Hospitals are supposed to help people recover, not get them sick. Unfortunately, an alarming number of hospital patients' recovery times are being prolonged after picking up a nosocomial or "hospital-acquired" infection during hospital stays. In fact, approximately 1.7 million healthcare-associated infections such as Clostridium difficile (C-diff) and Methicillin-resistant Staphylococcus aureus (MRSA) occur annually in hospitals in the United States, and are associated with nearly 100,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).

Because the amount of hospital-acquired infections being reported continue to rise from year to year (MRSA-related hospital stays have tripled since 2000 and increased nearly tenfold since 1995, according to the CDC), hospitals are being pressed by the U.S. government to step up their infection control efforts.

Government Involvement

Although most hospitals have their own infection control department and their own written policies, jan/san distributors can play an important role in infection control by recommending products and procedures approved for the different environments in the hospital.

Starting in 2009, the federal government began restricting Medicare payments to hospitals for the extra care required to treat Medicare patients harmed by certain preventable infections and medical errors. The Health Care Reform Bill signed by President Obama in March 2010 is expected to expand this policy to Medicaid in early 2011, so critical public funds will also no longer pay hospitals when patients covered by Medicaid are harmed during their hospital stay, according to the Centers for Medicare and Medicaid Services (CMS).

Beginning in 2011, consumers across the country will also be able to find out where a hospital ranks when it comes to preventing certain infections under new hospital acquired infection reporting regulations adopted by the Department of Health & Human Services (HHS). The new reporting requirements apply to hospitals that participate in CMS' pay-for-reporting program. Virtually every hospital in the country will be forced to participate because they will earn a higher Medicare payment for doing so. Infection rate information for each hospital will be made public later this year on the federal Hospital Compare website ( In October 2012, Medicare payments to hospitals will then be tied to how well they protect patients from hospital-acquired infections and how they perform on other patient safety standards.

The financial toll attributed to hospital-acquired infections is quite staggering. The CDC estimates that the direct costs associated with hospital-acquired infections are as high as $45 billion each year.

Hospitals are on notice regarding this epidemic and frequently revisit their infection control protocols to protect patients' livelihoods. But with the changes to how hospitals will be compensated for the care of Medicare and Medicaid patients moving forward, an increased emphasis will be placed on ensuring proper infection control procedures are being carried out.

Hand Hygiene

Besides doctor or nurse error, poor hand hygiene by hospital employees and inadequate disinfection of patient rooms are two of the three main causes of hospital-acquired infections.

"Nosocomial infections have been increasing dramatically in hospitals and the main reason is inadequate cleaning and hand washing procedures," says Steve Rathbun, environmental solutions manager for Cedar Falls, Iowa-based Martin Bros. Distributing Co., Inc.

Hospital workers often contaminate their hands when they touch soiled surfaces. Healthcare-associated pathogens can survive on the hands of healthcare workers and can be transmitted to other patients if hands are not adequately cleaned between contact with patients.

Washing hands as promptly and thoroughly as possible between patient contact and after contact with blood, body fluids, secretions, excretions and equipment or contaminated objects is the first line of defense against the spread of disease.

"Hand washing always has been and will probably always have the most impact on reducing hospital-acquired infections," says Louie Davis, senior territory manager for Central Paper Co., in Birmingham, Ala.

When hands are visibly contaminated, the CDC recommends washing hands with water and either antimicrobial or non-antimicrobial soap. If hands are not visibly soiled, the CDC suggests routine use of an alcohol-based hand sanitizer.

Microfiber And Vacuuming

Most people think of doctors and nurses as the professionals who keep patients healthy, but the cleaning staffs play a healthcare role, too, by preventing the spread of infectious diseases.

A popular product in a hospital's infection control program that is effective in cleaning both floors and surfaces is microfiber. Used for wet mopping, dust mopping and surface cleaning, microfiber does a superior job in cleaning compared to conventional string mops or hand cloths, thus removing bacteria more effectively.

"You can be much more effective with your level of efficacy on your germicides because of the fact you're not putting dirty tools back into clean solution," says Davis. "So when you take a mop for example and you mop the floor and put it back into the bucket, you're decreasing the dinsinfectant's ability to disinfectant."

The old rule of thumb for conventional string mops was to mop two to three patient rooms before changing out the bucket of water.

"With microfiber, you don't have to do that," says Davis. "You take your cleaning mop, you put it in the solution, you take it out and you clean with it and you don't put the dirty one back into the solution. You take it out and you clean with it and it goes into a laundry bag and gets laundered, so you're always using a fresh mop head."

The same can be applied with microfiber cloths for cleaning surfaces in patient rooms such as bed-side tables, door handles and bed frames. When partnered with disinfectant, microfiber cloths are effective in achieving proper disinfection using fewer applications than if using traditional cloth towels or paper towels.

"Microfiber physically removes bacteria viruses and picks it up and moves it," Davis says. "Whether it kills it or not, it takes it out of there and is so much more effective than traditional cloths and rags."

Patient rooms are typically cleaned by hand by both dust mopping and wet mopping with microfiber. Many hospitals now, however, require vacuuming of hard surface floors opposed to dust mopping because vacuuming reduces the amount of dust and other particulates that can become airborne. In fact, vacuuming hard floors has become the newest trend to reduce the spread of cross infection in hospitals, says Ian Greig, CEO of Phoenix-based Daniels Associates Inc.

"Many hospitals in other parts of the world vacuum hard surface floors," he explains. "They do no dust mopping whatsoever because although bacteria sticks to the floor, polyps and spores bounce in the air."

Distributors also recommend that a hospital's infection control program include the use of EPA-registered hospital-grade disinfectants that are effective against C-diff. A challenge in eliminating C-diff in particular is that the spores do not effectively react to quaternary disinfectants or phenols; however they do respond to the use of hypochlorite-based products. Hospital-grade quaternary disinfectants are usually effective against killing MRSA and other pathogens.

Most EPA-registered disinfectants suggest a 10-minute dwell time. Otherwise, the disinfectant may not be as effective. When selling hospitals disinfectants, Greig says as a value-add, distributors should provide training on proper disinfection techniques for patient-care areas and also educate cleaning crews on the potential risk of infection.

ATP Meters: Validating Cleaning

Surgical site MRSA infections cost as high as $60,000 per case, with the average case costing $15,275, according to Duke Universiy researchers. But at the fraction of this cost, hospital staffs can invest in an adenosine triphosphate (ATP) meter and ensure proper cleaning has been performed, says Davis.

An ATP meter measures and detects ATP — the energy molecule inside all living cells. It indicates areas and items in the hospital setting that may need to be recleaned, as well as the possible need for improvement in a hospitals' cleaning protocols.

Most hospitals still rely on visual inspection for monitoring cleaning procedures. This method, however has been shown to be inadequate for ensuring proper cleaning has been performed. Because the CDC guidelines for multiple drug-resistant organisms recommends that hospitals monitor cleaning performance to ensure consistent cleaning and disinfection of surfaces in close proximity to patients, distributors say incorporating an ATP meter into a cleaning program ensures that areas are properly cleaned and disinfected.

For example, if a hospital employs ATP meters into their cleaning program, once finished cleaning a patient room, the cleaning personnel can come back in and test the cleanliness levels in different areas in the room. If the reading they take comes back with high levels of ATP, then the cleaner can go back in and reclean the affected area and retest to ensure proper cleaning has been achieved. The advantage of the ATP meter is that it provides data in real time — seconds instead of days — compared to traditional lab testing methodology. This provides for immediate feedback and allows for quick corrective action as needed.

With an increased risk of hospital-acquired infections, hospitals need real-time results in order to make good decisions regarding proper cleaning and disinfection of rooms before the next patient is admitted. Helping hospitals implement adequate cleaning practices can help reduce hospital-acquired infections and ultimately ensure they are going to be compensated for patients covered under Medicare and Medicaid moving forward.

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