deserve the blame; the rest of us need to innovate too. We need to
get our products ready to be cleaned in a healthcare environment
by making them disinfectant ready. Disinfectant companies need to
know that better polymers exist that won’t break, crack, discolor
and become sticky after exposure to disinfectants. By supporting
HSI and companies that make products which are cleanable,
healthcare will be more selective about what they buy and use
disinfectants appropriately to reduce infection.”
“Manufacturers of chemical disinfectants need to improve
their understanding on the effects of their products on medical
devices and surfaces within healthcare organizations,” says
Graham. “Chemical disinfectant manufacturers can be an
agent for change by partnering with the manufacturers of the
various components used in the production of medical devices.
Understanding how and when various components are used
within devices or surfaces can provide insight on the best way
to disinfect such products. Before the medical device or surface
is even developed, testing the components ability to stand up to
the various chemical disinfectants can help the medical device
manufacturers realize the impact and provide better details within
their instructions for use on the downstream effects. Chemical
disinfectant manufacturers should not feel threatened at all, as
their engagement on this issue can contribute to reduction of the
harmful effects on healthcare devices and surfaces. By changing
their approach to including the impact of disinfectants during
the design process and not afterwards, can dramatically improve
the durability of medical devices and surfaces.”
The challenge is encouraging clinicians to speak up when they
get frustrated by surface and equipment degradation.
“Clinicians like biomedical engineers, nurses, technicians and
infection preventionists are well aware that disinfectants are
damaging devices and equipment,” Turner says. “They typically
don’t understand why because most of them don’t have material
science backgrounds. Other clinicians like doctors may not always
see the damage because it is handled during room turn-over
or set-up, so they may not be as aware that compatibility with
disinfectants is such an issue.”
“Product durability is critical,” confirms Carr at the Medical
University of South Carolina. “When we must replace flooring
every several years because of failure it causes delays, unfavorable
work environments and stress, particularly in a chaotic environment
like the emergency department. This makes patients feeling
easy and healthcare workers feel unhappy. There is science
around surfaces and antimicrobial activity, it should always be
employed. We also must consider favorable ergonomic design
for healthcare workers and anything we can do to reduce work
in cleaning/changing over a room. Examples include reduced
corners on tabletops, reducing nooks and crannies, decreasing
touch. We should use more voice commands to turn switches
on and off, to pull up imaging in a patient’s room, etc. like Alexa
or Siri. Stretchers need to be redesigned to include variable types
of patients– Not one structure for all patients. We should use
Apple watch-type charging for the stretchers and have plugs and
chargers built into the structures to reduce chords and things.
Cords are often not cleaned between patients and tends to fail
and add a trip hazard, etc.”
“Healthcare organizations will need to use their voice to
raise the bar on the standards for the types of materials used to
manufacturer medical devices and surfaces,” Graham says. “For
the designers, it is necessary for them to partner with healthcare
organizations before anything is even put on paper. Gaining
an understanding of healthcare organizations operate can
dramatically improve the design so it truly takes the patient
needs and staff use into account from the very beginning.
All too often when evaluating medical devices, the sentiment
with clinicians is frustration especially when the design lacks
the completeness necessary to improve patient outcomes or
prevents work around because it doesn’t fit or operate for their
patient population. For example, working within the pediatric
environment we consistently struggle with manufacturers on
how they design a product because the mentality is ‘one size
fits all,’ which doesn’t work for pediatrics.”
Healthcare stakeholders play a vital role in advancing
the agenda toward better compatibility between materials
and chemistries.
“Healthcare institutions should make it clear in all RFPs that
what they are purchasing needs to be cleanable with a wide
variety of effective disinfectants and cleaning protocols without
risk of premature failure or harboring pathogens,” Turner says.
“Material selection and design are crucial to the long-term
reduction of HAIs, and if healthcare demands improvement,
it will happen. Also, they need to help fund the successful
emergence of the HSI certification process until manufacturers
are buying the certification to ensure their long-term viability. It
is an investment that will keep paying dividends to healthcare.”
“Healthcare organizations should include testing of currently
used cleaning and disinfecting agents on potential equipment/
products/goods before final decisions are made,” advises Strain.
“If current agents yield detrimental effects different agents may
have to be tried before one or more are found acceptable. This
can lead to disruptive consequences to routine cleaning and
disinfecting of the myriad of equipment/products/goods already
established in the care environment. If you have ever walked
onto a care unit, you might already find an array of tubs of
wipes, packets of cloths, pump bottles and other containers.
Adding even one more may raise the risk that the wrong agent
might be used.”
Experts envision a path forward toward better standards
and testing methodologies and agree that what it will take to
get all stakeholders at the table is greater accountability and
better guidance.
“A well-executed independent certification for cleanability is
a great way to ensure better science makes it to market,” Turner
says. “Trade organizations should team up with the Healthcare
Surfaces Institute to leverage their expertise in reduction of pathogens
and material improvements. They should help them make it
through the early startup stage and pull through the certification.
The science of cleanability should be a topic covered at AAMI,
AVHAP, ASHE and many other clinical trade organizations — it’s
important. This is a problem we all need to address together.
It personally affects each one of us and our organizations. If
it isn’t addressed at your next trade organization meeting, do
your part to ask for it. Innovation occurs when scientists across
entire value chains talk and solve problems together. Be willing
to include this topic next time you have the chance. We have
one example of a device manufacturer that told us biomedical
engineers were asking them in the RFP process to be sure their
device could be cleaned with a wide range of disinfectants and
not break down. This tells me that they and other clinicians have
a voice. My advice is to keep speaking up!”
www.healthcarehygienemagazine.com • august 2020
29