It has long been thought that environmental cleaning is a very important key to curbing the spread of cross-transmission in the patient-care environment. Not to minimize meticulous handwashing by healthcare workers, but once hands are clean, they can quickly become contaminated if environmental surfaces are not clean and disinfected.
The mission of an Environmental Services Department should be to create a clean, safe environment where patients can get well and go home. But many times EVS leaders are overlooking a dirty little problem that is right at their fingertips: the privacy (or cubicle) curtain. Have you considered the possible link between these curtains and healthcare associated infections (HAIs). It’s time to address an often overlooked issue in patient-care areas.
The Centers for Disease Control and Prevention (CDC) has identified 23 high-touch objects in patient rooms. However, cubicle curtains did not make the list even though they rank as the sixth most commonly touched surface. In fact, one study in the November 2008 issue of Infection Control & Hospital Epidemiology has indicated that 42 percent of privacy curtains are contaminated with vancomycin-resistant enterococci, 22 percent with methicillin-resistant Staphylococcus aureus and 4 percent Clostridium difficile — making them the elephant in the patient room.
When a patient is admitted to the hospital room, the furniture (including the bed) has been cleaned and disinfected, clean linens are on the bed, the restroom is “Spic and Span” and sanitized, too. Yet the privacy curtain that is within two feet of their bed may not have been changed for weeks, months “or when visibly soiled.” The curtain may have visible blood or other “unknown” spots or stains that makes one wonder, “Is that curtain clean or not?”
Doctors, nurses, patients, family members, housekeepers and everybody else grabs the privacy curtain to open or close it–sometimes with gloves (clean or soiled), most of the time without gloves. Sometimes, the curtain is opened with clean hands, and sometimes with hands soiled with Staphylococcus aureus, MRSA, C-diff, VRE, or E-coli. In 1993, the U.S. had less than 2,000 reported cases of MRSA. In 2005, there were an estimated 94,000 cases and 18,650 deaths due to MRSA. Yet, the curtain often stays from one sick patient to the next, to the next, to the next…FEAR THE CURTAIN!
I suggest, a comprehensive approach to changing privacy (cubicle) curtains is necessary to reduce the numbers and frequency of healthcare associated infections. Collaboration between infection prevention/control practitioners and the environmental services department is essential in breaking the chain of infection.
In Part 2, I will address more of the clinical background for developing a protocol for changing privacy curtains. Then, in Part 3, I will present a “Policy Statement–A New Standard for Changing Privacy Curtains”. Please send me your own comments or ideas for a comprehensive policy statement; you might see your idea in the context of the policy statement!
So, keep checking back in the coming weeks.