Better Maintenance Of Hospital's Rolling Stock Effects Infection Control, Bottom Line

By Chris Wilkerson

Brooklyn, NY - Today, with nosocomial infections on the rise and making headlines daily, the need for an integrated approach in hospitals to maintain high standards of disinfection is evident. This is true not only of medical and surgical instruments but also the kind of non-critical care equipment that frequently "falls through the cracks" in healthcare settings. This includes all types of non-electric patient items such as geri chairs, over-the-bed tables, wheelchairs, stretchers, hospital beds, medication carts and IV poles.

The maintenance of such items is frequently overlooked as hospitals deal with funding cuts, insufficient staffing and day-to-day emergencies. Yet standardized practices make long-term financial sense. Equipment used to transport patients, hold IV medications or diagnostics that is not disinfected, maintained and inventoried can cause a financial burden to a hospital at best. At worst, contaminated surfaces are a danger to patients and employees.

At EquipSystems, we've found that when disinfection is coupled with equipment repair and inventory management, the situation becomes beneficial to the hospital not only for medical but also for financial reasons.

The majority of hospitals have established many common sense protocols to control nosocomial infections. Despite emphasis on such practices as hand-washing, hard surface sanitation and isolation, recent reports show that overall hospital-acquired infection rates in the United States are growing.

Some pathogens are persistent, able to survive on inanimate surfaces for an extended period of time. Many bacteria are common in healthcare environments, including Vancomycin Resistant Enterococci (VRE). A 2000 study published in the American Journal of Infection Control showed that VRE was present even on hospital furniture, including three out of ten chairs tested.

Last year, we conducted our own independent study to determine the amount of bacteria, viruses and fungi on non-critical equipment surfaces both before and after cleaning. The items we tested for this project included stretchers, geri chairs and over-the-bed tables in an actual hospital setting. Sites were tested for total bacteria, VRE, molds and yeast.

Our results showed that even the most dangerous bacteria were present in alarming quantities on all surfaces tested. As an example, innocent-looking over-the-bed trays, where patients ate and left their personal affects throughout the day, were overwhelmingly positive for VRE. In the hospital where we conducted our test, there was no standard disinfection procedure for this common fixture—and many others. Housekeeping routinely handled them as if they were a piece of furniture rather than a breeding ground for disease.

In a hospital environment, all heavily-used equipment should be carefully assessed. Emergency room stretchers, for example, frequently come into contact with the sickest patients. Our in-hospital study showed that the side rails, unlike the mattress, which is sometimes shielded with a sterile drape, were laden with VRE. It makes complete sense to ascertain their cleanliness as well as their function.

There are other reasons to strive for best practices as they apply to the maintenance of hospital equipment and facilities. State inspectors can make unscheduled visits to any acute healthcare facility. And, since January 2007, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has been making unscheduled visits, forcing healthcare providers to be vigilant.

No one denies that the care of such non-critical equipment is frequently neglected. As one hospital administrator put it, "Despite our best intentions, we cannot maintain this equipment the way it needs to be maintained. Because we're dealing with emergencies on a moment-to-moment basis and budgetary restraints, we need to find a better way."

Apathy, budget constraints and lack of planning all contribute to valuable items becoming overused and under-serviced. Like an automobile that runs for tens of thousands of miles without an oil change, dirty and unsafe equipment can potentially lead to injuries, infections and reduced patient and staff satisfaction.

Expenditures for such equipment are not small: Electric hospital beds range in price from $8,000 to $10,000; stretchers and med carts from $3,000-$9,000; and wheelchairs upwards of $500 a piece. Multiple this by dozens—or sometimes hundreds—and the financial responsibilities are obvious.

When expensive stretchers and wheelchairs are "lost" or moved to a backroom storage area when they no longer work correctly, or when basic equipment like medication carts and hospital beds are overused to the point of malfunctioning, there can be a number of negative outcomes. Patient care can be compromised. The hospital runs less efficiently. Nurses, aides and technicians are taken from their primary purpose of providing care to search for equipment. The equipment itself wears out before its time. New equipment is purchased when, if it was cared for in the first place, wouldn't need to happen. Hospital operating costs go up. The list goes on.

Our inventorying methods include common sense procedures borrowed from industry. After each piece of hospital equipment is cleaned and disinfected, it is bar coded for inventory and maintenance purposes. This creates a "history," making it easier for hospitals to quickly review its life cycle.

In the midst of busy routines, hospitals may find the upkeep of rolling stock difficult. But such maintenance is critical to a hospital's best practices. It is also extremely important to patient outcomes to insure infection control and cost-containment measures.

SOURCE: EquipSystems