HHM Compatibility Special Edition Feb/Mar 2020 HHM Compatibility Special Edition Feb:Mar 2020 | 页面 6

¡ The selection of surface materials often comes down to cost without first evaluating and validating that materials can be effectively and efficiently be cleaned, disinfected, and — when required — sterilized, without damage. Test methods must include the evaluation of surfaces for unseen damage caused by disinfec- tants and rigorous disinfection protocols. Surfaces can support and harbor microbes that cause deadly infections. We must know what surfaces support effective and efficient disinfection. How can we address this foundational problem if we don’t have any information other than we know surfaces play a key role in the acquisition and transmission of pathogens within the healthcare environment? How can we prevent it if we don’t completely evaluate and understand it? Instructions for Use Another problem that must be addressed are the instructions for use (IFUs) that are inconsistent, right down to the fact that not all manufacturers provide IFUs. There are currently no requirements for writing IFUs. Let me clarify this by stating that the Food and Drug Administration (FDA) does evaluate IFUs for medical devices that require FDA clearance. Even with that, there are no clear guidelines for writing the IFUs, which often leaves healthcare professionals in a fog of confusion. Manufacturers often don’t realize that healthcare facilities face penalties and fines during regulatory surveys when asked for IFUs to verify that healthcare professionals are following manufacturer recommendations. They not only have to have IFUs readily available, they also have to provide proof the IFU is being followed. Challenges with IFUs include a manufacturer requirement for the use of a proprietary disinfec- tant product. There are times when a healthcare facility uses completely different brands in the same category of disinfectants. This puts the healthcare facility in jeopardy of being fined, and often, when damage occurs, warranties are voided. Testing the categories of disinfectants will eliminate this problem. I have read many IFUs that don’t make sense; for instance, the warning will state ‘do not use bleach or peracetic acids; if used they may cause severe damage,’ and then the manufacturer recommends the use of soap and water. Soap and water do not eliminate C. difficile. These types of guidelines are not consistent with infection prevention policies, products and processes. The Challenge for Material Engineers, Designers, General Contractors I am grateful for several consulting clients that have helped me understand that they, too, are in the dark. While they are interested in developing innovated products that support patient care, there is a gap of knowledge and understanding about patient care, unexpected challenges and infection prevention strategies. They are quick to state they want to support healthcare professionals, not hinder them during 6 patient care. A question posed to me was, ‘Why or how would we know about infection prevention, as we are a medical device manufacturer with a focus on several medical devices?’ Well said. The expectation that they would simply know is outrageous and I see great potential for a bridge to be built that addresses this problem. It is important to state that manufacturers do test their products. In a 2018, a comprehensive literature review of 65 different search terms focused on surfaces, surface disinfection, medical devices, environmental surfaces etc., was conducted by the Healthcare Surfaces Institute. Expecting to find gaps in research and understanding, we were not prepared for the disparages between test methods and the types of microbes used for testing. When testing included patient rooms, they often varied in size, location, and didn’t take into consideration the often-unexpected infection control requirements in any given setting. Therefore, research results were inconsistent and inconclusive. There were significant inconsistencies when identifying high-touch surfaces (HTS). It is essential to observe the patient-care process before determining what HTS to include in research. I have done this several times and it is fascinating to watch healthcare professionals interact with surfaces and the patient. Clearly, a lot of the behavior came from their training, as most healthcare workers — no matter who they were — exhibited the same behavior upon entering the patient room. Even more interesting was the behavior of the patient and their family members. Visitors had a completely different form of interaction with a wide variety of surfaces. With a focus on what is believed to be high- touch surfaces, it left an incredible amount of highly touched surfaces completely overlooked. An example would be the nurse call button that spent a lot of time falling off the bed onto the floor. I counted people, including the patient, who came in contact with it in a two-hour time frame. Not once in three days was it even cleaned. Now is the time for a change, and change is not easy. HAIs are a health-safety concern, and the foundational issue of surfaces must be addressed immediately if we are going to realize sustainable reductions in HAIs. The Healthcare Surfaces Institute understand the many aspects of this foundational issue and are working to develop a surface certification program that will address many of these issues. If you are interested in being involved, contact me at [email protected]  Linda Lybert is founder and executive director of the Healthcare Surfaces Institute. Compatibility Special Edition February/March 2020 • www.healthcarehygienemagazine.com