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Going digital: Using real data to prevent infection

By Dustin Rahlf, Director of Healthcare Digital Solutions at Ecolab

While AI & robot enabled surgeries are capturing headlines, real-time digital dashboards and predictive analytics may be the overshadowed sidekick that enables a safer operating room (OR).

It is widely known that previously contaminated OR environments have an increased transmission risk of pathogens that cause healthcare-associated infections (HAIs).[1] However, HAIs – though largely preventable – continue to put patients at risk and cost hospitals thousands of dollars every year. Consider this: One out of every 31 hospitalized patients will contract at least one HAI, resulting in roughly 75,000 deaths each year in the U.S.[2] That’s more deaths than those caused by automobile accidents.[3] Even if the infections don’t result in death, the extended-stay for additional treatment can cost hospitals upwards of $20,000 per patient.[4]

Improved cleaning can decrease this risk, yet just 25% of critical high-touch surfaces in the OR are adequately cleaned.[5,6] While ORs may dedicate more time to cleaning in order to reduce contamination, there is, in fact, little correlation between the time spent cleaning and actual cleaning effectiveness.[7] This suggests there is a fundamental lack of process control during cleaning, which contributes to ineffective environmental cleaning in the OR, high turnover time, practice variations and HAIs.

How can a hospital take action to prevent undue infection? Many use audits and direct observation to evaluate compliance with current cleaning and hand hygiene protocols. However, audits only capture a snapshot in time, providing incomplete data. Direct observation can also be unreliable, in part due to the Hawthorne effect: when people are aware they are under observation, they modify their behavior.

A more dynamic, objective and effective approach is to use digitally enabled programs that allow for consistent, accurate monitoring. This monitoring produces real-time data points that feed into digital dashboards, which – through both real-time, actionable data and predictive analytics – allow healthcare systems to objectively monitor cleaning effectiveness, streamline workflows and prevent the spread of pathogens that lead to infection.

Accessing real-time data

Monitoring cleaning and disinfection activity as it happens is a vital first step in reducing the number of HAIs. A fully integrated digital dashboard system enables turnover teams and managers to track high-touch object (HTO) cleanliness and room turnover time in operating rooms. These dashboards extend to other parts of the hospital as well, including surgical instrument cleanliness in the central sterile department, cleaning thoroughness in patient rooms and hand hygiene compliance for staff, all in one place. Having the information available in real-time allows for immediate intervention, which can stave off the spread of infection once the risk is detected.

The ability to intervene is particularly important in the OR, where patients may be undergoing invasive surgery and are particularly susceptible to infection. There is a continuous flow of pathogens from infected or colonized patients to the hands of healthcare workers to environmental surfaces and then back to patients. The intervention allows hospitals to break the chain of infection. Studies have concluded that the OR should follow enhanced cleaning protocols based on the higher levels of contamination found on high-touch surface areas compared to other, lower-touch surface areas within a hospital.[8]

Contaminated surfaces and sub-optimal cleaning processes create an environment that is more susceptible to the transmission of pathogens that can lead to HAIs.[9] Real-time reporting helps monitor progress and provides assurance that equipment, instruments and rooms are clean and safe. It can also enhance operational efficiencies and drive increased productivity and patient flow. Ensuring all equipment and surfaces are sufficiently clean can reduce the cost and complications associated with HAIs, enabling hospitals to admit and treat more patients during the year. That’s important for generating more revenue.

Using data to make a change

Tracking the data is only part of the equation. Acting on it is what leads to real change. Digital dashboards translate data into easy-to-read, actionable reports at the system, hospital, unit, individual and even object level. Hospitals receive alerts when issues or inefficiencies arise, allowing them to immediately pinpoint the area (or areas) where corrective action is needed.

A hospital in Pittsburgh that performs more than 23,000 surgeries each year implemented the Ecolab OR Program, which includes digital dashboards. Before the program started, the hospital was cleaning just 20% of HTOs in between-case turnovers, and it was taking teams 30 minutes for each turnover. Over two months, dashboards tracked cleaning thoroughness of HTOs, allowing OR leadership to identify teams, individuals and objects that needed attention so they could take targeted corrective action. The insights derived from the dashboard enabled this hospital to improve HTO cleaning by 66% and decrease OR turnover time by an average of 21 minutes, resulting in a savings of approximately $800 per room.[10]

Having immediate access to this data enables hospitals to objectively assess workflows and processes across an entire healthcare system to drive consistency and standardization while actively optimizing performance and controlling costs.

Turning data into predictive insights

As technology improves, healthcare systems will increasingly have the ability to extrapolate collected data, allowing them to move beyond reacting to infection risk, to predicting and preventing the spread of infection in the first place. By analyzing current and historical data within the dashboards, hospitals can detect patterns, assess trends and identify correlations that may not have been as obvious through direct observation or audits. The comprehensive insights gained can facilitate quick decision-making in critical situations and contribute to strategic planning, setting hospitals up for continued improvement.

The most sophisticated digital dashboards can also generate customized reports that give hospitals the capability to set goals and benchmark internally or against industry averages. A customized report for the OR can track the thoroughness of cleaning, room turnover time and adherence to the Association of periOperative Registered Nurses (AORN) guidelines over time. The dashboards also produce scorecards, allowing hospitals to track progress against established target metrics to evaluate how effective they are from the facility level down to an individual. Tracking patterns and putting corrective measures in place allows a hospital to predict incidents before they happen, mitigating risk to patients, staff and hospital.

Looking ahead, the potential to pair information gained from digital dashboards with information from electronic health records (EHRs) may someday offer a powerful opportunity to minimize patient risk further. The collective insights from combining the hospital environment and staff data with individual patient risk data would help eliminate surprises and enable hospitals to put proactive measures in place so staff could intervene where necessary. For example, EHRs could help identify patients who are at higher risk of infection or have unique needs, and staff would reference the digital dashboards to ensure the quality of the patient interactions and the cleanliness of the environment met the patient’s needs to provide the best possible outcome.

Having access to real-time data and monitoring patterns enables clinicians to interrupt the chain of infection transmission, mitigating the risk of HAIs. When hospitals can tackle issues immediately and have the tools to predict and prevent the spread of infection, they can have the confidence to promote cleaner and safer environments. Encourage your facility to look into modernizing its infection prevention strategy by learning more about digitally enabled programs.

REFERENCES:

1 Cohen B, Cohen C C, Løyland B, and Larson E L. Transmission of health care-associated infections from roommates and prior room occupants: a systematic review. Clinical Epidemiology 2017;9: 297-310.

2 HAI Data and Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/hai/surveillance/index.html Accessed 3/27/2019.

3 Rau, J. Hospital infections kill more people than car crashes. Here’s how to cover them better. Columbia Journal Review. Oct. 2014. http://archives.cjr.org/the_second_opinion/how_to_use_the_hospital_infections_database.php

4 Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health Care-Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med. 2013;173(22):2039-2046. doi:10.1001/jamainternmed.2013.9763.

5 Link T, Kleiner C, Mancuso M et al. Determining high touch areas in the operating room with levels of contamination. Am J Infect Control. 2016 Nov 1;44(11):1350-1355.

6 Yezli S, Barbut F and Otter JA. Surface contamination in operating rooms: A risk for transmission of pathogens? Surg Infect (Larchmt). 2014 Dec;15(6):694-9.

7 Datta R, Platt R, Yokoe DS, Huang SS. Arch Intern Med. 171:6, Mar 28, 2011

8 Slide courtesy of Dr. Philip Carling, Boston University School of Medicine, 2012

9 Rupp ME, Adler A, Schellen M, Abstract 203 Fifth Decennial, Slide courtesy of Dr. Philip Carling, BU School of Medicine

10 Kramer M and Kriznik S. The impact of an OR environmental hygiene program on OR culture and cleanliness. OR Manager Conference; Las Vegas, NV; Oct. 21-23, 2016.

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