“It’s not consistent in most facilities,” Fechter acknowledges.
“In one unit you may have environmental services personnel
cleaning the equipment and then you go to another area of
the institution and you see clinical or biomed professionals
cleaning some of it, too. We see a lot of problems stemming
from improper cleaning, and we know it can be a challenge to
educate and train the many different people who are cleaning
and disinfecting the equipment.
“So, we have this device, and we know it must be cleaned,
but when it comes to manufacturers’ instructions for use (IFUs),
many of them can be suboptimal, confusing, or flat-out wrong,”
Fechter says. “Even if the IFUs are wrong, we are mandated to
follow them whether they are right or wrong.”
As an example, Fechter points to telemetry boxes. “These
are little wireless transmitters that have ECG leads attached to
pulse oximeters and they transmit data to a monitoring system.
Between patient use they are cleaned, but we are seeing electrical
contacts and patient cables in the batteries are all turning
green and fuzzy. These boxes are dropping like flies because
of improper cleaning. Patients are going unmonitored because
these boxes go offline or have failed completely. There are so
many of these in the hospital that when one of them drops off
the radar screen, someone must track it down and find out what
happened to it. Hospitals experience equipment shortages and
then have no means to monitor patients. If something happens
to a patient because the telemetry box wasn’t working, it is a
huge liability issue.”
Fechter provides another example. “Glucometers must be
cleaned and disinfected because they get blood on them, and
the healthcare worker wipes them with bleach wipes, which is
the cleaner/disinfectant recommended by the manufacturer, and
it doesn’t destroy the plastic and that’s good, but they sit in a
cradle when not used and the issue is that when you clean them
and then drop them into the cradle it corrodes those contacts,
they stop charging, they can’t transfer data and they go dead.
The glucometers may be working but when healthcare workers
drop them in the cradle they don’t charge. When you watch
how they are cleaned, you see that they will be wiped and then
dropped into the cradle immediately, while they still may be damp,
and that is the worst thing you can do. The contacts become
corroded and crusted, and you must scrape them off. if you read
the instructions for use carefully, you are supposed to wipe them
with the cleaner/disinfectant, look at your watch and wait 60
seconds or even maybe a minimum of three minutes depending
on the germs you’re trying to kill, and then after the exposure
time you’re supposed to wipe it dry. Nobody ever wipes it dry. If
people did that, we would have far fewer compatibility issues,
but nobody has time for it, and the reality is you need a product
where you can just wipe and go. You can’t put pieces together
with disinfectant trapped inside it does not dry out — that is a
guarantee that significant problems will develop.”
“Some manufacturers have figured out what is happening
and have changed their plastic formulations and we have seen
big improvements where that has occurred. But that is not
everybody, so the rest of the manufacturers need to get the
message,” Fechter emphasizes. “Healthcare facility designers
who are responsible for incorporating surfaces and fixtures in
the hospital need to be aware of compatibility issues, too. They
need to consider only certain kinds of plastics, examining every
material for its durability and performance. The take-home
Manufacturers of surfaces used within
healthcare environments need to know and
understand how healthcare organizations function
on a daily basis.”
message is we need to kill the germs, but we need to not kill
the equipment in the process.”
“Manufacturers of surfaces used within healthcare environments
need to know and understand how healthcare organizations
function on a daily basis,” says Gloria Graham DNP, RN, CVAHP,
past-president of the Association of Healthcare Value Analysis
Professionals (AHVAP), and the clinical value analyst at Cincinnati
Children’s Hospital Medical Center. “Healthcare organizations are
very complex and offer many different opportunities for a host
of issues around disinfecting while trying to avoid degradation
of medical devices and surfaces.”
Graham continues, “Improving the standards and test
methodologies for materials and equipment are important
because of the connection to patient outcomes. Similar to other
best practices for improving patient outcomes, the development
of surface and medical devices best-practice standards can
greatly improve the processes within healthcare organizations
in relationship to understanding the impact of disinfectants on
medical devices and surfaces.”
She adds, “It is critical to screen or test the materials or
equipment before they reach the end-user environment for
many reasons. Understanding the impact on how clinicians will
use the product before it is used for patient care, can prevent
serious safety events from occurring or negatively impacting
patient outcomes. During the testing or evaluation phase you
can determine if the device will increase or decrease staff’s time
required before or after the procedure or if there are any potential
risk for the clinician so mitigating strategies can be implemented
preventing harm. Additionally, this process is crucial to allow the
development of the education required to use the device, clean
the surface, etc. so staff can maintain competency, and thus
prevent serious harm.”
Strain advises manufacturers of surface materials for the built
environment to first “have a basic understanding of the effects
of humidity, soap and water, cleaning/disinfecting agents, bodily
fluids, iodine, alcohol, pharmaceuticals and other materials found
in the healthcare physical environment.” She adds, “A case in
point is the use of carpet or wallpaper in patient rooms. Both
have been found to harbor microorganisms and are hard to
clean and disinfect. Renovations, construction, minor repairs,
investigations of deaths or serious illness, etc. in care areas have
revealed mold.”
On the flip side, manufacturers of chemical disinfectants can
also become part of the solution.
“Disinfectant manufacturers save lives by providing much
needed chemical solutions to destroy infection and protect patients
and clinicians,” Turner says. “Their role is to kill pathogens and
make the solutions as compatible as possible with a wide range
of materials. However, if a manufacturer of equipment or devices
continues to use an inferior material and market it as cleanable,
disinfectant companies will continue to be blamed. They don’t
28 august 2020 • www.healthcarehygienemagazine.com