Technology is taking an old problem—the transmission of healthcare-associated infections (HAIs)—and looking at new ways to prevent it. Crothall Healthcare, which provides support services and environmental services (EVS)
to hospitals and other healthcare facilities, is one of the organizations implementing automated and smart technology to help stop the transmission of HAIs.
In 2019, Crothall Healthcare began a partnership with the American Nursing Association in its quest to reduce the instances of C. diff and other HAIs in the facilities it serves. “The association brought a wealth of knowledge
on how to best partner with clinical teams on combating healthcare-associated infections,” said Sophia McCrae, vice president of operational strategy at Crothall Healthcare. “It truly takes a team to minimize the spread of HAIs.”
The partnership increased the number of accounts that utilize a hygiene monitoring program using radio-frequency identification (RFID) to track whether healthcare employees wash their hands properly.
Washing until the green light
For example, a New York hospital, partnering with Crothall, installed RFID sensors on sinks, hand sanitizer dispensers, and soap dispensers, which healthcare employees use before treating patients or cleaning patient rooms. This technology communicates with sensors on staff badges to signal how long the employees are washing their hands.
“It’s a hospital-wide initiative; every department is monitored, not just environmental services, to create a culture that prioritizes hygiene,” McCrae said.
When employees approach an RFID-equipped sink or dispenser, they see a yellow light to remind them to wash. If they don’t wash long enough to remove germs, a red light flashes. The light remains red until they are compliant; then it flashes green.
“Green is clean, bright yellow is a reminder, bright red means stop and rewash your hands,” McCrae explained.
Employee noncompliance is reported to a supervisor. However, the system is not solely punitive; it also provides data on compliant employees. “This allows us to recognize and reward compliance,” McCrae said.
Since the RFID system was installed in 2021, the hospital has seen higher hand hygiene compliance and experienced increased patient satisfaction regarding hospital hygiene.
“Accounts that utilize this system are above the 75th percentile for patient satisfaction, based on surveys,” McCrae said. “When patients see hospital staff washing their hands during interactions, this improves their perception of cleanliness and increases their confidence in safety protocols.”
Revealing invisible C. diff spores
In addition to improving hand hygiene, technology is tackling challenges in surface hygiene, including detecting when a surface is contaminated with invisible pathogens.
“In environmental services, we aim to find the dirt and clean the dirt; find the dust and get rid of it,” McCrae said. “But what happens when you don’t really know what is living on a surface because you can’t see it?”
Crothall joined forces with an organization that created a microbiological visualization tool that reveals the presence of C. diff with a unique patented spray. Cleaning staff spray down a surface and wait three to five minutes. Then, using ultraviolet lights and goggles, they can see the illuminated C. diff spores.
Historically, Crothall EVS teams have concentrated on disinfecting specific high-touch patient room areas such as bedrails and over-the-bed tables. After testing multiple surfaces with the spray, they have added adenosine triphosphate (ATP) swab testing to additional high-touch areas, such as shower fixtures and glove boxes.
EVS crews learn how to use the spore visualization spray in simulation labs. New hires are trained to use it as part of their onboarding.
“We are exploring it in about 20 of our accounts today, and we are participating in research with an academic medical center,” McCrae said. “We are seeing significant research outcomes, both quantitative and qualitative.”
Automating UVC disinfection
Ultraviolet (UVC) light disinfection is not a new technology. However, the most modern units now feature artificial intelligence- (AI) powered automation.
Crothall-serviced facilities formerly used AI disinfection units that EVS workers needed to move around a room manually. Now they use fully autonomous UVC systems that are mounted in the corner of the room.
“You can tell the system which surfaces to disinfect, and when nobody is in the room, it will automatically turn on,” McCrae said. “It knows which surfaces to attack and the exact height of these surfaces. We can pre-set it to sporicidal mode, and if C. diff is present, it will intentionally target the spores.”
McCrae said the automated UVC disinfection system has resulted in a 3-log reduction in C. diff spore counts in facilities that use that system.
Enhancing manual cleaning
Technical advancements like AI-automated UVC disinfecting systems will not replace the importance of manual cleaning and the need for EVS staff to perform that cleaning. However, they can add an extra level of disinfection that lowers the risk of contracting an HAI. “The technology has resulted in a significant reduction in bioburden,” McCrae said.
Spore visualization sprays and other advancements also provide a roadmap that guides EVS teams to the surfaces most in need of attention, so they can distribute their time and effort more effectively.
“In cleaning, we always talk about turnaround times and benchmarks,” McCrae said. “Cleaning and disinfection technology helps us understand how much time we are spending on each surface and whether we are spending too much time in one area and not enough time in another.”
