ADDED VALUE Robots improve patient safety and could decrease the costs associated with healthcare-acquired infections.

If you're considering joining the increasing number of facilities that have invested in whole-room disinfection technologies like robots that emit ultraviolet light and devices that dispense aerosolized hydrogen peroxide, keep in mind that the capital outlay for these systems will be significant. Whether you decide to zap your ORs with light or fog them with gas, here's how to cost-justify the purchase.

Getting results
Some investments might be a tough sell to value-analysis committees, but adding whole-room disinfection to help prevent infections shouldn't be one of them, says Joel Sklar, MD, chief medical officer at Marin General Hospital in Greenbrae, Calif. "It's a straightforward calculation," he explains. "Infections are very expensive." There are the direct costs associated with prolonged patient stays, the indirect costs of harming your facility's reputation and the potential negative impact reportable infections can have on value-based reimbursements, says Dr. Sklar.

Capital committees tend to see whole-room disinfection as not only a matter of patient safety, but also as one of effective cost containment. Although the capital outlay for such a system is significant — a single disinfection robot can run more than $100,000, depending on the vendor — consider that HAIs cost U.S. hospitals in excess of $45 billion per year, according to CDC estimates. Patients infected with C. diff increased hospitals' cost per case by 40%, or an average of $7,285, according to a 2015 study published in the American Journal of Infection Control. These patients also had a 55% longer length of stay and were 77% more likely to be readmitted within 30 days. Such sobering statistics have helped drive adoption of whole-room disinfection systems. A few examples:

• Upper Allegheny Health System acquired 3 whole-room disinfection units to serve 2 facilities: Olean (N.Y.) General Hospital and Bradford (Pa.) Regional Medical Center. Raphael Moore, director of environmental services for Olean General Hospital, says each unit cost approximately $40,000, nearly all of which was paid for through creative fundraising efforts. Since Olean General Hospital adopted the disinfection robots last December, C. diff incidents have dropped by 17%. Mr. Moore considers these results "phenomenal," and he expects even more significant reductions in infection rates between year 2 and year 3. He also believes the investment will reap intangible benefits in the form of goodwill, by showing the community the hospital is taking an "extra step" to protect patients.

WIDESPREAD COVERAGE Whole-room disinfection could one day become the standard of care.

• Guthrie Robert Packer Hospital in Sayre, Pa., and Guthrie Corning Hospital in Corning, N.Y., invested in 4 disinfecting robots capable of sanitizing an entire operating room in 15 minutes. The hospitals spent $345,000 on the robots, says Barbara Pennypacker, RN, vice president of surgical services. That price might be considered a bargain given the fact that just 1 surgical site infection could cost tens of thousands of dollars to treat.
• Broward (Fla.) Health Imperial Point, which is part of a 4-hospital system serving the Ft. Lauderdale area, has been seeing "some good results in its ORs" since investing in a whole-room disinfection system, says W. Thomas Kester, RN, MSN, CNOR, the health system's chief nursing officer and COO. "We haven't had an SSI in abdominal hysterectomy in a year, and we haven't had an SSI in colon surgery since June."

Strong vendor relationships helped the company negotiate a discount on the system's price tag of approximately $125,000, says Mr. Kester. He also relied on the vendor to provide usage data that he could use to state his case to the hospital's C-suite.

"Have your data ready — that's the biggest thing," he says. "If you experience problems with HAIs, you need to outline how [whole-room disinfection] can contribute to your infection-control efforts, so you can show a good return on investment."

Also, when proposing the investment to value-analysis committees, Mr. Kester suggests focusing on cost savings through greater efficiency. For example, the system he chose takes 20 minutes to treat each room, which lets the staff cover more area in a shorter amount of time.

"Reducing SSIs was a big focus for our organization," he says. "Our CEO had a clinical background, so she was excited that the technology helps with our infection control efforts."

EVERY STEP COUNTS
Don't Ignore the Basics of OR Cleaning

SECOND PASS Robots treat surface areas that staff members might have missed during routine surface cleaning.

Although whole-room disinfection can be a valuable tool in stopping the spread of infection, it is by no means a cure-all.

Barbara Pennypacker, RN, vice president of surgical services at Guthrie Robert Packer Hospital in Sayre, Pa., characterizes whole-room disinfection as "an adjunctive measure." The hospital has adopted disinfecting robots that emit intense germicidal light to treat surfaces that might harbor multidrug-resistant organisms, particularly in the ORs and patient rooms upon discharge. She says the robots are "only one aspect of the prevention of SSIs," with others including best practices such as standard processes for cleaning high-touch surfaces between cases and terminal cleaning at day's end.

"You often hear people characterize infection control efforts in terms of spot disinfection versus whole room treatment, but it's all of it working together," says Joel Sklar, MD, chief medical officer at Marin General Hospital in Greenbrae, Calif. "If you take Lipitor, it doesn't mean you can have sausage and eggs for breakfast every day. So just because you're zapping the whole room, it doesn't mean you cut corners anywhere else.

"The point is, every step counts," he continues. "Hand hygiene counts. Proper cleaning between cases counts. The terminal clean at the end of the day counts. Whole-room disinfection is just the final stroke."

— Bill Donahue

Shooting for zero
More than a year has passed since Marin County General began using its "R2Clean2" robot in its ORs. In that time, R2Clean2 — a nod to the droid dreamed up by Star Wars creator George Lucas, whose Skywalker Ranch is based in Marin County — has begun to prove its worth.

"We've always had a very reasonable infection rate, but we needed to do something more dramatic," says Dr. Sklar. "Based on the literature, we're talking about the potential for double-digit reductions [in infections] — and not just 10%, but 25%, 30%, even 80%."

Although whole-room disinfection is considered a proactive measure, Dr. Sklar wouldn't be surprised if one day it becomes standard practice. He says, "I think the current feeling is that if you really do operate correctly, and do the right thing at the right time every single time, infections can be really rare."

How rare?

"It's not impossible to think we'll have nothing go wrong for years," he says. "The whole point is to allow for essentially no chance of an infection. It could happen, and that's the goal: shooting for zero and having everyone know it." OSM