Protection from Infection

There’s ‘clean,’ and then there’s ‘ St. Jude clean.’ Learn some of the tactics St. Jude uses to keep infection rates low.

By Elizabeth Jane Walker; Photos by Ann-Margaret Hedges

Tracy Davis

Tracy Davis of St. Jude Environmental Services oversees a robot named Troy as it cleans a patient room. The robot’s UV light kills germs by breaking down their DNA. Research has shown that UV light can reduce infections by multi-drug–resistant organisms by more than a third.

For more than a quarter of a century, Tracy Davis has done his part to foster the mission of St. Jude Children’s Research Hospital by ensuring the facility is spotless. There’s “clean,” and then there’s “St. Jude clean.” Davis is an expert on that distinction.

For the past couple of years, two new assistants have helped him wage war on germs. These hard workers are lean, mean cleaning machines.

They’re robots.

By emitting ultraviolet light, the robots provide an additional layer of germ-killing disinfection for patient rooms, Surgical Services, ICU and other areas. After a room has been deep-cleaned with traditional methods, Davis and his colleagues bring in one of the robots. The UV light kills germs by breaking down their DNA. Research has shown UV light can reduce infections by multi-drug–resistant organisms by more than a third.

“In Environmental Services, we do a great job of cleaning,” Davis says. “But the UV light gives us an additional level that’s needed for our immunosuppressed kids. It also gives parents a sense of confidence in knowing we’re doing a great job for their children.”

The robots are only one of many techniques that provides a cloak of security around the hospital’s vulnerable patients. At St. Jude, infection prevention is everyone’s business.

Extra layer of protection

Nearly every child at St. Jude has a fragile immune system and a high risk of acquiring infections.

“That’s why it’s critical not just to follow minimal requirements, but to take steps above and beyond to provide another layer of protection around our patients,” explains Hana Hakim, MD, medical director of St. Jude Infection Prevention and Control.

She heads a multidisciplinary team that works to prevent infections.

“We work with all departments to minimize and reduce infection risk,” Hakim says. “We review the air our patients breathe. The food they eat. The water they drink. Every possible source of exposure.”

Infection prevention is top of mind for employees and families alike. Each day, campus visitors and family members are screened to ensure they are healthy before they stroll the hospital’s corridors. At entrances to patient-care areas, gusts of wind blow air outward so that bacteria, viruses and other disease-causing organisms cannot drift into the facility. And hand-washing has been elevated to an art. Everyone on campus knows infection prevention is not just important—it’s a matter of life and death.

We review the air our patients breathe. The food they eat. The water they drink. Every possible source of exposure.

Hana Hakim, MD, Medical Director, St. Jude Infection Prevention and Control

 

From ordinary to extraordinary

Even hospital construction projects take infection control into account.

Dust poses a severe risk, because it can contain a common mold called Aspergillus. If inhaled by a child with a weak immune system, this fungus can cause a dangerous lung disease. During renovations or maintenance activities, employees erect special dust barriers. Workers also sprinkle water on construction sites to keep dust from blowing across campus. During construction of the Kay Research and Care Center, special exterior elevators enabled dusty construction workers to travel to their work spaces without walking through the hospital.

“For us, these practices are standard, but for other places they might be extraordinary,” says Craig Gilliam, director of St. Jude Infection Prevention and Control. “For instance, before we opened our newest building, we conducted fungal air counts. We wouldn’t occupy a floor until we had achieved two acceptable readings a week apart. The state didn’t require us to do that. It’s just what we thought we ought to do.

“We can’t afford to let a child develop an infection because we didn’t make the extra effort,” he continues. “At St. Jude, we don’t consider that to be an extra effort.”

The hospital and its housing facilities employ techniques such as positive air pressure and HEPA filters to provide optimum air quality for patients. Gilliam says the provision of housing is another important component of infection prevention.

“By providing housing for patients, we make sure that when they leave the hospital they return to a safe environment where they’re not exposed to pathogens,” he says.

Hana Hakim, MD, and Craig Gilliam

Hana Hakim, MD, and Craig Gilliam head efforts to provide a cloak of security around St. Jude patients, most of whom have fragile immune systems.

The cocoon effect

In addition to providing influenza vaccinations for employees, St. Jude vaccinates patients’ parents and siblings.

“Most institutions don’t provide this protection for family members,” Hakim says, “but we feel it’s important to have a cocoon effect. If all the people around a patient are vaccinated, they won’t get the illness and transmit it to the child.”

During a regional measles outbreak last year, the hospital’s Occupational Health staff checked the immune status of everyone on campus and vaccinated those who did not already have protection against the disease.

Each visitor and family member is greeted and screened for illness before entering the bone marrow transplant unit and other inpatient areas.

“It’s really important that we screen them,” Gilliam says. “A patient who gets a cold could develop respiratory distress or even require a ventilator.”

For us, these practices are standard, but for other places they might be extraordinary.

Craig Gilliam, Director, St. Jude Infection Prevention and Control

 

Applause for hand-washing

Hand-washing is serious business at St. Jude. Employees and families are educated about the role of hand hygiene in preventing infections. Each inpatient room is equipped with a sink just outside the door, so that hands can be washed at each entrance and exit. Observers monitor hand-hygiene compliance for staff, families and visitors, providing reports that are then used to further education and promotion.

Staff members sometimes use UV light monitors when teaching families about hand-hygiene techniques.

“You may think you’re washing your hands well, but this can show the areas you missed,” Gilliam explains. “It’s a simple way to emphasize the importance of thorough hand-washing.”

Studying the microbiome

Hakim and her colleagues are planning a new study to analyze the microbes living in the hospital and to learn how those microbes are shared among people in that environment. The researchers hope to use details gleaned from this project to create new approaches for preventing infections.

Before the Kay Research and Care Center opened in the fall, staff members obtained a baseline sample of the microbiome of floors, walls and other surfaces throughout the new patient-care floors. In 2017, the scientists plan to collect samples from patients, staff and family members in those areas.

“There’s never been a comprehensive analysis like this,” Hakim says. “Past studies have looked at culturing one particular organism rather than doing molecular testing and understanding all the microbes living in the environment. I’m excited, because I think we’re going to learn a lot from this study.”

Cleanliness saves lives

As a handler of the St. Jude robots, Davis says he derives a deep satisfaction from knowing his infection-control activities may help save young lives.

 “No matter what I’m going through, no matter what’s going on in my life, it’s nothing compared to what these kids are going through,” Davis says.

“Those babies are the reason we’re here.”

From Promise, Winter 2017

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