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Summaries for the IPS poster talks (part 3)

The IPS Digest continues to showcase outstanding contributions from the presentations at IP2024 Birmingham. This week marks the final feature highlighting some of the remarkable work presented during the poster talks.

  1. Evaluation of the efficacy of a multi-tower UV-C system. Professor Val Edwards-Jones (Essential Microbiology Ltd., UK) and Wares K.D (GAMA Healthcare), Hertfordshire, United Kingdom and University of Newcastle, Sydney, Australia.

UV-C is used following terminal cleaning to reduce residual surface bioburden. A new system (ARRAYDiate 5), with a central tower containing 9 UV-C lamps and 4 satellite lamps (compliant with BS8628), was evaluated in a patient’s room with en-suite facilities. For comparison, a single-tower system was run at 3 different locations in the room (3 x 10-minute cycles).

The multi-tower system was used in 3 separate runs: - Run A – 30 minutes (1 x 30 mins-0 reposition); Run B – 20 minutes (2 x 10 mins–1 reposition); Run C – 30 minutes (2 x 15 mins–1 reposition). The tower remained in a central position, but the satellites were repositioned.  UV-C emissions were determined using radiometers (n=4) and dosimeters (n=44) (colour-changing devices) placed on high-touch and shadowed surfaces.

The single tower system performed poorly with only 20.5% of surfaces showing UVC levels of 100mJ/cm2, 43.1% levels of 25-100 mJ/cm2 and 36.4% showed NO UV-C coverage at all. Poor levels were recorded on the radiometers in 4 positions.

The 30-minute cycle for the multi-tower UV-C system (Run A) showed superior coverage of UV-C with 63.6% of positions recording levels of 100mJ/cm2, 34.1% levels of 25-100 mJ/cm2 and only 1 position (2.3%) showed no UVC coverage. In optimisation studies (Run B, C), UVC coverage with levels of 100mJ/cm2 increased to 82% after 20 minutes (Run B) and 91% after 30 minutes (Run C). This was achieved by being able to deploy satellites around the room and position them both horizontally/vertically.

  1. Improving the care of a Urinary Catheter,  Central Vascular Access Device and Peripheral Venous Cannula by using monthly prevalence audits: Annette Koshti-Richman (Biomedical Device Specialist Practitioner) and Catherine Ford (Matron for Infection Prevention and Management Team), University Hospitals Plymouth NHS Trust

University Hospitals Plymouth NHS Trust Infection Prevention and Management Team (IPMT) Biomedical Device Prevalence Audits are completed by all clinical ward teams each month. The audits focus on the care of Urinary Catheters, Central Vascular Access Devices (CVADs) and Peripheral Venous Cannulas (PVCs).  Clinical teams gather key data on device care using the audit tool. Care issues are identified, and improvement actions supported both locally and across the organisation. Version 12.2 of the audit has recently been implemented, reflecting evolving practice.

These audits have facilitated significant quality improvement projects such as the creation of an electronic urinary catheter assessment and monitoring tool (eUCAM) with embedded clinical guidelines, increased use of Sheath Catheters to reduce numbers of indwelling catheters, improved urinary catheter fixation device use, increasing awareness of safest anatomical positioning of a PVC and embedding the use of Chlorhexidine-impregnated dressings for CVADs. 

The audits won the Influencing Change category of the Healthcare Quality Improvement Partnership’s Clinical Heroes Awards, 2024. Judges highlighted the clear structure and measurable impact of the audits, demonstrating reduced avoidable infections and improved clinical outcomes. By taking an evidence-based approach, the IPMT has successfully targeted changes to achieve the greatest benefit in patient care.

  1. Evidence-based cleaning project. Joanne Whateley - Clinical lead for service development (Healthcare NHS- ISS Facilities Services)

By using a scientific approach, we aim to answer the following question “By assessing the cleaning technique and revising the cleaning frequency of frequently touched surfaces, do we reduce the bioburden and rates of transmission?” In phase one, we observed frequently touched surfaces within a multi-occupancy bay on a surgical ward. In phase two this was extended to wards from different specialties to substantiate the initial dataset.

Specialities in phase two were the Medical Assessment Unit, Orthopaedics, Elderly care, Gastro, and Surgery. Each set of observations took place in a four-bedded bay. We completed 267 hours of observations. Using the elements in the National standards of healthcare cleanliness, the team observed touch points in the bay. The data collected was analysed to identify frequently touched surfaces and who touched the surfaces (patient, staff, or visitor).

The overbed table was the most frequently touched surface by all three groups across all the specialities. Frequently touched surfaces also included nursing equipment.

Some surfaces are touched consistently by all three groups in all specialties which could function as reservoirs for the transfer of bacteria. The next phase of the project is to swab surfaces touched by multiple groups to obtain baseline levels of bioburden.

  1. Implementation of a closed-loop recycling project in a non-acute paediatric healthcare centre. Bróna Fletcher - IPC Nurse Lead Adviser, Commissioning and Transformation Team, Children’s Health Ireland (CHI)

Children’s Health Ireland (CHI) provides health services for children & young people across Ireland. We operate 3 hospitals within the greater Dublin area & manage all national paediatric services.

Our pilot study took place in CHI at Connolly, an Urgent Care Centre & OPD in Dublin that has cared for 25,500 patients for minor illnesses and injuries and provided >9,000 in-person OPD appointments from August 2023 to August 2024.

Cartridges containing our hand hygiene products are recyclable however they are being disposed of via the domestic waste stream. Healthcare contributes to 5-15% of global carbon emissions. We wanted to identify how we can change a minor practice that could have a major climate impact.

Through innovation & collaboration, we aim to establish and validate the logistics, benefits & maintainability of recovery & recycling of foam soap & sanitiser cartridges. A multi-disciplinary group met to establish local practicalities, communications and education & training requirements for all stakeholders.

Recovery: the empty cartridge is removed from the dispenser and placed in a dedicated bespoke container. When at capacity, this container is collected & transported to the recycling plant. Because SC Johnson Professional uses HDPE (high-density polyethylene) this high-quality plastic can be processed & used to make new cartridges containing our essential hand hygiene products, thus closing the loop.

By measuring the data on a small scale, we can identify challenges & evaluate the potential for wider implementation.

Within 4 weeks, 40 cartridges were recovered & successfully removed from our healthcare waste stream. Current projections show we will recover 500 cartridges per annum equalling 33 kg HDPE plastic. Estimations for the new National Children’s Hospital project 15,000 cartridges = 1 tonne HDPE recovery. To date, we have had a 100% recovery rate based on consumption data & records kept by our lead multi-task attendant (MTA)- who monitors figures every month.