Better maintenance of rolling stock affects infection control, bottom line
With nosocomial infections on the rise and making headlines daily, the need for an integrated approach in hospitals to maintain high standards of disinfection is evident. This is true not only of medical and surgical instruments, but also of noncritical care equipment that frequently falls through the cracks in health care. This includes all types of nonelectric patient items such as clinical recliners, over-the-bed tables, wheelchairs, stretchers, hospital beds, medication carts and IV poles.
The maintenance of such items is frequently overlooked as hospitals deal with funding cuts, insufficient staffing and day-to-day emergencies. Yet standardized practices make long-term financial sense. Equipment used to transport patients, hold IV medications or diagnostic systems that are not disinfected, maintained and inventoried can cause a financial burden to a hospital.
At worst, contaminated surfaces are a danger to patients and employees. When disinfection is coupled with equipment repair and inventory management, the situation becomes beneficial to the hospital not only for medical, but also for financial reasons.
The majority of hospitals have established many common sense protocols to control nosocomial infections. Despite emphasis on such practices as hand washing, hard surface sanitation and isolation, recent reports show that overall hospital-acquired infection rates in the United States are growing. Many bacteria are common in health care environments, including vancomycin-resistant enterococci (VRE). A 2000 study published in the American Journal of Infection Control showed that VRE was present even on hospital furniture, including three out of 10 chairs tested. Last year, we conducted an independent study to determine the amount of bacteria, viruses and fungus on noncritical equipment surfaces both before and after cleaning.
The items tested included stretchers, clinical recliners and over-the-bed tables in a hospital setting. Sites were tested for total bacteria, VRE, molds and yeast. Our results showed that even the most dangerous bacteria were present in alarming quantities on all surfaces tested. As an example, innocent-looking over-the-bed trays, where patients ate and left their personal affects throughout the day, were overwhelmingly positive for VRE.
In the hospital where the test was conducted, there was no standard disinfection procedure for this common fixture and many others. Housekeeping routinely handled them as though they weren’t a breeding ground for disease.
In a hospital environment, all heavily used equipment should be carefully assessed. Emergency room stretchers, for example, are frequently used for the sickest patients.
Our in-hospital study showed that side rails were laden with both MRSA and VRE. There are other reasons to strive for best practices as they apply to the maintenance of hospital equipment and facilities. Since January 2007, the Joint Commission has been making unscheduled visits, forcing health care providers to be vigilant.
Apathy, budget constraints and lack of planning all contribute to valuable items becoming overused and underserviced. Dirty and unsafe equipment can potentially lead to injuries, infections and reduced patient and staff satisfaction.
When expensive stretchers and wheelchairs are lost or moved to a storage area when they no longer work correctly, or when basic equipment such as medication carts and hospital beds are overused to the point of malfunctioning, there can be a number of negative outcomes: Patient care can be compromised. The hospital runs less efficiently. Nurses, aides and technicians are taken from their primary purpose of providing care to search for equipment.
Inventorying methods should include common sense procedures. After each piece of hospital equipment is cleaned and disinfected, it is bar coded for inventory and maintenance purposes. This creates a history, making it easier for hospitals to quickly review equipment life cycles.
In the midst of busy routines, hospitals may find the upkeep of rolling stock difficult. But such maintenance is critical to a hospital’s best practices. It also is extremely important to patient outcomes to ensure infection control and cost-containment measures.
Chris Wilkerson is the president of EquipSystems, Brooklyn, N.Y.
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