This website uses cookies. to enhance your browsing experience, serve personalized ads or content, and analyze our traffic. By clicking “Accept & Close”, you consent to our use of cookies. Read our Privacy Policy to learn more.
Test your knowledge on facts from 2024 OSM stories and issues tackled in studies throughout the year.
International Infection Prevention Week is in October, and 2024 has already given those in the same-day-surgery industry much on which to reflect, including challenges regarding routine and whole-room disinfection, the best approaches for preventing SSIs and drying endoscopes, how AI can already help with daily tasks and why IFUs can be so maddening. Use this quiz to see how much you learned from the biggest stories of the year.
1. Where were 18 well-known human pathogens and a number of bacteria that can be pathogenic to humans found during a study at the Central Texas Veterans Healthcare System?
Answer: e In all, the study collected samples from 400 surfaces in June and July 2022. A total of 60 different kinds of bacteria were identified. The most common of the 18 pathogenic ones were Enterococcus, Staphylococcus aureus, Streptococcus, Escherichia coli and Klebsiella aerogenes. About half the bacteria detected were also found in clinical samples collected from patients in the healthcare system in 2022. Some of the potentially pathogenic types of bacteria have been associated with central-line associated bloodstream infections, meningitis and endocarditis.
The surfaces had been cleaned during routine disinfection using methods that were in compliance with routine disinfection protocols before researchers collected the samples. The fact that the results showed the microbial contamination on the high-touch surfaces — which also included simulation manikins — illustrates that more work needs to be done concerning keeping surfaces free of healthcare-associated infections.
The study, released earlier this year, demonstrates that even the current best practices for routine disinfection may be insufficient to prevent the spread of healthcare-associated infections (HAIs), notes the Association for Professionals in Infection Control and Epidemiology (APIC).
“It is a continuing frustration to healthcare professionals that HAIs persist despite rigorous attention to disinfection practices,” said Piyali Chatterjee, PhD, research scientist at the healthcare system. “Our study clearly shows the bioburden associated with high-touch hospital surfaces — including simulation manikins, which are not typically regarded as a risk because patients rarely touch them — and indicates that we must do better in protecting the health of our patients and our hospital employees.” Close
EASY TO READ Clarifying convoluted instructions for how to clean devices would make sterile processing technicians’ jobs much easier.
2. Which prevention protocol reduced the risk of dangerous surgical site infections (SSIs) in nearly 700 adult orthopedic patients?
a. Chlorhexidine gluconate (CHG) bathing
b. Replacing CHG skin antisepsis with intranasal povidone-iodine
Answer: c The study, which appeared in the American Journal of Infection Control earlier this year, highlights the importance of combating SSIs, which the U.S. Centers for Disease Control and Prevention (CDC) linked to more than 110,000 inpatient procedures in 2015 and are a known risk in outpatient surgeries as well.
SSIs can be deadly and are also expensive to treat due to the extended hospital admissions they often require. While numerous recommended protocols exist, they are often ineffective due to lack of patient compliance, high costs and bacterial resistance.
In this study, researchers focused on the Staphylococcus aureus pathogen. The study involved 688 hip, knee or spine surgery patients who were given a pre-surgical intranasal application of povidone-iodine and skin antisepsis using CHG. Their outcomes were compared to a group of patients who had only used the CHG before the povidone-iodine component was added to the protocol.
The pre-surgical protocol successfully eradicated S. aureus in nearly 40% of patients found to already harbor the pathogen and, overall, the study showed a significant decrease in severe SSIs among patients who received the newer protocol, according to a press release from APIC.
“This study shows the power of applying widely available antiseptics to reduce SSIs and improve patient safety,” says APIC President Tania Bubb, PhD, RN, CIC, FAPIC. “The results are encouraging not only because the regimen is effective in reducing SSI, but also because it is simple to implement and avoids the risk of antibiotic resistance.” Close
3. In a recent study, how many of the 42 distal ends of endoscopes had water in them after they went through an automated endoscope reprocessor (AER) and a subsequent alcohol flush? And how many remained wet after researchers attached them to a drying device with a 10-minute cycle?
WORTH THE WAIT A 10-minute hookup to a forced-air drying system can make scopes water-free and ready for storage.
a. All were wet after AER and alcohol flush; zero after the drying device
b. Twenty-one wet after AER and alcohol flush; 21 after the drying deviceBreakroom tables
c. Ten wet after AER and alcohol flush; 32 after the drying device
d. Thirty-two wet after AER and alcohol flush; 10 after the drying device
Answer: a Members of Ofstead & Associates, a research and consulting firm in Bloomington, Minn., that works with healthcare providers and device manufacturers, evaluated the drying effectiveness used on 22 gastroscopes and 20 colonoscopes. The company’s president and CEO, Cori Ofstead, MSPH, says the project is important because of the link to outbreaks that have infected numerous patients because of inadequate endoscope drying. To address the issue, guidelines recommend at least 10 minutes of forced-air drying.
The group assessed the scopes after they went through an AER and then alcohol flush/air purge cycles. They visually inspected the air/water connectors, suction connectors and distal ends of the scopes. They also used droplet detection cards that have blue ink on them that turn bright white if water touches the card.
“Water came out of everything — it was astonishing,” says Ms. Ofstead of the post-AER testing of all 42 scopes. After using the forced-air drying device, no water was detected in any of the scopes.
“It really reinforces what the guidelines from AORN and AAMI say, which is that you need those full 10 minutes of forced air,” she says. “This study also showed how you need to think about getting everything dry, not just the big channel.” Close
4. Artificial Intelligence (AI) tools need to advance to higher levels before they can assist infection preventionists in day-to-day functions.
Answer: b False, according to a study published earlier this year that found that AI technologies can already accurately identify cases of HAIs in even complex clinical scenarios. The findings offer promise that AI tools could emerge as a cost-effective component to assist infection preventionists by incorporating them into their surveillance programs.
Two AI tools were evaluated by researchers at Saint Louis University and the University of Louisville School of Medicine. One was built using OpenAI’s ChatGPT Plus and the other was developed using an open-source large language model known as Mixtral 8x7B. When given clear prompts, the tools accurately identified HAIs in six fictional scenarios with varying levels of complexity. “Our results are the first to demonstrate the power of AI-assisted HAI surveillance in the healthcare setting, but they also underscore the need for human oversight of this technology,” says Timothy L. Wiemken, PhD, MPH, an associate professor at Saint Louis University. “With the rapid evolution of the role of AI in medicine, our proof-of-concept study validates the need for continued development of AI tools with real-world patient data to support infection preventionists.”
Both AI tools were used with retrieval augmented generation, an approach that improves the quality of prompting through a knowledge repository that gives the AI tool additional context. In this case, the repository included material from CDC’s National Healthcare Safety Network, a tracking system for HAIs, according to APIC. The ChatGPT Plus tool developed for this study, HAI Assist, is available at the OpenAI GPT Store for those with a ChatGPT Plus subscription. Close
5. Which three nontraditional products and technologies below are promising ways to perform whole-room disinfection in operating rooms?
Answers: b, c and f While J. Darell Hicks, BA, CHESP, CMIP, owner of Safe, Clean and Disinfected, an infection control company in the St. Louis area agrees that traditional automated disinfecting systems can be effective and appropriate for outpatient settings, the price points of some products make them unrealistic.
Fortunately, Mr. Hicks says lesser-known products and technologies can help. For example, using chlorine dioxide tablets placed in water creates a gas to disinfect rooms. The ORs must be vacant for four hours afterward. “Like the hydrogen peroxide products, a once-a-week total disinfection over the weekend when an ASC is closed would be a valid use for this,” he says.
Continuous action disinfection (CAD) products, meanwhile, contain intermediate-level disinfectants that kill germs on contact but remain on surfaces for an extended period of time and kill what lands there weeks and months later. “It’s not a silver bullet, but I think CAD applications will provide a bit more security for facilities because it acts like a shield that will provide active, ongoing disinfection on surfaces for three or four months,” says Mr. Hicks.
He also sees a bright future for applying disinfectants in ORs with electrostatic sprayers. In theory, this method could require less pre-cleaning by traditional methods. “Most surfaces have a negative charge, and the electrical positive charge from the mobile sprayer units looks for areas of the surfaces that don’t already have a disinfectant on it. It gets into nooks and crannies that manual cleaning doesn’t — and you can apply it quickly and safely.” Close
ADDED VALUE A study showed that povidone-iodine in conjunction with CHG cleaning reduced SSIs in patients.
6. In APIC’s well-publicized report earlier this year about the poor state of cleaning instructions for medical devices, how many infection preventionists had to call companies for clarity about the instructions?
Answer: d The report, titled “Modernizing Medical Device Instructions for Use (IFUs): Infection Preventionists Speak Up for Patient Safety,” was prepared by APIC and shared with policymakers and regulators from the U.S. Food and Drug Administration (FDA), which handles federal requirements for the labeling of medical devices. The blistering report includes a long list of problems surrounding the IFUs, including them being unavailable, difficult to find, out of date or too complex. It also notes that the focus of many IFUs was more geared toward the maintaining the health of the devices than how to protect patients from infection.
“Instructions that are so unclear that more than eight in 10 infection preventionists (IPs) need to call the company for clarity are inefficient and need revision,” says Dr. Bubb, APIC’s president. “We stand ready to help improve and standardize this process.” The issues have multiple negative impacts for infection prevention efforts, including the time and money spent trying to decipher the IFUs, which result in inefficient operations.
Not only did 84% of nearly 1,200 IPs surveyed in 2023 for the report say they contacted manufacturers for clarity, more than a third of them said the responses they received weren’t helpful. Eight percent of those took the extra step of contact the FDA to confirm that the cleaning, disinfecting and sterilizing protocols they were using was sufficient. Sixty-five percent of the respondents said they had the most problems with cleaning instructions for non-critical devices such as blood pressure cuffs. OSM Close
.svg?sfvrsn=be606e78_3)
.svg?sfvrsn=56b2f850_5)