The fodder of many of the Talk Clean To Me blogs are
based on comments, questions, emails and conversations Lee and I have with the
infection prevention and control community from around the world. The impetus of this is that the conversation
we are having at that point in time is not likely an isolated occurrence but
that others are asking or pondering over the same question. So when I saw a
question posted on an infection prevention chat room about rust on furniture in
the OR, it seemed a perfect topic for this week's blog.
based on comments, questions, emails and conversations Lee and I have with the
infection prevention and control community from around the world. The impetus of this is that the conversation
we are having at that point in time is not likely an isolated occurrence but
that others are asking or pondering over the same question. So when I saw a
question posted on an infection prevention chat room about rust on furniture in
the OR, it seemed a perfect topic for this week's blog.
So, what is rust?
Most of us would describe rust as a reddish or yellowish-brown flaky
coating on a surface and generally associate it with corrosion of
metal surfaces. Technically, it is iron oxide that has formed on iron or
steel by oxidation, especially in the presence of moisture. Similar to a cut or abrasion on our skin,
once rust has formed there is no protection to the underlying iron. From a surface integrity, this loss of
protection can lead to further deterioration, but most importantly, rust cannot
be disinfected and provides the perfect habitat to harbour pathogens.
Most of us would describe rust as a reddish or yellowish-brown flaky
coating on a surface and generally associate it with corrosion of
metal surfaces. Technically, it is iron oxide that has formed on iron or
steel by oxidation, especially in the presence of moisture. Similar to a cut or abrasion on our skin,
once rust has formed there is no protection to the underlying iron. From a surface integrity, this loss of
protection can lead to further deterioration, but most importantly, rust cannot
be disinfected and provides the perfect habitat to harbour pathogens.
So why is rust becoming a concern to Infection
Preventionists? Well, as in our earlier
blogs "Unintentional Consequences of Improving Infection Prevention"
and "Is the EPA condoning the use of Steroids" in our efforts to
strive for ZERO HAIs and annihilate all germs from the environment we are
unwittingly causing an epidemic of degrading surfaces.
Preventionists? Well, as in our earlier
blogs "Unintentional Consequences of Improving Infection Prevention"
and "Is the EPA condoning the use of Steroids" in our efforts to
strive for ZERO HAIs and annihilate all germs from the environment we are
unwittingly causing an epidemic of degrading surfaces.
For some, targeting zero means using sporicidal agents
such as bleach and peracetic acid every day, everywhere. While some facilities may attest that this
movement has lead to a reduction in HAIs (C.diff in particular) and thereby a
perceived savings in terms of HAIs, what costs have been incurred from a
perspective of replacement of medical equipment, furniture and environmental
surfaces?
such as bleach and peracetic acid every day, everywhere. While some facilities may attest that this
movement has lead to a reduction in HAIs (C.diff in particular) and thereby a
perceived savings in terms of HAIs, what costs have been incurred from a
perspective of replacement of medical equipment, furniture and environmental
surfaces?
Choosing a disinfectant is a balancing act. Infection Preventionists must balance the
need for an effective disinfectant to minimize HAIs with the safety of the
product from an occupational health and safety, materials compatibility and
environmental impact perspective.
Chlorine (bleach) solutions are by nature highly corrosive. They should
not be used on surfaces that are prone to rust. Metal surfaces are prone to rust.
Metal surfaces are found in virtually every room in a hospital; bed
frames, wheel chairs, stretchers, the arms of OR lights etc, etc...
need for an effective disinfectant to minimize HAIs with the safety of the
product from an occupational health and safety, materials compatibility and
environmental impact perspective.
Chlorine (bleach) solutions are by nature highly corrosive. They should
not be used on surfaces that are prone to rust. Metal surfaces are prone to rust.
Metal surfaces are found in virtually every room in a hospital; bed
frames, wheel chairs, stretchers, the arms of OR lights etc, etc...
As one IP stated (and correctly so) "rust on
equipment cannot be disinfected".
But perhaps a more important consideration is what will Joint Commission
or CMS think? Well, as at least one
facility found out, CMS does not care for rust. In fact if they find it, they will cite you for it and perhaps more
importantly will require you (okay, your facility) to replace, clean or repurpose
all equipment that has rust on it.
equipment cannot be disinfected".
But perhaps a more important consideration is what will Joint Commission
or CMS think? Well, as at least one
facility found out, CMS does not care for rust. In fact if they find it, they will cite you for it and perhaps more
importantly will require you (okay, your facility) to replace, clean or repurpose
all equipment that has rust on it.
As we know, infection prevention and control is
multifactorial. There is no single
solution or silver bullet that will solve our HAI woes. Hand hygiene, antibiotic stewardship and
environmental hygiene all play a role in an effective and successful infection
prevention program. We talk about
building a business case for infection prevention programs, and while for most
we talk to the cost savings in terms of reduction of HAIs, we cannot ignore
incremental costs. Our business cases
may include the justification for increased costs for improved environmental
hygiene due to their associated impact on HAIs, however, we cannot forget to
consider the incremental costs for replacement or refurbishing of medical
devices, equipment, furniture or environmental surfaces.
multifactorial. There is no single
solution or silver bullet that will solve our HAI woes. Hand hygiene, antibiotic stewardship and
environmental hygiene all play a role in an effective and successful infection
prevention program. We talk about
building a business case for infection prevention programs, and while for most
we talk to the cost savings in terms of reduction of HAIs, we cannot ignore
incremental costs. Our business cases
may include the justification for increased costs for improved environmental
hygiene due to their associated impact on HAIs, however, we cannot forget to
consider the incremental costs for replacement or refurbishing of medical
devices, equipment, furniture or environmental surfaces.
The "KIS" or "Keep it Simple"
principle of one product for everything, while seemingly simplistic, does have
unintended consequences. It works if you
are only weighing the cost of HAIs, however, if you or your facility has a
problem with rust or other visually deteriorating surfaces and are not willing
to include replacement costs for surfaces, devices and equipment in your annual
budget...really, who wants to talk about spending $25,000 on a hospital bed or
$5000 - $12,000 on replacing rusty OR lights as part of the consequences of
using a corrosive chemistry everywhere, every day. If you're not willing to have that chat as
part of your business case, then you may want to consider a multifactorial
approach to disinfection by choosing a broad-spectrum disinfectant that can
kill the pathogens (bacteria & viruses) that cause the majority of our
outbreaks for daily use and a sporicidal agent for targeted use against
C.diff.
principle of one product for everything, while seemingly simplistic, does have
unintended consequences. It works if you
are only weighing the cost of HAIs, however, if you or your facility has a
problem with rust or other visually deteriorating surfaces and are not willing
to include replacement costs for surfaces, devices and equipment in your annual
budget...really, who wants to talk about spending $25,000 on a hospital bed or
$5000 - $12,000 on replacing rusty OR lights as part of the consequences of
using a corrosive chemistry everywhere, every day. If you're not willing to have that chat as
part of your business case, then you may want to consider a multifactorial
approach to disinfection by choosing a broad-spectrum disinfectant that can
kill the pathogens (bacteria & viruses) that cause the majority of our
outbreaks for daily use and a sporicidal agent for targeted use against
C.diff.
Maybe you'll find the best of both worlds? No rust, no deteriorating surfaces, decreased
costs from occupational injury associated with disinfectants AND a significant
reduction in HAIs. Now that would be a
Win-Win!
costs from occupational injury associated with disinfectants AND a significant
reduction in HAIs. Now that would be a
Win-Win!
Bugging Off!
Nicole
