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Lowering the Curtain on HAI’s

Lowering the Curtain on HAI's

It has long been thought that environmental cleanliness was the key to curbing the spread of cross-contamination. Not to minimize meticulous handwashing by healthcare workers, but once hands are clean, they can quickly become contaminated if the environmental surfaces are not clean and disinfected.

  1. The mission of the Environmental Services Department should be to create a clean, safe environment where patients can get well and go home. But, you may be overlooking a dirty little problem; the cubicle (or privacy) curtain. Have you considered the possible link between these curtains and health-care associated infections (HAI’s)? If you have not, perhaps you should.
    When a patient is admitted to a 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 24″ of  a patient’s bed may not have been changed for weeks or months. The curtain may even have visible blood or other “unknown” spots or stains that makes one wonder, “Is it clean, or not?”
    Doctors, nurses, patients, housekeepers and everybody else grabs the cubicle curtain to open or close it; sometimes with gloves, most often without gloves. Sometimes the curtain is opened with clean hands, and sometimes with hands soiled with MRSA, C-diff, VRE or e-coli. Yet the curtain often stays from one sick patient to the next, to the next, to the next…
    Hospitals are required to be in compliance with the Federal requirements set forth in the Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid payment. CMS (Centers for Medicare/Medicaid Services) is a Federal agency overseeing the government’s insurance program.
    Since 2008, CMS is no longer reimbursing hospitals for patients who acquire an infection during their stay. Hospitals will experience a negative economic impact due to HAI’s not being reimbursed by CMS. New standards, which force the medical institution to pay for treating HAI’s, have made prevention and reduction of HAI’s a primary concern.
    Cubicle curtains have been known to cause HAI’s, as shown in the following example. In a study published in the November 2008 issue of “Infection Control and Hospital Epidemiology”, it was discovered that 42% of hospital privacy curtains were contaminated with vancomycin-resistant enterococci (VRE), 22% with Methicillin resistant Staphylococcus aureus (MRSA) and 4% with Clostridium difficile (C-diff). Then, the clean hands of hospital workers were cultured after they opened/closed the curtains, and it was found that the organisms had transferred to the clean hands or gloves. The conclusion: healthcare-associated pathogens left on curtains are transferred to hands and could potentially lead to HAI’s.
    In another article on CBS, September 2011, (http://www.linkedin.com/news?viewArticle=&articleID=792853486&gid=1805565&type=member&item=91609277&articleURL=http%3A%2F%2Fwww%2Ecbsnews%2Ecom%2F8301-504763_162-20110737-10391704%2Ehtml&urlhash=aLIR&goback=%2Egde_1805565_member_91609277) researchers took 180 samples from 43 curtains, found potentially dangerous bacteria in 119. Researchers also placed 13 new curtains in a hospital for the study. Within a week, 12 were contaminated.
    Since the exposure of this phenomenon, some hospitals have begun to use anti-microbial curtains in an effort to impede the spread of HAI’s. However, a potential problem with that solution is that a lethal dose of antimicrobials may not be delivered and can make organisms more resistant, which is an even larger problem.
    Barnes-Jewish Hospital, St. Louis, concluded during a study that treating curtains daily with hydrogen peroxide may decrease gram-positive infections; however, results were confounded by other infection prevention activities. Hydrogen peroxide seems to have no effect on gram-negative organisms and fungi. If you want to know more about this study, contact Loie Ruhl, RN, BS, CIC at (314) 454-5573 or ler1631@bjc.org.
    Alice Neely and Matthew Naley (1999) concluded in a study that spraying privacy curtains with 3% hydrogen peroxide was an inexpensive and safe way of spot-disinfecting fabrics in the laboratory, and “may limit the spread of potentially pathogenic antibiotic-resistant bacteria.”  My questions are, Who sprays the curtains on a daily basis? Who monitors that program to insure the H2O2 is being sprayed on a consistent basis? When discharges and patient transfers are happening bang, bang, bang, spraying H2O2 becomes less of a priority.
    In my opinion, a better solution would be to change the bed curtains following each contact isolation. This should become a part of the discharge/transfer protocol for contact isolation rooms.
    I hear you say, “In the first place, I don’t have the staff for that. And, second, I don’t have enough curtains to do an exchange. Third, who is going to pay for the cleaning of these curtains (labor, utilities, etc. or sending them to the dry cleaners)?” I will suggest two possible answers or solutions to your dilemma.
    1. Install disposable cubicle curtains in your patient’s room. The features of this type of curtain over a conventional curtain include:
    *Safety-Reduces cross contamination and HAIs, reduces worker’s compensation issues by reducing injuries, eliminates stress on back, neck, and shoulders; eliminates cross-contamination risks for ladders in and out of isolation rooms; assures a clean/refreshed curtain with each new patient.
    *Time savings-Reduces changeover time to less than 2 minutes per semi-private room; compact packaging allows stocking product in nursing units to eliminate wait time; anyone (including Nursing) can change the curtains with this system which results in faster patient admissions; compatibility with current ceiling track’s; auto release system can reduce maintenance calls.
    *Money savings-Can be charged to each nursing division and stocked to a par level by Central Storeroom personnel; reduces worker’s compensation issues by reducing injuries (the elimination of one fall from a ladder by one Housekeeper could pay for curtains for an entire year!; reduced FTE’s/labor cost associated with changing, laundering, etc. 2 minutes v. one hour; eliminates acquistion cost of current curtains if you don’t have the necessary 30% overstock needed to implement frequent changes; stocks a single SKU and reduces storage costs; faster curtain changes allows for patient admissions (improving patient throughput from the ER); eliminates one more possible source of HAI’s due to soiled curtains remaining in the room from one sick patient to the next.
    *Increase Patient Satisfaction & Regulatory Compliance-Faster patient admissions means happier patients and families; maintain patient privacy with consistent curtain length in every room; no torn or yellowed mesh at the top of the curtain; no mis-matched curtains; no waiting on curtain changes, HAI’s due to soiled curtains.
    2. Install a more traditional fabric curtain utilized in a 2-piece cubicle curtain snap-panel system: If a patient or member of the hospital staff soils a small section of a conventional cubicle curtain, health codes require that the Environmental Services or Housekeeping staff remove the entire curtain for laundering and hang a clean replacement curtain in its place.
    This requires most hospitals to keep a stock of replacement cubicle curtains. Many times, two complete sets are purchased for each existing track. This practice is extremely expensive for hospitals to maintain.
    With a cubicle curtain snap panel system, one size fits every track in every room. This is the case since snap panels have been engineered to allow each section to be added or removed one at a time to the antimicrobial curtain mesh. The maintenance staff simply needs to find a clean-snap panel and snap it on. By removing only the soiled panels of a curtain system for cleaning, laundering costs are greatly reduced. During the panel replacement process, staff can load a cart with many snap panels and change out soiled panels on several floors in just one trip to the curtain storage room, thus saving the staff time and the facility money.
    Ladders are not required to change these panels. This is accomplished by varying the length of the antimicrobial curatin mesh to accomodate various ceiling heights. So, the average 5’5″ female (nurse or housekeeper)can change the curtain flat-footed.
    The disadvantage of this program over the disposable curtain is you will still have the acquisition cost for changing over your current curtain system. For planning purposes, you will need to purchase 30 to 100% replacement curtains (depending on the high turnover of isolated patients).  You must also allow for the cost associated with laundering the curtains.
    In conclusion, a comprehensive approach to changing cubicle curtains is necessary to reduce the numbers and the frequency of hospital-acquired infections. Collaboration between infection prevention/control practioners and the Environmental Services Department is essential in breaking the chain of infection. Who knows? The life you save may be your own, or that of your loved one.

References and Cubicle Curtain Systems vendors upon request.



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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