Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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28 ICT January/February 2019 www.infectioncontroltoday.com side rails, head and foot board, the mattress, and any accessories added to the bed, such a detachable mattress cover. As the FDA explains, "A hospital bed mattress cover provides outer protection to a mattress by preventing blood and other body fuids from entering the inside (inner core) of the mattress. Such covers may be coated with or contain an antimicrobial solution that kills viruses or bacteria or prevents bacterial growth. There are multiple terms used to describe hospital bed mattress covers: water-resistant, water-proof, or water-repellent. Covers are usually detachable from the mattress or the mattress lining, meaning that they can be removed or replaced." The FDA shares ECRI's concerns, noting, "Over time, hospital bed mattress covers can wear out and allow blood and body fuids to penetrate and get trapped inside mattresses. If blood or body fuids from one patient penetrate and get absorbed in a mattress, the fuids can leak out the next time the mattress is used. Coming into contact with these fuids poses a risk of infection to patients using the bed." The FDA issued a safety communication in 2013, alerting healthcare providers, healthcare facility staff, and caregivers to these safety concerns. From 2011 through 2016, the FDA received more than 700 reports of a hospital bed mattress cover failing to prevent blood or body fuids from leaking into the mattress. As the ECRI Institute report states, "Healthcare facilities must take care to use appropriate products and procedures for cleaning and disinfecting mattress covers, and they should regularly inspect mattresses and covers for signs of damage or contamination. One key challenge, however, is that not all mattress cover suppliers recommend products and procedures that will successfully remove the likely surface contaminants without compromising the cover's integrity (i.e., creating weak spots that could allow leaks). This situation needs to be remedied." The FDA's recommendations, based on guidelines for environmental infection control in healthcare facilities issued by the Centers for Disease Control and Prevention (CDC), are as follows: 1. Develop an Inspection Plan • Create an inspection plan for all hospital bed mattresses and mattress covers in your facility. • Check the manufacturers' guidelines for an expected life time on the hospital bed mattress and mattress covers and follow any additional recommendations listed there. • Contact the mattress cover manufacturer for any additional questions not covered here. 2. Inspect • Regularly check each hospital bed mattress cover for any visible signs of damage or wear such as cuts, tears, cracks, pinholes, snags, or stains. • Routinely remove the hospital bed mattress cover and check its inside surface. Once the mattress cover is removed, inspect the mattress for wet spots, staining, or signs of damage or wear. Check all sides and the bottom of the mattress. • Be aware that it may be difficult to identify damaged or soiled mattresses without removing the mattress covers frst. Mattress covers tend to be dark in color, making it hard to see what lies underneath. 3. Remove and Replace • Remove any damaged, worn, or visibly stained hospital bed mattress according to the health care facility's procedures and manufacturer's instructions. • Immediately replace any hospital bed mattress cover with visible signs of stains, damage or wear to reduce the risk of infection to patients. 4. Maintain • Clean and disinfect undamaged hospital bed mattress covers according to the manufacturer's guidelines. "To reduce the risk of body fuid contamination of your facility's current mattress inventory, ECRI Institute recommends conducting a house-wide inspection of mattresses to identify and remediate any contaminated units," Sivek says. "Afterward, facilities should focus on effective mattress cover cleaning and disinfection; Environmental Services (EVS)/Housekeeping staff training and room cleaning checklists; and mattress and mattress cover inspection and service lives. For future procurement of mattresses and mattress covers, facilities should favor mattresses and covers that facilitate effective cleaning, inspection and tracking." The second infection prevention-related issue is retained sponges as a surgical complication. The technical term, gossypiboma is used to denote a mass of cotton material, usually, gauze, sponges and towels, inadvertently left in the body cavity at the end of a surgical operation. These kinds of retained objects can occur after virtually any type of operation; this hazard has been reported after intrathoracic, orthopedic, intraspinal and neurological procedures, but the most common is after intra-abdominal or pelvic surgery. Kaiser Permanente found 55 percent of retained sponges after abdominal surgery and 16 percent after vaginal delivery. Five years ago, the Joint Commission issued a safety alert about retained surgical objects; the agency recommends that facilities develop effective processes and procedures for preventing unintended retained foreign objects. Their recommendations include a standardized and highly reliable counting system; development of policies and procedures; practices for counting, wound opening, and closing procedures; performance of intraoperative radiographs; use of effective communication to include briefings and debriefngs; documentation of counts; and assistive technologies (i.e., RF tags, RFID, radiopaque, bar coding). Also, the hospital should defne a process for conducting RCA for sentinel events, such as URFO. As the ECRI Institute report explains, "Surgical sponges that are unintentionally left inside the patient after the surgical site is closed can lead to infection and other serious complications, including the need for secondary operations. Manual counts—in which the surgical team verifes that all sponges are accounted for The Top List for 2019 1. Hackers Can Exploit Remote Access to Systems, Disrupting Healthcare Operations 2. 2 "Clean" Mattresses Can Ooze Body Fluids onto Patients 3. Retained Sponges Persist as a Surgical Complication Despite Manual Counts 4. Improperly Set Ventilator Alarms Put Patients at Risk for Hypoxic Brain Injury or Death 5. Mishandling Flexible Endoscopes after Disinfection Can Lead to Patient Infections 6. Confusing Dose Rate with Flow Rate Can Lead to Infusion Pump Medication Errors 7. Improper Customization of Physiologic Monitor Alarm Settings May Result in Missed Alarms 8. Injury Risk from Overhead Patient Lift Systems 9. Cleaning Fluid Seeping into Electrical Components Can Lead to Equipment Damage and Fires 10. Flawed Battery Charging Systems and Practices Can Affect Device Operation

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