The Evaluation of Electrolyzed Water, Sodium Dichloroisocyanurate and Peracetic Acid with Hydrogen Peroxide for the Disinfection of Patient Room Surfaces

BACKGROUND

Sporicidal disinfectants are necessary to control Clostridioides difficile and Candida auris. Novel application methods such as electrostatic sprayers may increase disinfection effectiveness. We employed a standardized protocol to assess three sporicidal disinfectants: electrolyzed water (EW), sodium dichloroisocyanurate (NaDCC) and peracetic acid/hydrogen peroxide (PAA/H₂O₂).

METHODS

The study was conducted at two New York City hospitals (1,082 total beds) over an 18-month period. The three chemicals were applied by housekeeping personnel following the hospital protocol; the use of electrostatic sprayers was incorporated into EW and NaDCC. In randomly selected rooms, five surfaces were sampled for microbial colony counts after cleaning. Data analyses were performed using negative binomial logistic regression.

RESULTS

We collected 774 samples. NaDCC-disinfected surfaces had a lower mean colony count (14 CFU) compared to PAA/H₂O₂ (18 CFU, p=0.36) and EW (37 CFU, p<.001). PAA/H₂O₂ and EW had more samples with any growth (both p<.05) compared to NaDCC. NaDCC applied with wipes and an electrostatic sprayer had the lowest number of samples with no growth and <2.5 CFU/cm² (difference not significant).

CONCLUSIONS

The use of NaDCC for surface disinfection resulted in the lowest bacterial colony counts on patient room high touch surfaces in our study.

977 IMPLEMENTATION OF THE FIRST FRAILTY UNIT IN WESTERN AUSTRALIA

Background

Implementation of the first Frailty Unit in Western Australia within the tertiary Hospital—Fiona Stanley. The Frailty Unit was based within the Acute Medical Unit and included a Geriatrician, Medical team, Multidisciplinary Allied Health (AH) Team and Acute Medical Nursing Staff to manage a 12 bed Frailty Unit.

Introduction

Evidence shows that a prolonged hospital stay can be a risk factor for hospital acquired complications, deconditioning, loss of independence and early entry into residential care. This is especially evident amongst the frail population. This leads to poor outcomes of patients, high costs from complications and prolonged hospital admissions. The primary goal of this unit was to provide comprehensive Geriatric assessment from a multidisciplinary team at the front door of the hospital which will improve patient centered care and allow earlier discharges with a multitude of issues being addressed on day 1.

Method

included the allocation of staffing as documented above which provided earlier Geriatric assessment as well as comprehensive AH input. The intent was to redirect patients out of the hospital and back into the community to utilise nursing, medical and AH staff who can further assess and support patients in their own home environment and out of the busy hospital system.

Results

The impact of this change comparing 2018 (calendar year) with 2020/21 (financial year) has included: Readmission rates (0–7 day readmission) reduced from 8.5% to 6% Increase of 7% (182 patients) returning to their usual residence For those returning home, significant reduction in length of stay on this ward by 30%.

Conclusion

The effect on length of stay and higher quality assessments of elderly patients on day 1 has been clear not only from the data but also from staff experience who have seen a difference in the impact of this model.

981 FIONA STANLEY FREMANTLE HOSPITAL GROUP'S CHOICE PROJECT SUPPORTS EARLY DISCHARGES AND MINIMISES LENGTH OF STAY FOR FRAIL PATIENT

Background

In 2019, Fiona Stanley Fremantle Hospital Group (Western Australia) launched a project to support earlier than usual discharges for frail elderly patients. This project was branded CHOICE—Consider Home Over Inpatient Care Every time.

Introduction

Evidence suggests that older adults admitted to hospital are at greater risk of further complications and declining health than those cared for at home. Our problem is that the decision to prolong admission can be influenced by our perception of risk which can delay discharges and increase risks for deconditioning, functional decline, hospital acquired complications and early entry into residential care.

Method

CHOICE implemented 2 key strategies improve patient outcomes and reduce health care costs by minimising LOS: 1. Promotion of a home-first culture began in April 2019 using staff education, training and positive reinforcement. A focus was on positive risk taking behaviours that keep the unique values of our patients at the forefront of all decisions. 2. The CHOICE Team launched in November 2019 to support early diversion of care and assessment into the community. Key elements included an Allied Health led Discharge to Assess service, rapid response Geriatrician clinic and a Nursing outreach service.

Results

Outcomes achieved in the 20/21 financial year were compared against pre CHOICE (2018) data for patients aged greater than 75 years on target wards 1,756 bed days were saved for patients returning home 22% reduction in discharges directly into care facilities 444 additional home discharges 91% of surveyed patients (n100) felt completely satisfied having their health assessments completed at home Readmission rates did not increase.

Conclusion

The CHOICE model has been shown to be more cost-effective and clinically effective than traditional practice. CHOICE is now embedded into the operational budget with workforce costs offset by bed day savings and an increase in activity based funding.

Waste generation and carbon emissions of a hospital kitchen in the US: Potential for waste diversion and carbon reductions

This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitchen generated 1515.15 kg (1.7 US tons) of solid waste daily or 0.23 kg of total waste per meal served. Extrapolating to all meals served in 2019, the hospital kitchen generates over 442,067 kg (487 US tons) of waste and emits approximately 294,466 kg of CO2e annually from waste disposal. Most of this waste (85%, 376,247 kg or 415 US tons annually) is currently sent to landfill. With feasible changes, including increased recycling and moderate composting, this hospital could reduce landfilled waste by 205,245 kg (226 US tons, or 55% reduction) and reduce GHG emissions by 189,025 kg CO2e (64% reduction). Given NYC's ambitious waste and GHG emission reduction targets outlined in its OneNYC strategic plan, studies analyzing composition, emissions, and waste diversion potential of large institutions can be valuable in achieving city sustainability goals.

Discharge before noon: an achievable hospital goal

BACKGROUND

Late afternoon hospital discharges are thought to contribute to admission bottlenecks, overcrowding, and increased length of stay (LOS). In January 2012, the discharge before noon (DBN) percentage on 2 medical units was 7%, below the organizational goal of 30%.

OBJECTIVE

To sustainably achieve a DBN rate of 30% and to evaluate the effect of this intervention on observed-to-expected (O/E) LOS and 30-day readmission rate.

DESIGN

Pre-/post-intervention retrospective analysis.

SETTING

Two acute care inpatient medical units in an urban, academic medical center.

PATIENTS

All inpatients discharged from the units.

INTERVENTION

All staff helped create a checklist of daily responsibilities at a DBN kickoff event. We initiated afternoon interdisciplinary rounds to identify next-day DBNs and created a website for enhanced communication. We provided daily feedback on the DBN percentage, rewards for success, and real-time opportunities for case review.

MEASUREMENTS

Calendar month DBN percentage, O/E LOS, and 30-day readmission rate.

RESULTS

The DBN percentage increased from 11% in the 8-month baseline period to an average of 38% over the 13-month intervention (P = 0.0002). The average discharge time moved 1 hour and 31 minutes earlier in the day. The O/E LOS declined from 1.06 to 0.96 (P = 0.0001), and the 30-day readmission rate declined from 14.3% to 13.1% (P = 0.1902).

CONCLUSIONS

Our study demonstrates that increased DBN is an achievable and sustainable goal for hospitals. Future work will allow for better understanding of the full effects of such an intervention on patient outcomes and hospital metrics.

Reengineering a cardiovascular surgery service

BACKGROUND

Reengineering, involving the radical redesign of business processes, has been used successfully in a variety of health care settings. In 1994 New York University (NYU) Medical Center (MC) launched its first reengineering team, whose purpose was to redesign the entire process of caring for patients-from referral to discharge-on the cardiovascular (CV) surgery service. REENIGINEERING TEAM: The multidisciplinary CV Surgery Reengineering Team was charged with two goals: improving customer (patient, family, and referring physician) satisfaction and improving profitability. The methodology to be used was based on a reengineering philosophy-discarding basic assumptions and designing the patient care process from the ground up. THE TRANSFER-IN INITIATIVE: A survey of NYU cardiologists, distributed in April 1994, suggested that the organization was considered a difficult place to transfer patients. The team's recommendations led to a new, streamlined transfer-in policy. The average waiting time from when a referring physician requested a patient transfer and the time when an NYUMC physician accepted the transfer decreased from an average of 9 hours under the old system to immediate acceptance.

OTHER INITIATIVES

Three customer satisfaction task forces implemented multiple programs to make the service more user friendly. In addition, referrals increased and length of stay decreased, without an adverse impact on the mortality rate.

CONCLUSION

For the first time at NYUMC, a multidisciplinary team was given the mandate to achieve major changes in an entire patient care process. Similar projects are now underway.

Finger flexion function in rheumatoid arthritis: the reliability of eight simple tests

The inter- and intra-observer errors of eight tests of finger flexion function were estimated from the results obtained by three observers assessing 10 patients with rheumatoid hand involvement. Measurements of finger flexion and muscle power involved both conventional and novel techniques using simple and easily constructed apparatus. For each test, measurements were in agreement between observers and were reproducible on three occasions. These tests may now be used with confidence by other investigators.