HHM Compatibility Special Edition Feb/Mar 2020 HHM Compatibility Special Edition Feb:Mar 2020 | Page 8

typically associated with poor surface compat-
ibility, because the very ingredients that break
down pathogens can break down other things
as well. This can put the healthcare professional
in a difficult spot of making trade-offs between
efficacy or compatibility. Replacing damaged
equipment adds unnecessary costs to facilities
when most are already financially constrained.
Surface damage like discoloration, cracks,
residue, and stickiness, can negatively affect
patient perception of the facility. Anecdotally,
facility staff often have makeshift “solutions”
for handling equipment that has cracked or
became discolored due to disinfectant use. This
highlights the fact that healthcare professionals
are aware of these problems but sometimes feel
resigned or powerless about finding solutions.
The compatibility issue was addressed in ECRI
Institute’s report, Top 10 Health Technology Haz-
ards for 2017, which described device failures
caused by cleaning products and practices: “The
use of cleaning agents or cleaning practices
that are incompatible with the materials used
in a medical device’s construction, or that are
otherwise inappropriate for the device’s design,
can cause the device to malfunction or to fail
prematurely, possibly affecting patient care.”
Specifically, the ECRI Institute report noted:
• Repeated use of incompatible cleaning
agents can damage equipment surfaces
and degrade plastics, often resulting in
device breakage—possibly with no visible
warning signs.
• The use of improper cleaning practices
can damage seals, degrade lubricants, and
cause fluid intrusion. This can result in damage
to electronics, power supplies, and motors.
The report adds, “Because there is no single
cleaner or cleaning process that will work
with all devices, hospitals must stock and use
multiple cleaning products and familiarize staff
with device-specific cleaning methods—tasks
that pose a significant burden. Nevertheless,
failure to do so can lead to ineffective cleaning
(a potentially deadly circumstance), as well as
excessive component breakage and premature
equipment failures (which can affect patient care
andbe a significant financial burden).”
It’s an issue not widely reported in the medical
and scientific literature.
“A review of publications about this topic
discovered a good job of addressing how to
clean and/or disinfect surfaces and equipment,
such as hard surfaces, bed rails, floors, etc.,
as well as what class of agents to clean them
with and the importance of doing this,” says
Barbara Strain, MA, CVAHP, SM(ASCP), founding
member and past president of the Association
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Addressing the Surfaces Issue
Begins at Design
Healthcare Hygiene magazine (HHM) spoke with Linda
Lybert, founder and executive director of the Healthcare
Surfaces Institute, about the challenges related to surface
materials compatibility-related imperatives.
HHM From your consulting experience, what is the level of
awareness of this issue among hospital stakeholders, and why
is it an issue that may not be on everyone’s radar?
Linda Lybert (LL): I believe everyone is aware of it at some level.
Some of them are aware of it because they have accountability and
responsibility for preservation of property. Others based on their need
to maintain for instance medical devices and equipment. Others are
aware of the repair and replacement costs associated with incompatibly.
Hospital leaders probably aren’t as aware of the problem but more
aware of the costs for replacement or renovation. The ability to
effectively clean and disinfect products and the environment is the
first line of concern and it goes up from there.
HHM What are some real-world examples you’ve witnessed
that explain the severity of the issue and the serious fiscal and
clinical challenges they present?
LL: I have been with facilities managers in rooms where medical
devices, beds and other equipment have been taken out of service
because they can’t read the monitors or serious damage has occurred.
I also have toured hospitals where hallways are lined with wooden
handrails sometimes clearly bleached out from the bleach they are
using to keep them clean. There are cracks in the edge of tables that
are trimmed with wood. In addition, I have been in a meeting when
someone from sterile processing brought in a surgical instrument
for bone biopsies they were concerned that they were not able to
clean it completely so they broke it open and it was full of bioburden.
Clearly that product needed to be redesigned. The list goes on
and on. The other issue is room turn-over times and the ability to
effectively disinfect these areas. I was included on an email about a
community outbreak of C. difficile that was coming in through the
emergency department and spreading throughout the hospital. The
discussion was around the ability to effectively clean and disinfect
the surfaces and particularly the mattresses on gurneys. One of the
biggest concerns is to minimize the risk to patients and healthcare
works. It is difficult to do if we depend on visual inspection when we
are dealing with microbial contamination. Microbes can’t be seen!
HHM For those who are unaware of this issue, what are the
consequences of incompatibility and why are they so impactful?
LL: Significant research shows microbial rebound following terminal
disinfection, and experts Dr. Stephanie Dancer and Dr. Curtis Donskey
have conducted work in this area. Surface damage is often unseen,
cracks, crazing and fissures create perfectly hospital environments
for microbes to harbor and proliferate. In fact, microbes can go deep
into surfaces as further damage takes place. Seams and texture also
provide great locations for microbes to attach, form biofilm and
Compatibility Special Edition February/March 2020 • www.healthcarehygienemagazine.com