and families with a chance to offer their feedback on hospital policies and resources around infection prevention. “There’s no better way to evaluate the effectiveness of IPAC education than to get feedback straight from patients and families,” says Fitzpatrick. “Our patient- and family-centred approach often generates fresh new ideas and insights.” For example, family members with loved ones on contact precautions told the IPAC team that available information about putting on and removing personal protective equipment (PPE) didn’t meet their needs. In response, the team created new PPE instruction signage that contained the level of detail patients and families asked for, and ensured it was widely available on the patient floors. The IPAC team went further by flagging the issue for nursing staff so they were aware of family members’ need for extra support with PPE procedures. In addition to enhancing safety at Runnymede, the feedback gathered by the IPAC team also serves to improve the patient experience. To help protect patients if an outbreak is declared, the hospital may temporarily restrict the number of visitors to just one per patient. “Our patients told us this had a negative impact on their experience, and they asked if we could do something about it,” says Fitzpatrick. “Non-compliance with infection control procedures clearly wasn’t an option, so we had to dig deeper and be creative with the way we acted on this identified patient need.” Continued on page 28 www.hospitalnews.com
INFECTION CONTROL 2019
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FEBRUARY 2019 HOSPITAL NEWS 27
Continued from page 26 The team connected with Runnymede’s activation therapy department, and a solution was developed: By facilitating Skype and FaceTime calls, Runnymede now enables patients to have virtual face-to-face interactions with loved ones when visiting is restricted, all while upholding the hospital’s commitment to safety during outbreaks. In-person access to Runnymede’s IPAC team members through the bimonthly meetings engages patients and families about infection prevention and underscores its impact on safety and the recovery process. “These meetings have sparked discussions about infection control that might never have happened if we hadn’t created an environment in which patients and families could meet with our IPAC team,” Sewda says. “This is another example of how Runnymede’s staff actively collaborates with patients and families to enhance their experience and make them true partners in H their own care.” ■
Bimonthly Patient Family Engagement Committee meetings at Runnymede Healthcare Centre are a forum for the hospital’s IPAC team to share information about infection control and raise awareness about its importance.
Michael Oreskovich is a communications specialist at Runnymede Healthcare Centre.
INFECTION CONTROL 2019 SPONSORED CONTENT
Revolutionizing human waste management and infection control in hospitals n today’s hospital environment, the patient experience, their health outcomes and the support of their professional care-givers has never been more important. One of the key areas within the hospital and health care setting that has, and remains a challenge, is the safe and efficient method of dealing with human waste. With mounting pressure on cost reduction, demands for increased efficiency and the need for improved infection control, the process of effectively dealing with human waste can put additional stress on nursing and care staff. Within the last century, a simple, yet effective way to combat these pressures, while delivering optimum care results has been achieved through the development of environmentally friendly, moulded pulp products and maceration disposal units. The pioneer and current leader in this field is Vernacare, who first introduced moulded pulp products and maceration units to the healthcare system. Vernacare brought the new biodegradable pulp product line made from 100% recycled post-consumer newsprint to the market in 1959 to replace the traditional method of human waste disposal via plastic or metal reusable bedpans, urinals, bowls and basins.
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SINGLE USE PULP PRODUCTS DRAMATICALLY REDUCE THE SPREAD OF INFECTION AND SAVE PRECIOUS NURSING TIME PREVIOUSLY SPENT ON UNPRODUCTIVE AND OFTEN UNSAFE MANUAL WASHING AND DISINFECTING OF REUSABLE BEDPANS, URINALS AND BASINS. This new product line revolutionized human waste methods by introducing single use, maceratable waste containers to the bedside. Single use pulp products dramatically reduce the spread of infection and save precious nursing time previously spent on unproductive and often unsafe manual washing and disinfecting of reusable bedpans, urinals and basins. To complement the advent of moulded pulp products and further enhance the human waste disposal system, environmentally friendly, compact and hands-free maceration units were added to complete the system. The maceration unit allows for the ultra-hygienic and efficient disposal of single use pulp products through the existing sewer system with minimal and in some cases no disruption to the existing plumbing configuration within the health care facility or hospital. Not
all maceration units can provide the assurance of minimization of particle size to ensure no dry or bulky material can pass into the pipework and causing disruptive clogs. Only Vernacare’s SmartFlow Technology can deliver this type of efficiency. Single-use containers and maceration units are now common place in hospitals around the world, thanks to the dedicated product development innovation focus of Vernacare. Other critical factors to consider and ensure successful implementation of this type of human waste disposal system are the ongoing training, support and supply chain effectiveness of your supplier. Selecting a supplier who has singular control from product manufacturing through to distribution and servicing of the products and system ensures the highest quality and reliability of this critical function. Again, Vernacare has the
only moulded pulp factory in the world that is exclusively dedicated to the manufacture of medical grade products and their comprehensive training and service support is unparalleled. Downtime in human waste management is simply unacceptable. By working with the only end to end supplier in human waste systems, health care facilities can enjoy the benefits of improved infection control, assured excellence in material quality, better use of nursing resources, and improved efficiencies all resulting in enhanced patient experiences and cost control. The industry has been well served by Vernacare in their dedication to this vision, as the originator and leader in the field of human waste systems. The healthcare and patient care sectors are experiencing rapid evolution and change. Vernacare is an organization that is a trust partner known for delivering uncompromised quality and service support. Excellence in patient outcomes and staff morale depend on the quality of care often contingent on products that facilitate wellbeing and positive, reliable results. This objective is well served and understood by Vernacare, the global leader and innovator in human waste management H systems. ■
FEBRUARY 2019 HOSPITAL NEWS 29
INFECTION CONTROL 2019
Early report:
Flu vaccine providing substantial protection against influenza this year he 2018/19 influenza vaccine is 72 per cent effective against the H1N1 kind of influenza A virus that is dominating this year’s flu season in Canada. The vaccine is offering much better protection than recent years, according to the mid-season analysis performed by the Canadian Sentinel Practitioner Surveillance Network (SPSN). The SPSN is a network headquartered at the BC Centre for Disease Control (BCCDC) that measures how
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well the influenza vaccine works every year. Those estimates are based on specimens and data submitted by hundreds of general practitioners from patients presenting with flu-like illness. The network operates in the four largest provinces of Canada: Alberta, British Columbia, Ontario and Quebec. “A vaccine effectiveness of about 70 per cent means for every 10 cases of influenza in unvaccinated people, the
number would have been reduced to just three cases if they had been vaccinated,” says Dr. Danuta Skowronksi, lead for the Influenza and Emerging Respiratory Pathogens Team at the BCCDC and the lead of the Canadian SPSN. “That’s an important reduction in risk, especially for people with underlying medical conditions who face a greater threat of serious complications if infected by influenza.”
both H3N2 and H1N1 influenza A viruses, as well as influenza B, which may make an appearance later in the season. “Vaccine effectiveness in general tends to be better against H1N1 viruses than the other kind of influenza A, called H3N2,” says Dr. Skowronski. “This year’s vaccine performed well in part because the H1N1 kind of influenza A virus has been dominating and
In addition to vaccination, there are other steps people can take to reduce their own risk and minimize the spread of viruses to others. This includes: ■ Wash your hands frequently especially if you’ve been out in public. ■ Avoid touching your face, especially your eyes, mouth and nose. ■ Cough and sneeze into your elbow. If you use a tissue, make sure to dispose of it properly and wash your hands. ■ If you feel unwell, stay home so you don’t pass your infection onto others, especially those who may be at higher risk. ■ If you are in close contact with people at higher risk of serious complications from influenza, get the vaccine and don’t visit them if you feel unwell. The H1N1 virus tends to have a greater effect on children and non-elderly adults, whereas the H3N2 virus tends to be harder on the elderly. The vaccine affords protection against
30 HOSPITAL NEWS FEBRUARY 2019
because this year’s vaccine is a good match to that circulating virus.” The vaccine effectiveness results were published online in the journal H Eurosurveillance. ■
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ASEPTIC RE FO CEDURE BE RO P
BEFORE INITIAL PATIENT/PATIENT ENVIRONMENT CONTACT
AFTER PATIENT/PATIENT ENVIRONMENT CONTACT
AF BO T E R D EX D Y F L U I K POS URE RIS
EVIDENCE MATTERS
Shedding light on ultraviolet disinfection for infection prevention:
A new wave of cleaning techniques? By Barbara Greenwood Dufour and Sarah Garland hen we go to the hospital for treatment, we expect to leave healthier than how we arrived. However, each year, more than 200,000 Canadians acquire an infection during their hospital stay. These acquired infections often mean more antibiotics are needed and hospital stays are longer. And about 8,000 patients die per year as a result of a hospital-acquired infection. Hospital-acquired infections can be caused by contact with contaminated surfaces. Pathogens – germs that are capable of causing illness – can commonly be found on chairs, bedrails, over-the-bed tables, curtains,
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and medical equipment. But they can be found anywhere in the hospital. One possible route of transmission is through droplets suspended in the air. Pathogens can become airborne and then settle on surfaces; when a contaminated item is moved, the pathogens can spread and contaminate new surfaces after they settle. Some pathogens don’t have to exist in high quantities to present a high risk of infection. Examples of these include microorganisms that are highly resistant to antibiotics, such as vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA), and pathogens that can cause severe illness, including
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Clostridium difficile, Acinetobacter baumannii, and Pseudomonas aeruginosa. To reduce the infection risk, hospitals have cleaning and decontamination protocols in place, which traditionally have included the manual cleaning of rooms where patients known to have these pathogens have been.
the research on drugs and medical devices. A 2014 CADTH review, which looked at non-manual disinfection in a variety of health care facilities, found low-quality evidence from one cohort study suggesting that UV light might be effective for reducing the incidence of hospital-associated C. difficile infections. However, it also uncovered two
SOME PATHOGENS DON’T HAVE TO EXIST IN HIGH QUANTITIES TO PRESENT A HIGH RISK OF INFECTION. These rigorous cleaning and disinfection measures, even though they are resource-intensive and costly, are not always effective at reducing infection rates to more acceptable levels. This may be because traditional, manual cleaning methods can result in the wrong choice of cleaning solution, the solution not being left on surfaces for long enough, and areas being missed. Non-manual disinfection devices have been suggested as a way to overcome the limitations associated with manual methods. These are intended to supplement, not replace, manual cleaning, which is still required to remove dirt and debris. One type of non-manual disinfection technology emits a specific intensity of ultraviolet (UV) light that is strong enough to destroy pathogens. UV disinfection devices have been proposed as an easy and efficient supplement to manual cleaning to reduce the rate of hospital-acquired infections. However, is there evidence that they do this? CADTH has produced a few evidence reviews of non-manual room disinfection techniques for infection prevention over the past few years. CADTH is an independent agency that finds, assesses, and summarizes
evidence-based guidelines concluding that there was insufficient evidence to make recommendations about the use of UV light decontamination methods. The following year, CADTH conducted another similar review that found some new studies – a retrospective study and a prospective study, both non-randomized – indicating that UV light room disinfection methods are effective at preventing or reducing infection in health care facilities. However, the limitations of these studies suggested that further research would be needed to confirm this conclusion. More recently, in October 2018, CADTH looked for any new studies on this topic. After reviewing the outcomes and findings detailed in the abstracts of these studies, CADTH produced a Summary of Abstracts report on what was found. Although it isn’t a comprehensive review of the studies and CADTH hasn’t critically appraised the evidence, it gives us a broad sense of what the new research reveals, which is that the evidence continues to support the idea that using UV light room disinfecting devices can reduce the rate of hospital-acquired infections. Continued on page 35
32 HOSPITAL NEWS FEBRUARY 2019
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INFECTION CONTROL 2019 Cutline: MSH’s Corporate Services Department and Infection Prevention and Control Department are teaming up to create a safer, greener, cleaner MSH. (l-r) Maria Pavone, Director of Facilities and Support Services, Food Services; Nisha Punja, Manager, Infection Prevention and Control.
Creating a safer, greener and cleaner MSH By Andrew Aggerholm arkham Stouffville Hospital’s (MSH) Infection Prevention and Control Department (IPAC) and Corporate Services Department are teaming up to create a safer, greener and cleaner hospital. It’s vital that these two departments support and learn from each other to ensure the safety of MSH’s staff, patients and their families while also providing an excellent patient experience. A major component of this support is the education these two departments can offer each other. IPAC works closely with environmental services staff, patient transport and food services to educate them on infection control practices such as enhanced cleaning procedures, donning /doffing personal protective equipment and hand hygiene. “In the event of an outbreak I want to know why it happened and how we can prevent it from happening again,” says Maria Pavone, Director of Facilities and Support Services, Food Services. “We aren’t always able to implement IPAC’s solutions immedi-
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ately but we certainly work together to come to a mutual agreement on the best way forward. ” IPAC has also taken a more active role in supporting construction projects throughout the hospital. “Before we start any construction project, we work closely with IPAC to determine what type of protocols are required to protect our patients and staff,” says Pavone. “We have a construction matrix we follow as outlined by the Canadian Standards Association (CSA) which identifies the population at risk and the type of work that needs to be completed. Based on that information, we devise a plan for preventative measures,” says Nisha Punja, Manager, IPAC. “We also work to educate the vendors about the importance of IPAC while they’re working here.” These preventative measures include how the space will be prepared for the construction, whether hoarding and/or an anteroom is required and, at a minimum, these measures must be initiated to ensure patient safety throughout the project.
By working together, the two departments identified opportunities to reduce waste and the mess created by construction hoarding. When construction hoarding is required, current CSA standards indicate for it to be built with gypsum board, which generates dust when it’s cut onsite, needs to be stored properly in moisture free environments and discarded once it’s damaged. Additionally, because it’s a porous surface it can’t be cleaned readily and/or reused in future projects. MSH decided to look for alternatives to this type of hoarding that would address these pitfalls. In December 2018, MSH tried using a prefabricated containment system for its hoarding. “Because this product is prefabricated it doesn’t generate the same mess that gypsum board does especially during tear down. It meets the Infection Control Risk Assessment (ICRA) requirements for hoarding and dust mitigation. Since it’s not porous we can clean it as per manufacturer’s instructions and reuse it for other construction projects in various patient
care areas throughout the hospital,” says Punja. This means that less waste is being put into the landfill after construction and the work site is cleaner, which is important as it’s often close to patient care areas. The hospital first used this new hoarding during renovations in one of its operating rooms (ORs) and continues to trial the product at this time. “As part of our green innovation energy project we were installing sensors in our ORs that monitor temperature, pressure, air changes per hour and relative humidity in the room. In a sterile environment like that, keeping construction mess to a minimum was really important. The other advantage was that it reduced the cleaning time significantly, which allowed us to get the OR back into use faster,” says Pavone. As the relationship between the two departments continues to grow, both Pavone and Punja will continue to look for ways to collaborate and improve upon the ways MSH provides safe, environmentally friendly, high quality care to its patients, their famH ilies and the communities it serves. ■
Andrew Aggerholm is a Communications associate at Markham Stouffville Hospital. 34 HOSPITAL NEWS FEBRUARY 2019
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cleaning techniques? Continued from page 32 The studies included a health technology assessment of portable ultraviolet light surface-disinfecting devices, a systematic review and two non-randomized studies of no-touch ultraviolet light disinfection methods, a non-randomized study of a UV disinfection robot, and two non-randomized studies of a UV disinfection strategy. All of these studies conclude that UV technologies reduce the incidence of hospital-acquired infections. However, a more detailed review is needed to determine the quality of the evidence and provide a better understanding of how well these methods work. UV devices certainly won’t replace manual cleaning, and they may be better used in specific situations – such as to thoroughly clean a room after a patient infected with a known pathogen or colonized with it (having the pathogen but not showing signs of illness) has
been staying there. However, this type of non-manual UV room disinfection technology continues to show promise for
preventing hospital-acquired infections. If you would like to learn more about CADTH, visit cadth.ca, follow
Barbara Greenwood Dufour and Sarah Garland are Knowledge Mobilization Officers at CADTH.
us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your H region: cadth.ca/Liaison-Officers. ■