A Clean Sweep

Inside the latest whole room disinfection and air quality control technology.

When the wildfires raged in California earlier this year, it wasn’t just firefighters who were concerned about the impact of the smoke. Surgery centers throughout the greater Los Angeles area had to consider the fires’ environmental impact on patients very quickly.

According to a national study by the American Cancer Society and Harvard’s School of Public Health, many post-op patients who are exposed to dangerous air pathogens are more likely to be hospitalized for much longer periods of time than patients who have surgery during “normal” times.

Imagine now how an AI system might be able to monitor air quality in real time during a procedure. Imagine too that it can reliably predict if/when contamination could happen. It’s a technology already being developed and rolled out in surgical facilities worldwide. And it has the potential to change the way ASCs look at infection prevention.

A team effort

At the Ambulatory Surgery Center at the Dell Medical School at the University of Texas at Austin, Administrative Director Jessica Hovland, DNP, RN, CPAN, NE-BC, PMCT-BC, is focused on infection prevention standards that specifically relate to mitigating and preventing cross-contamination.

“We have an entire team dedicated to our BACS (Building Air Control System) where there are remote monitoring and alarm systems when temperatures are too high or too low,” she explains. “They also monitor the number of air exchanges electronically, which is helpful in tracking and trending.”

The Lone Star State ASC also has a dedicated facilities team business partner who advocates for all the OR needs. She said it’s been a game changer in terms of communicating up the ranks.

“Everything is designed with the patient experience in mind,” says Dr. Hovland, “from policies and procedures to implementation of new workflows.” The center even uses storytelling learning to help influence the ancillary teams to understand the minimum standards when it comes to infection control.

Dr. Hovland says the lessons learned from the pandemic continue to apply today. “We have to continue that mindset, so we can be ready for all the changes that will happen in the future.” she says.

In addition to staff training, communication and learning from past experience, Dr. Hovland says that innovative technology is becoming an even more influential part of the process. “The big buzzword everyone needs to be aware of is ‘integration,’” she says. “What does that look like in your ASC or hospital, and how can we integrate more than just the OR setting? This is a team sport. Think about that and what it means to you and your organization.”

A great track record

While ASCs notably report far lower infection rates than traditional hospitals do, the risks still exist. In a comprehensive study of almost 300,000 ambulatory surgeries across eight U.S. states, less than 0.5% of patients ever developed clinically significant surgical site infections (SSIs) within the first 14 days after their procedures. And in a survey of 35 surgery centers reporting more than 100,000 surgeries nationwide, the overall infection rate was less than 0.1%, equating to one infection per every 1,000 procedures.

Infection rates at Lewis & Clark Outpatient Surgery in Lewiston, Idaho, are reported to be less than 1% thanks to streamlined best practices and ongoing staff training. And at the Mississippi Valley Surgery Center in Davenport, Iowa, patient safety and infection risk are mitigated by using a three-step approach to infection control involving observation, investigation and prevention.

“Everything is designed with the patient experience in mind.”
— Jessica Hovland, DNP, RN, CPAN, NE-BC, PMCT-BC

One of the biggest advantages ASCs have when it comes to lowering infection rates is being able to develop and maintain rigorous infection control standards that often outpace hospitals. Much of this starts and ends with better overall adherence and effective standards, as well as ongoing training and technology.

No breathing room for mistakes

According to the ASHRAE Standard 170, ventilation in surgical centers should have a minimum of 20 air changes per hour for proper ventilation. Proper ventilation, filtration and pressure management each help to prioritize quality control for minimizing infection risks and enhance patient safety.

A few things to consider when it comes to best air quality practices:

• Filtration. High-efficiency particulate air (HEPA) filters remove particulate matter from the air effectively, including the most dangerous pathogens.
• Pressure management. Maintaining a positive pressure differential in surgical areas helps prevent outside air from entering and potentially introducing contaminants into surgical and recovery areas. In the case of the California wildfires, this became mission-critical in order to continue to perform procedures despite the environmental hazards posed outside.
• Airflow direction. Laminar airflow systems can help maintain a controlled and clean environment by minimizing airborne particles above the sterile field.
• Humidity control. Maintaining humidity levels between 30% and 60% reduces risks like condensation and static electricity. It also genuinely improves the comfort of staff and patients.
• Temperature control. A temperature that ranges between 20°C and 24°C limits bacterial growth.

Ongoing monitoring and maintenance are also integral to ensuring best air quality compliance. This means routinely checking the HVAC system and changing filters on schedule. Staff should also be trained on how best to implement these procedures with an emphasis on a clean, infection-free environment inside and outside the surgery area.

A big umbrella

It’s not just air quality at stake for ASCs. If the industry has learned anything from the COVID pandemic, it’s that whole room disinfection plays a vital role in overall patient outcomes and safety. In fact, standard precautions now tend to include all aspects of hand hygiene, personal protective equipment (PPE) usage and disposal, safe injection practices and safe handling of equipment that risks contamination.

New infections also present different risks each season and each year, such as with the recent rise in measles, norovirus and avian flu.

The statistics already provide plenty of reasons to be especially cautious in outpatient centers where patient traffic can be heavy from day to day. For example, the Centers for Disease Control and Prevention report that since last year, norovirus infections have more than doubled and other diseases that we have not seen in years are also on the rise, particularly among children and the elderly.

The good news is that a recent study about an orthopedic hospital in the American Journal of Infection Control suggests that newer technology like HEPA ultraviolet air purification systems in operating rooms can significantly reduce infection risks no matter what the trend.

New technology

There are many new technologies that make disinfection in sterile surgical and patient recovery areas even easier. This is especially true as more outpatient surgery centers are adopting better overall solutions to reduce the risk of healthcare-associated infections.

For example, UV-C light can rapidly disinfect both surfaces and air to kill bacteria and viruses instantly. These robots work by autonomously navigating and identifying high-touch areas using smart technology that can provide a consistent system of disinfection that’s free from human error.

Because UV-C light is known to be very effective at killing various pathogens, including bacteria, viruses and even fungi, it can provide a reliable pathway toward better overall patient outcomes thanks to pulsed germicidal UV light that can reach sometimes challenging areas that manual cleaning can miss, according to a study by the National Institutes of Health.

Another technology is a dry mist hydrogen peroxide fogging system that delivers a proprietary disinfectant that can achieve a 6-log kill rate against pathogens that are common in hospital settings. It can provide uniform coverage in a space that reaches beyond traditional cleaning methods, and is non-corrosive and safe to use around electronics.

There are also thermally controlled airflow systems that use a combination of temperature control and air distribution to remove particles and pathogens specific to surgical rooms. The goal of such systems is to automate the sterilization of medical devices using hydrogen peroxide and activated oxygen that can eliminate harmful residue. Staff tend to appreciate reducing exposure to harsh chemicals, too. It’s a plug-and-play system that doesn’t require installation.

Not surprisingly, AI is being developed to monitor and manage air quality in real time. These systems are already able to detect contamination levels, adjust filtration settings and predict potential air quality issues in order to avoid problems in advance before they even pose a threat.

Bottom-line impact

SSIs destructively impact the bottom lines of patient health and facility operations to varying degrees. They introduce potentially serious problems for patients specifically, from delayed recovery times, increased pain and complications to risk of death and the need for sometimes expensive ongoing medical intervention.

With proactive room and equipment disinfection strategies and equipment, ASCs can create healthier environments for patients and staff, reducing the likelihood of infections, improving ratings, boosting patient trust and keeping operating costs low.

Incorporating advanced disinfection technologies can also offer enhanced protection through broad-spectrum, highly maneuverable lights or mists that reach all areas to disinfect both targeted and non-targeted bacteria, while also deodorizing and eliminating spores.

Want more?

Between new technology and whole room disinfection systems entering the market and the volume of research that’s available, it can feel overwhelming for busy surgical facility leaders to navigate which practices and systems are best for their centers. The good news is plenty of resources are available — many of which are free. Visit government and regulatory agency websites for free information and links to the latest research into the best infection control practices. Study top healthcare facilities and talk with suppliers about the latest tools being used. OSM