Modern healthcare is all about choices, with patients having the legal right to choose which hospital their GP refers them to for specialist treatment. The NHS suggests a number of criteria for comparing hospitals, from the mundane to the critical, for example parking facilities to mortality rates and hospital location to hospital infection rates.
Infection rates are still a hot chestnut that can deliver many a sleepless night to trust chief executives and cost the public purse dear. Much progress has been made in reducing the prevalence of bugs such as MRSA and C-Diff. The latest Health Protection Agency figures show there were 419 cases of MRSA from April to June 2010, a welcome drop on the peak years around 2006.
That said, infection rates are still of great importance yet there is one line of defence that has yet to gain widespread adoption in healthcare environments – antimicrobial building products.
These products, from Marshall-Tufflex’s Bio Trunking Solutions range from cable management solutions to door handles, privacy curtains, floor and wall coverings and light switches, are proven to be 99.9% effective against bacteria responsible for some healthcare acquired infections, for example MRSA, Klebsiella Pneumonia, E-Coli, Salmonella and other less dangerous infections which can, nonetheless, hamper recovery.
The science behind these systems revolves around the use of silver ions, which prevent bacteria from reproducing, killing 99.9% of bugs. If a person carrying MRSA or E-Coli, for example, touches the treated surface, bacteria transferred to that surface begins to die, minimising the risk of cross contamination. On untreated products the harmful bacteria flourish. Silver ion technology activates when in contact with minute quantities of moisture in the air. For this reason bacterial resistance is not an issue. And for those systems with the antibacterial agent integral to the PVC-U (it’s mixed in during manufacturing) performance is maintained throughout the lifetime of the product, even if the material is knocked, chipped or scratched.
So, would you prefer to be treated on a ward that has been kitted out with these antimicrobial products or on a normal ward with no such protection? It’s a vexing question given that at present it’s very difficult for patients to know which hospitals have adopted this new approach to infection control and, indeed, which departments within individual hospitals have taken this belt and braces route, which has to be in addition to scrupulous cleaning and hand washing regimes.
Silver ion technology is proven to work – consider the results of a study that compared two hospital wards, one equipped with a range of antimicrobial building products and the other with standard-issue products and compared bacteria counts. The study revealed that counts on the antimicrobial products were 95% or more lower than bacteria counts taken from a similar product on the untreated ward. Great news, but not the most interesting finding of the research; samples taken from untreated surfaces in the antimicrobial ward were 40% lower, suggesting that antimicrobial products have a positive effect on their environment as well.
Barrier to specification
So, building products enhanced with silver ion technology are highly effective against some of the most virulent and dangerous bacteria found in hospitals and health-care environments. So why aren’t more health trusts snapping them up and incorporating them into new-build and refurbishment projects? It’s a vexing question with an equally frustrating answer.
At first it seemed there was no nationwide NHS policy on the specification of antimicrobial products and systems, with some Infection Control Panels immediately interested and others largely unaware of this new technology. Confusingly, a few trusts had disparity within their own organisations, with some departments specifying treated building products and others not interested. We also discovered that many NHS managers did not realise antimicrobial products could be incorporated into design and build materials and most would not have considered design and build materials as part of an HCAI programme.
However, after much head scratching, research and consultation we discovered there was a policy. Contained within Health Building Note (HBN) 00-09 (due for publication July/August 2010) is a reference to antimicrobial products that states: “There is, at present, no definitive data to support their efficacy in reducing health-care associated infections”.
At first reading this appears to be a body blow to the whole antimicrobial building product community. But it’s not. The Department of Health is simply stating that it needs hard data demonstrating that antimicrobial building products reduce HCAIs. And that means live tests on live patients in live, controlled, health-care environments. Until such research is possible health trusts are free to specify and install antimicrobial solutions but each is left to make its own decision. This piecemeal approach is a great shame given the effectiveness of these products, which are tested to international standards and often cost only a little more than the standard version. We’d argue that, at the very least, they should be high on the list of considerations for wards and units treating more vulnerable patients, for example neo-natal units, cancer units, geriatrics etc.
The financial cost
To put the extra cost of antimicrobial building products into perspective, patients contracting an HCAI spend, on average, an extra 11 days in hospital and cost three times more to treat (often in isolation) than uninfected patients. The overall cost to the health service annually is estimated at £1 billion.
The approvals issue is not the only stumbling block. One health trust has been quoted as stating that it is worried that if the public gains information about antimicrobial building products they will only want to attend hospitals equipped with these systems. Others are concerned that cleaning operatives will not work as effectively if they know these systems are installed. We wonder why that should be the case. If the job profile states that the cleaning team should clean surfaces once every 24 hours, then it is not a matter for discussion. At a recent seminar discussing the use of silver ion technology Edwina Currie, a patron of MRSA Action UK, strongly disagreed with the view that it would encourage cleaning operatives to be less thorough.
It’s important to stress that the effectiveness of silver ion technology is not in question – it is already used widely within the NHS for wound dressings, medical equipment etc, where evidence-based data has shown its efficacy. Building products incorporating silver ion technology have demonstrated huge bacteria count reductions ‘within the environment’ but there’s no data to support a direct link to HCAI reduction. We know it works, they know it works but protocol dictates a testing procedure that could prove virtually impossible to carry out and may not reach a satisfactory scientific conclusion.
Conclusion
While there is no substitute for meticulous cleaning regimes and scrupulous personal hygiene, building products such as this are a valuable and additional weapon that can be used to great effect in the fight against superbugs and other infections. Antimicrobial cable containment is a straight-forward, cost-effective and proven method of neutralising some of the most common and dangerous bacteria found in hospitals, care homes and other locations where infection control is an issue. It works silently, invisibly and round the clock, killing bacteria and helping to prevent cross-infection.
In the face of such compelling evidence it is frustrating that more healthcare facilities and environments where cross-contam
ination is an issue are not being equipped with these highly effective products.