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Fear the Curtain–Part 2

Fear the Curtain--Part 2

BACKGROUND
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.

The Current Industry Standard:

Increased Laundering

  • 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.
  • The Centers for Disease Control and Prevention guidelines state, “Regardless of whether a detergent or disinfectant is used on surfaces in a health-care facility, surfaces should be cleaned routinely and when dirty or soiled to provide an aesthetically pleasing environment and to prevent potentially contaminated objects from serving as a source for health-care-associated infections.”

UV-C Light

  • Not for daily use. For use during terminal cleans only. Room must be clear of occupants.
  • Does not replace a hospital protocol on laundering—does not remove dust or stains.
  • Substantial capital equipment and routine maintenance cost.
  • Could delay turn-over time in a room vacated by a patient with C-diff as it takes up to 50 minutes to eliminate spores.

Contaminants

  • Can be present on patient care equipment items, privacy curtains or environmental surfaces.
  • Can survive on dry surfaces for weeks or months.
  • Can live for months on soft surfaces.

Reusable Curtains

  • Primarily made of flame resistant polyester, reusable privacy curtains are laundered according to the manufacturer’s specifications based on facility protocol.
  • 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 to hang while laundering.
  •  Curtains can be damaged or go missing during laundering process.
  • Space needs to be allocated for the separate storage of soiled and clean curtains.
  • Multiple patterns are stocked in a facility leading to a management nightmare.
  • Obviously 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 a spot or stain on a curtain.

Why Address the Problem with Privacy Curtains Now?

Reimbursement

  • The Patient Protection and Affordable Care Act of 2010: Hospital Value-based Purchasing Program implies the better a hospital performs, the higher their value-based incentive payment for the fiscal year will be.
  • Will private insurers follow suit?

Cost

  • 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.
  • HAIs erode the bottom line—a study of 1.69 million admissions from 77 hospitals found that patients with health-care acquired infection reduced overall net inpatient margins by $286 million or $5,108 per infected patient.
  • 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

  • Colleen Sweeny, RN, BS conducted the “Patient Empathy Project” SM, interviewing more than 1,000 people and identifying their top health care fears. Of the TOP 11 FEARS: #1—Infections, #8—Germs.
  • 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.

In the next and final post, I will offer my own policy based on my understanding of the problem.  It will be “A New Standard for Changing Curtains”.



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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