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

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Presentation on theme: "“Let there be Light”: New light-based technologies to prevent infections Elizabeth Bryce Regional Medical Director, Infection Prevention and Control."— Presentation transcript:

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 Standards and Guidelines Policy and Procedure Education Surveillance Consultation 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 5

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

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

9 MRSAid™ Treatment Protocol 1.Connect nasal illuminator tips to laser cable port via fiber-optic connector 2.Illuminate for 2 minutes with tips placed as shown above (directed into inner tip of nose for 1 st cycle and posterior for 2 nd cycle) 1 st Illumination Cycle2 nd Illumination Cycle

10 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 How Photodisinfection works

11 11 Advantages of this Approach

12 VGH SSI reduction decolonization QI project Objectives: 1.To determine if immediate preoperative decolonization using nasal photodisinfection therapy + CHG wipes reduces SSI rates in elective non-general surgeries. 2.To assess the feasibility of integration of a decolonization program in the pre-operative area 12

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

14 1. Microbiological Efficacy, Safety, and Compliance Microbiological Efficacy GrowthMSSA reduction n = 1286 (%) MRSA reduction n=51 (%) Heavy105/109 (96.3%)8 /10(80%) Moderate348/383 (90.9%)13/16 (81.3%) Scant598/794 (75.3%)18/25 (72%) Total1051/1286 (81.7%) 39/51 (76.4%) *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 routinely done N= 3274 SSI surveillance not routinely done N = 1912 Cases not treated N = 206 Cases treated pre-op N = 3068 94% compliance

17 Comparing SSI rates: Treated and Historical (1) CHG/mupirocin program in place previously (2) CHG bathing program in place previously Specialty Treated Patients4-year Historical Group P valueOR SSIsRate % SSIs (Average) Rate % Cardiovascular 1 19/6283.083/3334 (21)2.50.43730.82 Neuro 2 2/5020.431/2152(7.75)1.40.07643.65 Orthopedics 1 (all) 6/8920.750/2844 (12.5)1.80.02512.64 Spine18/4753.8136/1606 (34)8.50.00092.35 Thoracic1/4310.214/1357 (3.5)1.00.14784.48 Vascular3/1402.125/1094(6.25)2.30.91521.07 Total49/30681.6339/12,387 ( 85) 2.70.00041.73 42% reduction

18 Impact: Financial ServiceCases AvoidedCase Cost*Cost Avoidance Neurosurgery6$25,000$150,000 Cardiovascular3$30,000$90,000 Orthopedics8$33,000$ 264,000 Spine15$30,000$450,000 Vascular2$20,000$ 40,000 Thoracic1$10,000 Total35**$1,040,000 * Case Cost provided by A. Karpa Financial Planning and Business Support **Cases were rounded down by “1”

19 Impact: Readmissions ParameterProject PeriodAverage previous two years Average number of readmissions/Fiscal period 1.25/pd4.04/pd Average days stay16.516.5 days Readmissions/fiscal year 1548.5 Days Stay x Cost/dy15 x 16.5 x $500/day =$123,750 48.5 x 16.5 x $500/day = $400,125 Cost Avoidance $276,375 Patient Days saved552

20 Impact: Cost Avoidance 1.LPNs able to treat 5176 patients/yr 2.3608 were cases routinely followed for SSI outcomes 3.If remaining 1912 cases had a similar SSI rate reduction (0.016), 31 additional infections prevented. 4.$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 **Conditional logistic regression analysis of the matched data with treatment as the only covariate: coefficient = -1.44, z = -3.65 p=0.0026 Propensity Score Analysis: 1:4 Matching TreatedUntreatedTotalP-ValueStand d Number of Patients 704188892 Age 59.6 (± 1.2 )59.3 (± 2.5 )59.6 (± 1.1 )0.8320.15 Gender (Male) 329 (46.7%)92 (48.9%)421 (47.2%)0.6220.04 ASA (3-5) 433 (61.5%)118 (62.8%)551 (61.8%)0.9170.02 Scheduled Case 623 (88.5%)160 (85.1%)783 (87.8%)0.2110.1 Cancer Suspected/Proven 113 (16.1%)32 (17%)145 (16.3%)0.3790.14 Surgery Time 152.1 (± 8.3 )149.2 (± 17.8 )151.5 (± 7.6 )0.7710.21 Median Time 120111118 Cases Greater than 2h 351 (49.9%)87 (46.3%)438 (49.1%)0.4120.07 T time: cases higher than 75 percentile 141 (20%)40 (21.3%)181 (20.3%)0.6850.03 Type of Service Cardiovascular 136 (19.3%)39 (20.7%)175 (19.6%)0.680.04 Neurological 117 (16.6%)29 (15.4%)146 (16.4%)0.740.03 Orthopedic 198 (28.1%)52 (27.7%)250 (28%)0.9270.01 Spine 104 (14.8%)25 (13.3%)129 (14.5%)0.7260.04 Thoracic 123 (17.5%)36 (19.1%)159 (17.8%)0.5930.04 Vascular 26 (3.7%)7 (3.7%)33 (3.7%)10 Infected 131427 Not applicable 1

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)


25 The Team Surgery: Bas MasriGary Redekop Perioperative Services: Debbie JeskeClaire Johnston Kelly BarrShelly Errico Anna-Marie MacDonaldTammy Thandi Lorraine Haas Pauline Goundar Lucia AlloccaDawn Breedveld Steve Kabanuk Infection Control: Elizabeth BryceChandi Panditha Leslie ForresterDiane 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

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

27 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

28 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.


30 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

31 The technology SmartUVC aka TruD UVC light automatically delivers lethal UV doses required for each room using a 360 0 sensor Two settings: Bacterial and sporicidal Evaluated already in USA for effectiveness 9 hospital cross over study re outcomes in USA underway

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

33 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


35 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

36 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

37 Tru-D MRSA Bed Kill at <7.2 x 10 0 CFU RD MRSA Bed Kill at >7.2 x 10 3 CFU

38 UVC + Decluttering and Equipment Cleaning Campaign: Impact 38 ↓ 30%

39 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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