A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Danielle Bouchat-Friedman
Published: 10/7/2020
With public health experts sounding the alarm about the likelihood of a second COVID-19 spike this winter in the midst of flu season, whole room disinfection technologies are becoming more appealing because manual cleaning alone simply isn't an effective enough way to fully clean and disinfect the OR. "Studies have shown that about 50% of surfaces in hospitals that need to be cleaned are not," says Luci Perri, RN, BSN, MSN, MPH, CIC, FAPIC, CSPDT, the owner and president of Infection Control Results, a consulting company located in Charlotte, N.C. "If the surfaces are not properly cleaned and disinfected, you have a greater likelihood of a healthcare worker picking up organisms off the surface and potentially transferring them to a patient."
The reasons for a lack of adequate surface disinfection range from a variability in cleaning tactics among environmental services staff to historically high turnover in those positions, says Ms. Perri. Of course, in many smaller, free-standing ASCs, nursing staff clean ORs between cases. The expanded safety protocols stemming from the pandemic have stretched staff thin, making it more difficult for them to follow proper surface disinfection and cleaning protocols.
That's where mobile ultraviolet-C (UV-C) devices and hydrogen peroxide vapor (HPV) systems come in. These systems can eliminate an array of bacteria, viruses (such as COVID-19) and fungi, including multidrug-resistant organisms. Both of these options have their advantages and their disadvantages, according to Ms. Perri. Let's look at the pros and cons of each.
Still, the devices are effective and can be used in a variety of ways. For instance, St. Charles Health System in Bend, Ore., acquired three UV-C devices that have been used to reduce the cases of hospital-acquired infections from C. diff., disinfect a surgical instrument sterilization room following a sewage pipe burst and disinfect emergency room areas during a flu outbreak. The facility also employs a UV-C device to disinfect ORs used for total joint replacements, sterilize a cardiac cath lab and spot clean other areas of its facilities.
"The greatest benefit of the device is being able to kill spores in the areas that you can't reach to clean," says Rochelle "Rockie" Shatka, CHESP, environmental services manager at St. Charles Health. After the environmental services staff completes a thorough manual cleaning of rooms, they run the UV-C machine — purchased for around $100,000 — through a cleaning cycle, which takes 45 minutes to complete, according to Ms. Shatka.
You may think incorporating whole-room disinfection into a well-established workflow process would take some getting used to, but Ms. Shatka says the process was pretty seamless. "We just incorporated it as part of our standard cleaning process," says Ms. Shatka.
For safety reasons, both UV-C and HPV systems require staff to close and stay out of the room while the devices are in use. However, because hydrogen peroxide is extremely toxic to humans, the HPV safety requirements go a step further. "You have to seal the room off completely, close all HVAC vents and monitor the room to make sure vapor isn't escaping," she says.
Regardless of what type of whole-room disinfection system your facility opts to use, there are considerations you need to keep in mind before making a significant upfront investment. Obviously, cost is a factor. But if the cost is comparable between two vendors or even two different systems, you want to assess what vendor reps bring to the table, says Ms. Perri. For instance, before purchasing a UV-C system ask: How long do the bulbs last? Can you change the bulbs yourself or does a company rep have to travel onsite to do it?
You also need some guarantees about the vendor's customer service capabilities. After all, anyone can answer questions during business hours, but what happens in an after-hours situation? "If your staff runs into a problem at 8 p.m. on a Wednesday, which is when they'll likely be using these disinfection systems for terminal cleanings, is there someone they can get through to?" asks Ms. Perri.
In the end, look at whole-room disinfection technology as a way to complement robust manual cleaning processes. It will never make manual cleaning obsolete, but it will kill whatever bacteria staff didn't wipe away. That alone should be a compelling reason to invest in the technology. OSM
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