The landscape of multidrug-resistant organisms has changed over the past 10 years. To keep up with these evolving superbugs, Stanford has added two robotic cleaning systems to its house keeping staff—Frost and Dazzle.
Where hand washing and cleaning protocols were successful in greatly reducing levels of MRSA at Stanford in the past, they are not enough against drug-resistant microorganisms such as Clostridium difficile (C. diff). Infection by such organisms is one of the most serious threats to the recovery of hospital patients. The Centers for Disease Control and Prevention reports that C. diff alone is related to 14,000 deaths annually in the United States.
Because antibiotics have become less effective against drug-resistant microorganisms such as C. diff, prevention has become the focus of Stanford's infection prevention and control department. The department has augmented its conventional protocols that include patient screening, stringent compliance with hand washing and glove-use protocols, and cleaning of patient rooms using bleach and other disinfectant chemicals, with the ultraviolet light power of the Frost and Dazzle robots.
Stanford is the first hospital in the Bay Area to employ these germ-killing Xenex robots, which attack antibiotic-resistant organisms with pulsating UV light that disrupts an organism's DNA, killing spores, bacteria, viruses and mold. The lights also get into nooks and crannies that can be hard for human fingers to reach.
The robots do not replace cleaning, says Sasha Madison, manager of infection prevention and control, but instead are an adjunct to Stanford's infection prevention program. They are used to clean patient rooms after people with multidrug-resistant infections have been discharged, as well as all contact isolation and oncology unit rooms. They also work all night, cycling through the operating rooms. Their germ-zapping process takes about 15 minutes.
"You can't make a room completely sterile," she says. "But you try and bring the load of potential organisms down to the lowest level. The robots give us a higher level of assurance that the room is truly the cleanest it can be for our patients."
The robots chosen by Stanford are in place in about 100 other U.S. hospitals. At the University of Texas, MD Anderson Cancer Center, use of the Xenex UV room disinfection system to clean rooms that previously housed patients with C. diff or vancomycin resistant enterococcus (VRE) infections resulted in a reduction in the number of patients contracting infections.
"We are always looking at new ways to get at resistant micro-organisms and felt this was the best technology for us," says Madison. But it cannot work in a vacuum. "What drives C. diff rates more than anything else is antibiotic stewardship, and that is where our physician colleagues need to examine how they are treating patients."
Refresher course on antibiotic stewardship
Antibiotics are among the most frequently prescribed class of drugs. But it is estimated that approximately 50 percent of antibiotic use is inappropriate.
"The use of antibiotics is unlike the use of any other drug," says Stan Deresinski, MD, clinical professor of infectious disease and medical director of the antimicrobial stewardship program. "Because unlike other drugs, the use of an antibiotic whether appropriately or inappropriately, has a potential public health consequence because of the potential for resistance."
To help physicians improve their ability to prescribe antibiotics safely and appropriately, Stanford has developed an online course, led by Deresinski, together with Elizabeth Robilotti, Emily Mui and Michael McAuliffe. The course launched at the end of November during the CDC's "Get Smart with Antibiotics Week." Nine days later it had 20,550 learners registered. The course offers a practical approach to prescribing antibiotic therapy using a number of illustrative cases to lead to optimal decision making, improved outcomes for patients and harm reduction regarding bacterial ecology.
To enroll, go to https://www.coursera.org/course/antimicrobial. The course can be taken for instruction only, or for CME credit.
By Grace Hammerstrom