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The pillow is a vector for infection

Reduce infection risks,Improve patient care,Save your hospital money

Supported By: Acknowledgement to:

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Pillows as a Risk Area

Pillows as a Risk AreaLange V. AJIC (2014) 42 S34-35

Exterior surface of 100 pillows swabbed• Previously cleaned with a quaternary ammonium

compound38% contaminated

• MRSA, VRE, Coliforms, inc E. coli and K. pneumoniae

Concluded• Reusable hospital pillows may serve as

reservoirs for nosocomial pathogens• Clear and rigorous guidelines should be

established for decontamination of patient beds and pillows

• Outbreak investigations should include…pillows and mattresses

• Currently reviewing options such as a barrier pillow cover

Control of CA-MRSA in a Burn CentreShik N., Ford S. et al AJIC (2014) 34(5) E100-102

Burn Centre• Nurses discovered patient pillows varied in

weight and detected stains on some pillow covers

Presence of small manufactured openings for air exchange within the pillow core

• Potential for wound drainage contamination and transfer of microorganisms

2 outbreaks in a Burns Unit• During the outbreak investigation it was noted that

pillows used in the hospital were not fluid-proof, and when cut open, many were visibly contaminated with body fluids Examination of Pillow Cores

Mottar R., Roth M et al AJIC (2006) 34(5) E107-108

Patient pillows and a control (unused) sent for testing

• Pillow seams and pillow label tags were found to be a mechanism for pillow contamination allowing for drainage wicking from outside the pillow to the pillow core

Multiple pathogens found growing within pillow cores of all patient pillows

• Correlation to organisms from colonised and infected patients

• Acinetobacter cultured from a patient with colonisation of the face

Study looking at 100 standard and 100 barrier pillows (Sleepangel™, a class 1 medical device)

• Pneumapure™ nanofilter membraneIn use for 3 months and sent for analysis

• External contamination of both types• Internal contamination of standard

pillows, all barrier pillows contamination free

• 60% of standard pillows failed mechanically at 3 months, no barrier pillows failed

• Whole Trust replacement programme Significant MRSA and CDI reduction Pillow is a Vector

Tucker A., Dewhurst, M. Abstract, IPS Conf 2012

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Pillows – pathogen ingress and transmission routes

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Does the clinical community care?“A key element of this strategy is to control the dispersal of microbes via contaminated bed linen, mattresses and other points of close contact with infected individuals”Thilagavathi, G. Kannaian, T. 2008 Indian Journal of Fibre and Textile Research, Dual antimicrobial and blood repellent finishes for cotton hospital fabrics“Often only the bedrail has been sampled during investigation of outbreaks, rather than more important potential reservoirs of infection, such as mattresses and pillows, which are in direct contact with patients. It is essential that these items and other bed components are adequately decontaminated to minimise the risk of cross-infection.” Creamer E, Humphreys H. The contribution of beds to healthcare-associated infection: the importance of adequate decontamination J Hosp Infect. 2008 May;69(1):8-23.

“As a result evidence is clear: good practice in infection control in hospital, should include the deployment of CE medical device infection control pillows such as SleepAngel, as well as diligence in cleaning and disinfection, together with the implementation of a pillow audit protocol.”Diane Wake, Chief Operating Officer, Liverpool & Broadgreen University NHS Trust, Reducing HCAI Conference, London, 2013

Infection control and cross-infection

present a major problem for hospitalsi

greatly increasing risk to health and

causing considerable expense. Bedding

interiors colonised with bacteria, become

a reservoir of infectionii, posing an

increased risk of Hospital Acquired

Infections.

(i) Wilson, Jenny Infection control in clinical practice Balliere Tindall, London 1995

Medical device hospital pillowSleepAngel® with PneumaPure™ Filter Technology

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Class I Medical Device

SleepAngel™ Testing and Validation

6Dr. Bruce Mitchell, Clinical Immunologist and CEO, Airmid Healthgroup

Please visit youtube to view this video www.youtube.com/watch?v=EQjKz9eDDB0?list=PLshwoY7GBQqcFmbcX38mws6N5ig_JDWC9

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Post market evaluation – NHS HospitalSame story – pillows as a potential vector

• They don’t just get used under heads..

Respiratory ward – a problem area (Abx, revolving door)

• Prior to intervention; 0.52 CDI/month• Post intervention; 0.12 CDI/month• No other differences (virtually all other

wards increased)Although antibiotic prescribing targets were raised the ward was already meeting new standards

Very popular with staff• Plus: Easy to clean, robust and comfortable

for patients; Less numerically required• Concern: Disappearing act..

Beds of RosesMaintenance of safe patient environments by nurses, Reducing HCAI Conference, London, June, 2014

Martin KiernanChair Education Committee HIS, Former President of World Infection Prevention SocietiesNurse Consultant, Southport and Ormskirk NHS Hospitals Trust

CLICK LINK TO VIEW MARTIN KIERNAN MASTER CLASS SLIDES

(Slides 33 on refer to hospital pillows)www.bit.ly/bedsofroses_2014

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Post market evaluation – NHS Hospital

Reducing HCAI Conference, London 2013

Diane Wake, Chief Executive Officer(previously Director of Infection Prevention and Control at Liverpool & Broadgreen University NHS Trust)

• “One of the most insidious pockets of resistance is the hospital bedding”

• 100 new SleepAngel pillows and 100 standard hospital pillows were deployed in wards

• After 90 days, sample pillows were sent for microbiological analysis:• Majority of standard hospital pillows tested

contained “potentially dangerous organisms”• None of the SleepAngel® pillows tested

contained pathogens• 60% of standard hospitals pillows tested had

failed mechanically (ripped or flattened)• None of the SleepAngel® pillows tested had

failed mechanically• Recommendation “to deploy CE marked

infection control pillows such as SleepAngel®”

Highlights of HCAI Reduction StrategyMRSA reduces from 34 to 4 cases (-94%)C Diff reduces from 363 to 64 cases (-84%)

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Reducing HCAI Conference, 2013

Please visit youtube to view this video www.youtube.com/watch?v=HK6Xh0aD1VE

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Save Your Hospital MoneySleepAngel™ Cost of Ownership Benefit

• Use less - two per bed not three or four (1)

• Replace less – observed to last up to 4 times longer than wipe down pillows (2)

• Launder less – pillow laundry becomes obsolete, pillow case laundry is reduced

• Dispose less – reduce costs associated with product obsolence and disposal

Our financial model shows that replacing standard wipe down pillows with SleepAngel™ pillows can achieve meaningful cost savings over the lifecycle of the product, before the benefits associated with contamination reduction and infection risk reduction are factored in. Our cost saving calculator demonstrates how savings are achieved.

(1) Post market observation., Galway University Hospital, Therese Byrne , Purchasing officer in Hermitage Clinic , Dublin

(2) Marie Dewhurst, Infection Control Team Leader, Royal Liverpool and Broadgreen University Hospitals Trust

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Thank You

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