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“Let there be Light”: New light-based technologies to prevent infections

“Let there be Light”: New light-based technologies to prevent infections. Elizabeth Bryce Regional Medical Director, Infection Prevention and Control. The Goals of Infection Prevention and Control. Protect Patients Protect Staff & Visitors Do this in a cost effective manner.

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“Let there be Light”: New light-based technologies to prevent infections

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  1. “Let there be Light”: New light-based technologies to prevent infections Elizabeth Bryce Regional Medical Director, Infection Prevention and Control

  2. The Goals of Infection Prevention and Control • Protect Patients • Protect Staff & Visitors • Do this in a cost effective manner

  3. The Role of Infection Control Policy and Procedure Surveillance Consultation Standards and Guidelines Education Research

  4. Topics for Today • Immediate Pre-operative decolonization to prevent surgical site infections • Use of Ultraviolet C to disinfect patient rooms

  5. Immediate Pre-operative Decolonization Therapy Reduces Surgical Site Infections: A multidisciplinary quality improvement project Dr. Elizabeth Bryce On behalf of the Vancouver General Hospital Decolonization Team Vancouver, British Columbia, Canada

  6. Pre-operative Decolonization: Background • Most surgical site infections (SSIs) arise from the patient’s own bacteria • Decreasing the bacterial load on the skin and nose prior to surgery can decrease the risk of surgical site infections (SSIs) = DECOLONIZATION • Traditional decolonization consist of antiseptic soap (chlorhexidine) +/- intranasal antibiotics (mupirocin) • Compliance with chlorhexidine + mupirocin poor • Resistance to mupirocin is an issue

  7. Our Innovative Approach • Nasal Photodisinfection • Methylene blue applied to nares • Two – 2 minute pulses of red light • Chlorhexidine Wipes • applied to limbs and torso the night prior to or day of surgery

  8. Chlorhexidine Washcloths • Alcohol-free washcloth impregnated with CHG • FDA and Health Canada approved • Used below the neck day of or night prior to surgery • Left on the skin (not rinsed off) • Equivalent to 4% CHG on skin http://www.sageproducts.com/lit/20778C.pdf

  9. MRSAid™ Treatment Protocol 1 2 3 4 1st Illumination Cycle 2nd Illumination Cycle • Connect nasal illuminator tips to laser cable port via fiber-optic connector • Illuminate for 2 minutes with tips placed as shown above (directed into • inner tip of nose for 1st cycle and posterior for 2nd cycle)

  10. How Photodisinfection works Treatment Site Tissue Colonized with Pathogenic Bacteria Irrigation Apply Photosensitizer that binds to bacterial surfaces Illumination Illuminate the Treatment Site Using Non-Thermal Light Energy Eradication “Activated” Photosensitizer creates reactive oxygen species, killing bacteria

  11. Advantages of this Approach Targets both gram positive and negative bacteria Eradicates antibiotic resistant bacterial strains Does not generate bacterial resistance No/minimal effect on human tissues Rapid action – maximally effective in minutes Increased compliance

  12. Objectives: To determine if immediate preoperative decolonization using nasal photodisinfection therapy + CHG wipes reduces SSI rates in elective non-general surgeries. To assess the feasibility of integration of a decolonization program in the pre-operative area VGH SSI reduction decolonization QI project 12

  13. Decolonization Protocol • Surgeries excluded: • open fractures, dirty/contaminated cases, duplicate cases, cases in 6 week introductory period • Surgeries included: • cardiac, thoracic, ortho-recon, ortho-trauma, vascular, neuro/spine, and breast cases. CHG within 24h Nasal Culture Photodisinfection Therapy (MRSAid) SSI Surveillance Perform Surgery Document Compliance, AE

  14. 1. Microbiological Efficacy, Safety, and Compliance • Microbiological Efficacy *unpaired data was excluded ** reduction defined as complete or partial bioburden reduction

  15. 1. Microbiological Efficacy, Safety, and Compliance • Safety: • All adverse events were tracked and reported • 7 cases of transient, mild burning sensation in throat after application of methylene blue • Total adverse event rate of 7/5691 = 0.123%

  16. SSI Data - Extraction Cases during study period and study hours N=5176 SSI surveillance not routinely done N = 1912 SSI surveillance routinely done N= 3274 Cases treated pre-op N = 3068 Cases not treated N = 206 94% compliance

  17. Comparing SSI rates: Treated and Historical 42% reduction (1) CHG/mupirocin program in place previously (2) CHG bathing program in place previously

  18. Impact: Financial *Case Cost provided by A. Karpa Financial Planning and Business Support **Cases were rounded down by “1”

  19. Impact: Readmissions

  20. Impact: Cost Avoidance LPNs able to treat 5176 patients/yr 3608 were cases routinely followed for SSI outcomes If remaining 1912 cases had a similar SSI rate reduction (0.016) , 31 additional infections prevented. $20,000/SSI x 31 = $ 611,840 avoided costs Total Cost Avoidance: $1,040,000 + $276,375 + $611,840 = $1,928,215

  21. Comparing Treated and Untreated Patients in Intervention Period • 206/3274 (6.3%) of patients routinely followed for SSI surveillance were not treated during the intervention period • 49/3268 (1.6%) treated patients had a SSI • 17/206 (8.3%) of untreated patients had a SSI • Propensity score analysis with 1:4 matching performed

  22. Propensity Score Analysis: 1:4 Matching **Conditional logistic regression analysis of the matched data with treatment as the only covariate: coefficient = -1.44, z = -3.65 p=0.0026

  23. Conclusions Reduction in surgical site infections by 42% Takes 10 minutes: easily integrated into workflow Safe and has excellent patient compliance (94%) Cost-effective ($1.3 million in cost avoidance)

  24. The Team Surgery: Bas Masri Gary Redekop Perioperative Services: Debbie Jeske Claire Johnston Kelly Barr Shelly Errico Anna-Marie MacDonald TammyThandi Lorraine Haas Pauline Goundar Lucia Allocca Dawn Breedveld Steve Kabanuk Infection Control: Elizabeth Bryce Chandi Panditha Leslie Forrester Diane Louke Tracey Woznow Medical Microbiology: Diane Roscoe Titus Wong Patient Safety:Linda Dempster Ondine Biomedical: Shelagh Weatherill et al Special Thanks: microbiology technologists, and perioperative staff Thank you

  25. Ultraviolet Room Disinfection Elizabeth Bryce On behalf of the Innovation Award Team January 9, 2013

  26. Background • Contaminated environments increase risk of transmission of HAIs • Prior room occupancy by a pt with an antibiotic resistant organism (ARO) increases risk to subsequent pts • Novel disinfecting systems could minimize this risk particularly of Clostridium difficile infection

  27. Clostridium difficile • Clostridium difficile infection (CDI): most common cause of nosocomial diarrhea, with an incidence of 3-8 cases per 1000 hospital admissions. • Symptoms:from mild or moderate diarrhea to severe complications such as pseudomembranous colitis, toxic megacolon, septic shock, renal failure, and mortality.

  28. Ultraviolet surface disinfection • Used in laboratories for years • New literature demonstrates its value as an adjunct to cleaning • Demonstrated to reduce CD spores, MRSA, VRE within hospital rooms • Ability to integrate the technology into workflow needs to be evaluated

  29. The technology SmartUVC aka TruD UVC light automatically delivers lethal UV doses required for each room using a 3600 sensor Two settings: Bacterial and sporicidal Evaluated already in USA for effectiveness 9 hospital cross over study re outcomes in USA underway

  30. The R-D RAPID DISINFECTOR: Advanced Technology for Reducing Pathogens in Patient Environments August 20, 2013 Similar technology but: Allows repositioning of the machine Only one setting for all organisms Steriliz, LLC.

  31. Is it Safe? Yes, there are sensors that shut machine off if door opened. Additional barriers are across door. UV light doesn’t penetrate through glass

  32. http://www.vickers-warnick.com/news/uv-disinfecting-lights-brought-to-new-york-state-hospital-to-control-c-diff-outbreaks/http://www.vickers-warnick.com/news/uv-disinfecting-lights-brought-to-new-york-state-hospital-to-control-c-diff-outbreaks/

  33. Project Proposal • Use equipment on isolation rooms with priority on floors with most Clostridium difficile cases • Use it on the ORs, endoscopy suite and equipment depot at night • Use it as required during outbreaks • Assess its effectiveness microbiologically • Assess it’s impact on bed turn around time • Assess user satisfaction

  34. Results • Both machines effective: one machine has slightly better microbial kill in the presence of protein under lab conditions • Both machines effectively remove organisms in patient rooms • Machine B is preferred by users • Machine B has a faster disinfecting time

  35. RD MRSA Bed Kill at >7.2 x 103 CFU Tru-D MRSA Bed Kill at <7.2 x 100 CFU

  36. UVC + Decluttering and Equipment Cleaning Campaign: Impact ↓ 30%

  37. What’s next? • Business case to purchase the machines • Incorporation into regular work flow • Monitor outcomes not only with C.difficile but with other organisms • If efforts can be sustained, roll out to other regional facilities

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