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Additional Measures

Tue, 06/17/2014 - 10:08am
Mike Schmidt, Editor, Surgical Products

This article will appear in the upcoming July-August print issue of Surgical Products.

Asif Kattak (EVS Director) and Dr. Raymond Casciari (Chief Medical Officer) from Orange County, Calif-based St. Joseph Hospital with their Xenex germ-zapping robot.Improved infection control, better clinical outcomes, and reduced readmission rates are little more than pipe dreams for those hospital facilities unwilling to invest in the tools and technology designed to help accomplish those goals.

This fact became abundantly clear to a pair of Orange, Calif.-based healthcare facilities – St. Joseph Hospital and Hoag Orthopedic Institute. Staff tasked with making purchasing decisions ultimately decided to purchase Xenex ultraviolet disinfection technology to allow them to combat drawbacks and shortcomings related to their cleaning and sterilization efforts.

The Xenex robot uses ultraviolet (UV-C) light that is 25,000 times more powerful than the sun to ‘zap’ organisms that cause infections (such as the flu, norovirus, MRSA, or Clostridium difficile (C. diff). In minutes, the device can disinfect a room at a facility by pulsing the light, which washes over the surfaces where germs reside.

For St. Joseph Hospital, a significant and growing C. diff problem led to the establishment of a rapid improvement event task force to investigate the problem and devise an effective solution. The team determined C. diff cases were coming into the hospital from the outside and being spread throughout the facility.

“We began to isolate all cases of diarrhea immediately by nursing observation versus physician orders,” says Raymond Casciari, M.D., Chief Medical Officer at St. Joseph.  “Our rates began to decrease. However, it was apparent that even with rigorous cleaning with the proper solutions it was impossible to sterilize a room from C. diff spores.”

The task force also uncovered another significant problem. There were surfaces in the room – such as keyboards, spaces underneath beds, and drapes – that were difficult to clean with traditional methods.

UV disinfection technology eventually became the consensus means to address the C. diff problem at St. Joseph. The facility acquired a Xenex robot on a four-month trial basis.

“During that time, we did notice a reduction in infections,” says Dr. Casciari. “This was not a rigorous scientific study, but it was enough to convince us that the technology was useful.”

However, financial constraints prevented the facility from investing in the technology until a donor came forward and purchased a Xenex robot. Then came the matter of determining how best to employ it.

“Along with the company, we designed a schedule and system for cleaning the rooms of the hospital on a rotational basis,” says Dr. Casciari. “The highest priority rooms were the operating rooms and any room where a C. diff patient had been present.”

Aside from dealing with the challenge of working around an additional 20 minutes or so in the cleaning cycle and finding room for that in the facility’s environmental services and nursing schedules, employing the device at St. Joseph has gone well. At this time, data is being collected to confirm the effectiveness of the Xenex technology at St. Joseph, though Dr. Casciari maintains there is significant data in the literature that indicates its value. 

Meanwhile, the Hoag Orthopedic Institute is a 4-year-old facility where readmission rates and infection control have always been top priorities and part of a long-standing vision to be recognized nationally for clinical outcomes.

“We want to be the best at what we do,” says Robert S. Gorab, M.D., Chief Medical Officer and a board-certified orthopedic surgeon at Hoag Orthopedic Institute.

“We want to be a leader in orthopedic clinical outcomes and show our commitment to prevent any infections from occurring,” he adds.

According to Dr. Gorab, Hoag Orthopedic Institute’s all-cause readmission rates is one of the lowest in California. The facility’s joint replacement readmission stands at just 1.4 percent, while its readmission for surgical sites is even lower than that.

“HOI had a very low infection rate to begin with and so there was a lot of discussion around if we wanted to invest in the Xenex technology,” says Dr. Gorab. “We felt that any reduction in infection would make this valuable, despite the relatively high cost for this the device. Readmissions and infections are much costlier – and not just monetarily speaking.”

Key decision-makers at Hoag Orthopedic Institute also agreed an investment in UV disinfection technology would serve as evidence of their emphasis on positive clinical outcomes and its quest to maintain its status as a leading healthcare institution in its field.

“This technology really shows HOI’s commitment to having zero infections,” says Dr. Gorab.

The success of the purchase and implementation of the Xenex robot at Hoag Orthopedic Institute hinged on the efforts of the facility’s environmental services team. Environmental services was forced to reorganize its workflow and staffing to accommodate the technology and effectively incorporate it into its cleaning processes. Now the EVS team conducts terminal cleanings of each and every patient room and operating room at Hoag Orthopedic Institute. Once those efforts are completed, the Xenex robot – or Xena, as it is affectionately known to the staff – is brought in as the last line of defense.

The robot is positioned somewhere by staff in each room and conducts a disinfection cycle that lasts 10 minutes before being repositioned in another area of the room. Staff members also work to ensure the success of the process by turning beds, flipping mattresses, opening and closing drawers and doors, among other efforts.

“Every area of the room and equipment is exposed,” says Dr. Gorab.

Based on his experience, Dr. Gorab also offers some advice for facilities seeking to improve infection control methods, achieve better clinical outcomes, or see a marked reduction in readmission rates.

“Technology only helps if you use it correctly and follow the guidelines and recommendations,” he says. “If you have technology and you don’t use it properly, it won’t really do much to control infection. Xenex is a nice compliment to a facility’s already existing, robust infection control protocol.”


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