EDANA Tackles Infection Control

May 17, 2006

first-ever IN CONTROL! conference held in Prague

EDANA’s first-ever IN CONTROL! Infection control conference took place in Prague March 20-21, 2006 and featured 15 speakers covering many aspects of infection control, ranging from the various emerging infections throughout the world, such as the Avian Flu, SARS, Ebola and HCAI and the critical role the nonwovens industry is playing in this field. Preventing infection is critical in reducing patient suffering and morbidity, protecting medical staff and minimizing post-operative costs.         

The conference, was organized by EDANA (International Association for the Nonwovens and Related Industries) and supported by EFHSS (European Forum for Hospital Sterile Supply), EORNA (European Operating Room Nurses Association), EUCOMED (European Medical Technology Association), WHO (World Health Organization) and several national health care departments and associations. It marked an important step forward in the strengthening of the vital partnership between industry, healthcare establishments and national and international organizations.

Health Care Associated Infections (HCAI)

Professor Barry Cookson, director laboratory of Healthcare Associated Infection, Center for Infections, Health Protection Agency, Colindale, U.K., and Ronny Russell, Senior Lecturer in Microbiology; Moyne Institute of Preventative Medicine at Trinity College, University of Dublin, Ireland. Both highlighted the paradox of HCAI. It carries a high physical and financial burden, but infection control budgets are often small and relatively little action is taken in this domain, or worse, the problem is not even recognized.  Infection prevention is a complex problem with no ‘easy’ solution, requiring a multi-disciplinary approach and is sometimes perceived to be an almost superfluous expense.     

It is estimated that in the EU alone, HCAI, or nosocomial infections, affects one out of every 10 patients, causing roughly 3 million infections and some 50,000 deaths per year. This leads to not only a high cost in terms of human suffering and loss, but when looking at the bottom line, it costs in excess of €6.3 billion to annual health care budgets, not including litigation costs.  It is estimated that about one-third of HCAIs are preventable by improvements in infection control.

Professor Cookson outlined some pragmatic approaches to HCAI prevention and pan-European experience in controlling the spread of epidemic MRSA strains. Preventing infection is a feasible goal and is achieved much faster and more efficiently with industry/health care/public policy partnerships, which foster teamwork, synergies and exchange of best practices, he said. Cooperation at the European level has great potential to bring benefit, and indeed several European networks operate already, including HELICS (Hospitals in Europe Link for Infection Control through Surveillance), EARSS (European Antimicrobial Resistance Surveillance Scheme) and ESAC (European Surveillance of Antimicrobial Consumption). With the possibility of HCAI rapidly spreading between countries, these organizations play a vital role.

Healthcare Procurers Must Make The Right Choices to Prevent Infection

Mr. Russell confirmed that the use of barrier fabrics is now more necessary than ever to protect the staff and patients and also the medical devices used in their treatment. It is therefore critical for those procuring medical devices to be knowledgeable about them and make the correct choices regarding quality and suitability for purpose.  Infection prevention must be seen in a more holistic way, so cost should not be the main factor in making decisions regarding products to reduce the risk of infection.  By looking at the whole picture preventing infection will ultimately save money, but savings to the hospital or agency are usually reflected in other budgets—not in infection control.

The struggle goes on to produce better barrier fabrics, offering even better protection under the most difficult of circumstances while microbes continually change their properties in order to overcome the obstacles put in their way.

Infection Prevention

Melanie van Limborgh, Immediate Past Chairman of the Association for Perioperative Practice (UK), provided a fascinating insight into the role of the operating department in infection prevention.

There are a number of critical areas that help determine the effectiveness of infection control, ranging from the environment, design and preparation of the operating room to the preoperative preparation of personnel and the patient. Using the right surgical barrier and protective gowns, masks and head- and footwear are some of key means to achieving optimal protection from infection.

European Standard EN 13795

The need for preventing the transfer of infection between patient and medical staff has never been greater.  The introduction of the three-part European standard for surgical drapes, gowns and clean air suits, used as medical devices, EN 13795, has been put in place for the protection of patients, clinical staff and equipment.

Part 1 provides the framework for the standard, lists the characteristics that are to be used for evaluation of the product's performance and what information the manufacturer has to provide. It also describes the manufacturing and processing requirements. Part 2 is a list of test methods to be used for each of the characteristics listed in part 1. Part 3 relates to performance requirements and at the time of the conference, this had not been yet adopted.  However in terms of the structure of the performance requirements, it is confirmed that for both drapes and gowns, there are four possible categories of performance—standard and high performance for both the critical and less critical product areas.

The Role of Nonwovens In Infection Prevention

For decades nonwovens have been used as the material of choice for medical fabrics in the operating room and for the prevention of disease and infection. The principal advantage of nonwovens is that they are used only once on one single patient and incinerated after use, thus avoiding the need for handling and the consequent potential for spreading contaminants.

For use in the operating room single-use medical nonwovens meet all the requirements stipulated by EN 13795:

• the avoidance of bacterial penetration and the spreading of contaminants;

• water-repellency, which is not only a matter of comfort, but is essentially aimed at preventing bacteria from penetrating the fabric;

• softness, breathability and drape - all relating to the comfort of the user.

Nonwovens provide the additional attributes of low linting and cost-efficiency. The type of nonwoven used in the operating theater depends on the desired properties.  

Hydroentangled carded or so-called spunlaced fabrics are very comfortable for the wearer, offering optimal breathability, drape, moisture vapor permeability and other comfort related properties.   Their barrier properties, however, compare less favorably with other types of nonwoven fabrics.

The other technology of choice for medical fabrics is known as SMS, which is a polymer-to-web sandwich construction including at least two spunlaid webs and an increasingly large number of meltblown webs. Meltblown technology provides the highest water penetration resistance without the need for additional, subsequent repellency treatment—and still, it is air permeable. Better results can be achieved only with fully impervious film laminates, which are also breathable. The introduction of an increasing number of meltblown webs is viewed as a way of increasing water repellency and consequently bacterial barrier properties. Resistance to water penetration above 800 mm water column can be achieved with SMS fabrics.  

Nonwovens Used To Combat SARS in China

The nonwovens industry has demonstrated the ability to rapidly respond to natural and man-made disasters with products that aid in the prevention of disease transmission, and it continues to develop enhanced performance materials to meet these demanding applications.

Over 100,000 tons of nonwovens were used in the fight against SARS in China in 2003.  Nonwovens' outstanding bacteria filtration capabilities, barrier properties, splash resistance and breathability made it the material of choice for the thousands of millions of masks and protective apparel used by Chinese citizens and health workers during the crisis.

Sterilization and Packaging

Packaging not only makes it possible to store sterile medical devices and to use them when needed, it also makes it possible to have the devices treated in a specialized and dedicated unit namely the central sterilization department.

The choice of packaging for nonwovens is extremely important as it has to meet its primary aim which is to guarantee the sterility of the content until the time of use.  Sterility always implies that the packaging is intact because otherwise the microbial barrier is compromised.

Wim Renders, Chairman of the European Forum for Hospital Sterile Supply (EFHSS) reported that today anonymous committees make the decisions on almost everything including purchases for hospitals’ Central Sterile Services Departments. When decisions are made the cheapest quotation is often preferred.  The committee members often lack the necessary product knowledge and thus savings on packaging materials are easy ways of saving money.

A trend toward outsourcing sterilization is growing and is supported by a number of decision makers inside the hospital who do not think that sterilization activities are a core business of the hospital and thus can be outsourced in the same way as cleaning, catering and technical services.

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