An Australian study has evaluated various functional characteristics of the RediRoom, a temporary isolation room designed for single patient use. The mixed methods approach involved video recording, interviews, and objective temperature and humidity measurements within a crossover intervention study, concluding that the RediRoom had similar functional performance to performing patient care in an open plan area.
Single rooms are in short supply in many parts of the world, especially in the NHS. The RediRoom provides a temporary single room that can be used for contact or droplet isolation of patients. It is designed to be used to provide additional isolation capacity for individual patients in inpatient hospital settings, and also to provide temporary single rooms for patient triage in emergency situations.
In this study, the RediRoom was evaluated in a simulated clinical ward environment. Participants undertook a range of clinical nursing activities in the RediRoom or in a control area, including transferring patients, administration of medications, measurement of observations, performing an aseptic technique, bed bathing a patient, and cardiopulmonary resuscitation. A network analysis of staff movements in the room, and staff feedback via interviews and a questionnaire were used to evaluate the functionality of the RediRoom vs. control area. Also, temperature and humidity was measured in the RediRoom and control area.
The time taken and the number of movement required to complete the clinical nursing activities was broadly similar in the RediRoom and control area. A network analysis of the two activities that involved the most individual movements showed that there was close similarity in the pattern of movements in the RediRoom and control area. Recurring themes from interviews with staff were a sense of restriction, temperature, and management of critically ill patients. However, it is important to note that the RediRoom was not compared against another single room, but against an open plan area. It is likely that the sense of restriction and temperature themes would be less prominent if the RediRoom was compared to an isolation room. There was a slight increase in temperature in the RediRoom compared with the control room, of around 0.5°C.
Overall, the RediRoom had similar functional performance to performing patient care in an open plan area. The study focussed entirely on any impact that the RediRoom would have on functional performance of clinical nursing tasks, and did not quantify the main benefit of the RediRoom, in terms of reducing infection prevention and control risk, which is another story altogether...
A recent JHI study highlights both the promise and limitations of self-disinfecting surfaces. The study evaluated the efficacy of five different self-disinfecting surfaces against S. aureus under simulated real-life conditions. The small antimicrobial effects noted initially disappeared once most of the surfaces began being cleaned using alcohol wipes!
The team examined the efficacy of five self-disinfecting surfaces: a micro-patterned film (based on Shark skin to reduce bacterial adhesion), and four surfaces dosed with antimicrobial agents: zinc molybdenum (ZM), polyguanidin silica (PS) and two based on membrane-active polycations (maPK-I and maPK-a). A bacterial load of 8-log cfu was applied and then dried, before being sampled at 15 mins and 3 hours using contact plates. Only the MP, maPK-I and maPK-a based surfaces resulted in a reduction in bacterial contamination. The antimicrobial impact of MP and maPK-i disappeared after a single disinfection cycle, so were not stable enough to be useful. However, the maPK-a surfaces continued to exhibit an antimicrobial impact but only up to 19 disinfection cycles.
The inoculum used in the study was rather high (at 8-log), and probably not representative of the real-life environment, where contamination levels are usually lower. Also, the first exposure point tested was 15 minutes, whereas more rapid activity would be a favourable characteristic for a self-disinfecting surface: after all, how long does it take for a transmission to occur? Finally, the study only included S. aureus and, importantly, did not include C. difficile spores; sporicidal activity would be a huge plus for a candidate self-disinfecting surface.
The study used copper alloy surfaces as a control group, and based on these results, copper surfaces remain the prime candidate for antimicrobial surfaces. However, installing copper alloy surfaces is expensive, not suitable for all surfaces / equipment, and may not be durable in the clinical environment. Therefore, further development is required to achieve a low cost, high efficacy, durable self-disinfecting surface suitable for use in the clinical environment.
Neutropaenic patients are susceptible to fungal infection, which are extremely difficult to treat and can often be fatal. The problem is that fungi are all around us - especially in the air. This isn't a problem for healthy people, but can be a major problem for neutropaenic patients, who have a low white cell count so struggle to fight infection. An emerging approach to this problem is the use of stand alone air handlers to reduce the amount of fungi in the air. A recent study shows that this approach significantly reduced the rate of Aspergillosis in neutropaenic patients.
The study was performed over two years in patients with chemotherapy-induced neutropaenia in a haematology ICU. Half of the 15 bed unit was fitted with Plasmair air decontamination units. Regular environmental sampling demonstrated a significant reduction in air contamination above 5 cfu/m3 (7% vs. 19%), and particle count above 350,000 per m3 (4% vs. 93%). There was also a non-significant reduction in surface contamination in Plasmair-containing rooms. More importantly, there as a significant reduction in the rate of Aspergillosis in patients admitted to Plasmair-containing rooms (1 case) vs. non-Plasmair-containing rooms (10 cases) (odds ratio 0.11, 95% confidence interval 0.00-0.84).
The study isn't perfect: patients were not randomised to the different rooms, and the number of clinical cases of Aspergillosis was low. However, the study does demonstrate a stark environment and clinical impact of Plasmair in patients who have chemotherapy-induced neutropaenia.