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Fear the Curtain–Part 2

Fear the Curtain--Part 2

BACKGROUND
Essentially, patient cubicle curtains serve two purposes: privacy and safety. Caregivers can use curtains as a screen while delivering procedures. They also take on the splash of blood and other potential infectious materials in acute care areas. The Problem with Privacy Curtains: Science has demonstrated time after time that privacy curtains are frequently and rapidly contaminated with pathogenic microorganisms. Within days of clean curtains being placed around the patient’s bed, 95% were contaminated on at least one occasion (21% with MRSA; 42% with VRE; 4% with C-diff). The healthcare workers hands were cultured after opening and closing the contaminated curtains. The pathogens were found to have transferred to their hands. The overall conclusion: Curtains have the potential to transmit these organisms and possibly lead to HAIs.

While cubicle curtains serve important purposes, how to clean and how often to change them is a conundrum. There are several issues involved:

  • Many organizations have not developed a cubicle curtain cleaning or changing policy.
  • Many organizations do not document cubicle curtain changes.
  • The hospital does not have room to store a sufficient inventory.
  • Laundering slows room turnaround time.
  • Hanging curtains often requires added resources like ladders and extends the room turnaround time.

It’s time to rethink cubicle curtains and consider non-fabric solutions that could include:

  1. Determine which department “owns” and has budgetary responsibility for all the cubicle curtains in the facility.
  2. Use standard sizes with varying mesh lengths and hardware that allow housekeepers to remove curtains without using ladders.
  3. Use polypropylene recyclable curtains that eliminate laundering cost. They become part of the hospital’s supply chain and are charged to each patient care division.
  4. Using curtains that have a clean edge that helps users to know where to place hands.  The clean edge would be like a stack of sticky notes that could be routinely peeled off revealing a new, clean edge.
  5. Documenting curtain changes to ensure that curtains are cleaned according to the facility’s policies for infection prevention/control.

The Current Industry Standard:

According to AHE (the Association for a Healthy Environment of the American Hospital Association) privacy curtains should be cleaned any time there is visible dust or soil and as part of the terminal cleaning process whenever an area has been occupied by a patient who has been on Contact or Droplet Isolation precautions.

Unfortunately, a 2011 survey by UMF Corp. of environmental services managers found that their departments were, on average, short by five to nine full-time employees. Managers said that despite hospital expansions, expanded services, increased patient admissions and shorter lengths of stay (creating more room turnover), many hospitals have found Housekeeping an easy means of budget cutting, leaving housekeepers to simply dump trash and move on to the next room.

In 2013, a survey administered by the Association for Professionals in Infection Control and Epidemiology (APIC) asked infection preventionists how often privacy curtains in their facilities are cleaned, 37% of respondents answered “only when visibly soiled”, 13% answered “every month,” 13% answered “every three month,” and another 13% answered “once per year.”

Contaminants

Research shows that nearly three quarters of patient’s rooms are contaminated with MRSA and VRE.  A 1997 study found that 42% of personnel who had no direct contact with infected patients had contaminated their gloves with MRSA merely by touching hospital room surfaces including privacy curtains. If left unaddressed, contaminated curtains can pose a risk of infection and can undermine any hard surface disinfection routines a facility may have as well as put patients, families and staff at risk.

Proper hand hygiene, cited by many as the most important solution to nosocomial infections (HAIs), is moderately effective. If bacteria and viruses are not eliminated from the patient-care environment, hands quickly become contaminated again.

Reusable Curtains

  • Primarily, privacy curtains in healthcare facilities are made of flame resistant polyester.
  • Reusable privacy curtains are laundered according to the manufacturer’s specifications based on facility protocol.  The longevity and appearance of the fabric is compromised by laundering on a frequent basis (i.e., after every contact isolation).
  • Frequently and rapidly (within 14 days) contaminated.
  • Durable through a finite number of washes (fire resistant properties are diminished).
  • Substantial initial investment and routine management requirements.
  • Need additional replacement curtains in order to return the patient room to service.
  • Curtains can be damaged or go missing during laundering process.
  • A fairly large, clean space needs to be allocated for the separate storage of clean curtains.
  • Often, multiple fabric patterns are stocked in a facility leading to a “Curtain Management Nightmare.”
  • Obviously stained/soiled, wrinkled curtains of different patterns, lengths and heights, torn mesh and unhooked grommets inevitably result in the “Ugly Privacy Curtain.”
  • Patient satisfaction is negatively impacted by an “Ugly Privacy Curtain.”

Why Address the Problem with Privacy Curtains Now?

Financial Impact of HAIs

HAIs lead to longer hospitalizations; a recent analysis estimates that these infections accounted for more than 27 million additional hospital patient days annually. The study extrapolated data from a 2002 CDC report and a 2010 report from the Pennsylvania Department of Public Health, the only governmental entity that has consistently tracked HAIs.

The cost of treating an HAI varies study to study. In one report the cost per patient is $13,973 on average with a cost to treat MRSA soaring to $35,367.

Eliminating HAIs can provide the hospital with additional patient capacity at little or no cost—a 2005 study conducted in Pennsylvania reported that the average length of stay for a patient without an HAI was less than 5 days. A patient with an HAI had an average length of stay of 23 days.

Safety and Risk Management

More and more studies are addressing the issue of curtain contamination. Many come to the conclusion that more than likely curtains are a source of cross transmission but none has linked an HAI to a contaminated curtain. The need for such a study has been acknowledged. It’s just a matter of time before the link is proven.

With the given studies revolving around curtain contamination and possible exposure to patients, visitors, physicians and nursing staff, we are left with answering the question, “What would a prudent man do?” The answer is, he would develop a curtain changing standard that would guarantee that every patient has a clean and safe curtain upon admission.

 



About Darrel Hicks

J. Darrel Hicks, B.A., is the author of Wiley Publishing's "Infection Prevention For Dummies", and is nationally recognized as one of the top experts in infection control. Darrel Hicks is also the Past President of the IEHA and is an active member in AHE where he holds the designation of CHESP. View all posts by Darrel Hicks

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