key: cord-0321638-9q7zwcqw
authors: Balachandran, P.; Mathur, K.; Ritter, J. T.
title: Retrospective Clinical Surveillance Measuring Healthcare Associated Infection 1 (HAI) Rates Pre-and Post-Inclusion of Novel Silver Ion Antimicrobial Textile 2 Intervention in an Infection Control Program
date: 2020-12-11
journal: nan
DOI: 10.1101/2020.12.09.20246702
sha: d6f74c1f8c21231011bb9a16318c46c3ef86cb12
doc_id: 321638
cord_uid: 9q7zwcqw

Healthcare linens act as a vector of microbial transmission through use, storage and handling. 2 In this retrospective multi-year, multi-site study, the impact of an infection prevention program, 3 that included an automated silver ion-based antimicrobial laundry treatment, was studied. A 4 composite reduction of 42% in healthcare associated infection (HAI) rates was observed, with 5 the biggest reductions associated with CAUTI and CDI rates. Although further study is needed 6 to better understand the exact contribution of such an intervention towards prevention of 7 HAIs, ionic silver treatment of healthcare textiles may prove to be a useful tool in HAI reduction 8 strategies.

Healthcare textiles are recognized as an epidemiologically important environmental surface 2 implicated in outbreaks caused by pathogens within the hospital environment [1] [2] [3] [4] . A recent 3 environmental sampling study for 13 confirmed COVID-19 patients found extensive 4 contamination of patients' surroundings including pillows and bedsheets 5 . Microbial 5 contamination of healthcare textiles occurs at mutliple points, each contributing in varying 6 degrees to the spread of infections. Linens become contaminated while in use by patients and 7 healthcare workers, due to intimate contact with the patients' skin, which constantly sheds 8 pathogen laden skin scales and hair fibers 1, 3, 4 . Similarly, ambulatory patients track pathogens 9 on the soles of their feet/socks back into the bed 6 . In hospitals where bed linens are not 10 changed daily, contamination poses an infection risk to the patient who has indwelling devices 11 such as urinary and vascular catheters which provide a direct portal of entry for pathogens 7 . 12 Privacy curtains are another type of soft surface/textile in patient rooms that commonly 13 become contaminated due to frequent handling. Contamination, especially on the grab area of 14 the curtains, acts as a source of pathogen transmission from patient to patient via healthcare 15 worker hands 1 Escherichia coli, norovirus and other mutli-drug resistant organisms (MDROs) 3 . While effective, 25 these threaded/embedded textiles require purchase of new, specialized inventory which can be 26 costly to implement, maintain and replace when inventory is lost or degrades over time. 27 Our previous work found that hospital textiles treated with ionic silver during each laundry 28 cycle resulted in over an 80% reduction in post-laundry levels of aerobic bacterial counts, 29 Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA), pre-and post-30 patient use 4 . Ionic silver has broad spectrum antibacterial, antifungal and antiviral activity 8 . 31 In this follow-on study continued at the same community hospital locations, the impact of the 32 same silver-ion treatment of textiles was evaluated on HAI rates when implemented as a preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020. ; https://doi.org/10.1101/2020.12.09.20246702 doi: medRxiv preprint METHODS 1 A retrospective, non-randomized before-and-after control study was designed to assess the 2 efficacy of a silver ion-based laundry additive on HAI rates over an 18-month period (January 3 2016 to June 2017) and a 30-months period (January 2016 to June 2018). The study was 4 conducted at five community hospitals located within the same hospital system, three of which 5 served as treatment hospitals. All three treatment hospitals have similar patient acuity levels, 6 demographics and are serviced by the same laundry facility accredited by the Healthcare 7 Laundry Accreditation Council (HLAC). Hospital 1 had 286 available beds with a 67% occupancy 8 rate, Hospital 2 had 112 available beds with a 67.5 % occupancy rate and Hospital 3 had 35 9 available beds with a 67% occupancy rate. All three hospitals had average length of stay of 4 10 days. 11 Two additional hospitals within the same hospital system, with similar patient acuity levels, 12 demographics and infection prevention programs, served as control sites during 18 of the 30-13 month baseline period ("before"), and 18 of the 30-month after intervention period ("after"). 14 Control hospital 1 had 155 available beds with a 46% occupancy rate, Control hospital 2 had 15 240 available beds with a 52% occupancy rate. Both hospitals had an average length of stay 4 16 days. At 18 months into the study period, based on the success of the study hospitals, the 17 control hospitals opted to include silver ion laundry treatment for their infection control 18 program and discontinued serving as control sites. 19 In January 2016, the silver ion dosing unit installed at the contract laundry facility servicing the 20 three treatment hospitals was turned on and the treatment of laundry was monitored via preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020. ; https://doi.org/10.1101/2020.12.09.20246702 doi: medRxiv preprint RESULTS AND DISCUSSIONS 1 In a prior peer-reviewed published study, treatment of incumbent linens with silver ions during 2 laundering resulted in statistically significant reductions of > 80% in the levels of total bacteria, 3 S. aureus and MRSA, both pre and post patient use, as a result of residual antimicrobial effect 4 . 4 This current follow-on study shows that an infection prevention bundle strategy at the three 5 community hospitals within a hospital system, which included this seamless, automated silver 6 ion laundry technology, reduced overall healthcare associated infection rates by 42% after 30 7 months of implementation. 8 In the current study, the impact of the silver-ion based laundry treatment on individual HAI 9 types varied. Although all HAI types were not measured, of those tracked during the study (CDI, 10 CAUTI, CLABSI and SSI) clinically significant reductions were seen in CDI and CAUTI. There was a 11 statistically significant (50%) reduction in CDI from 4.7 to 2.4/10,000 patient days (p=0.001), 12 and a 41% reduction (not statistically significant) in CAUTI from 8.8 to 5.2/10,000 patient days 13 (p=0.081). A minor impact was observed on SSI rates and no impact was observed on CLABSI 14 rates ( Figure 1 ). This variation in percentage reduction for the different HAI types can be From there it is possible for patient hands or objects to become contaminated, and then for 27 that contamination to be transferred from hand to mouth, resulting in potential infection 10 . 28 The impact on SSI was marginal. Possible explanations could include that infections are 29 introduced during the procedure itself and/or that post surgically patients are on antibiotics. 30 No impact was observed on CLABSI rates potentially indicating that textile-borne pathogens do 31 not contribute to these types of infections. When the infection rates were evlauted for each 32 individual hospital, consistent declines of 48%, 21% and 16% for each of the three hospitals (for 33 a composite decline of 42%), primarily contributed by the declines observed in CAUTI and CDI 34 rates (Figure 2) . The hospitals observed a decline of 43% in overall infection rates at the interim 35 18-month evaluation period (8.72 to 4.91/10,000 patient days), during which time the control 36 hospitals observed 4% decline in their infection rates (10.50 to 10.05/10,000 patient days). At 37 this time, these hospitals dropped out as controls and began using the silver ion laundry 38 treatment. While all three treatment hospitals showed a declining trend in infection rates, 39 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020. ; https://doi.org/10.1101/2020.12.09.20246702 doi: medRxiv preprint majority of the decline observed in the composite number was driven by Hospital 1, which also 1 had the largest number of occupied beds. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020. ; https://doi.org/10.1101/2020.12.09.20246702 doi: medRxiv preprint CONCLUSIONS 1 This study highlights the benefit of a silver ion-based laundry treatment as an added 2 element in infection prevention programs. This technology is fully automated, requires 3 no additional inventory, training or change in workflow. The specific reduction in CDI 4 and CAUTI reported in this study, suggests that certain infection prevention bundles 5 may benefit more with this soft surface intervention than others. 6 One limitation of this study is that the exact contribution of the silver ion-based 7 antimicrobial textile intervention cannot be measured using the retrospective anlayses 8 study design. Additional studies would also be required to replicate these findings and preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020. ; https://doi.org/10.1101/2020.12.09.20246702 doi: medRxiv preprint Before silver ion laundry treatment After silver ion laundry treatment All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2020.

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The authors acknowledge Elizabeth Hutt Pollard, Sean Morham, Sue Barnes, Bill Morris 21