Disposable curtains/screens

[Wilkinson, Irene (Health)]

Hi all,

Rachel makes some very valid points about the limitations of in vitro testing of these materials. What is needed are some good quality in vivo studies using sampling of curtains at various times after first hang.

I know from conversation with Dr Stephanie Dancer at the last ACIPC conference that she is not keen on the blanket use of these curtains throughout a hospital, since no-one has yet published a good cost-effectiveness study, and there are concerns (as pointed out previously) about the waste issue.

It would seem prudent to me in the current state of knowledge to limit the introduction of these curtains to those areas where we know that frequent changes of cloth curtains are causing bed block problems, such as in ED. One also needs to have in place a system for monitoring the hang date to make sure they are not left in place indefinitely! Rachel also makes a good point about who is going to monitor for the presence of soiling?

There has been limited introduction of these products in South Australia due to the concerns expressed below.

Irene Wilkinson
Manager, Infection Control Service
SA Health
Irene.wilkinson@health.sa.gov.au

Hi all,

I would like to put out there some thoughts and observations in relation to disposable biocidal curtains from a personal perspective.

The biocidal curtains currently on the market have one property that has got nothing to do with Infection Prevention & Control, but a property that makes these items very appealing to organisations (and managers within them). That is, that they are light weight and relatively easy to change. This would seem to have a couple of distinct advantages therefore over traditional cloth curtains, that is;

* Reduced risk of injury during curtain change

* Likely increased compliance with a request to change
(I am aware that others have now commented on these benefits)

There is then the infection prevention and control perspective. I would like to comment on this.

I do not believe that the product information and the available literature is as clear in relation to the Infection Prevention & Control properties as we might like it to be (or might think it to be). The testing that is applied to these curtains, as I understand it, is a ‘modified Kirby-Bauer test’. This test (again as I understand it) measures disinfectant or antiseptic susceptibility of various organisms on a modified agar plate. Bacteria are applied to the agar and, for the purposes of these tests, a square centimetre of the biocidal fabric is placed on the plate and inhibition zones are measured in millimetres. These measurements are taken with the use of ultra-violet light to increase the exposure rate and extrapolated results are taken from these findings. This may be a simplistic interpretation of this test and I would welcome comment from the more ‘microbiologically-minded’ subscribers to the list. My comments on this testing methodology for the efficacy of the curtains are the following;

* Testing does not include ‘real world’ data. The transferability and reliability of the modelling and results achieved from the modified Kirby-Bauer testing is not clear to me.

* Whilst a known quantity of a known pathogen is tested with this fabric, there is no capacity to understand if this actually relates to alternate inoculation methodologies. E.g. From multiple contaminated hand touching of the curtain on the leading edge through to faeces splattered onto fabric etc.

* Testing against agents such as non-enveloped viruses (e.g. norovirus) is not documented or reported on in the product literature. If there is no testing data, what action will need to be taken to ensure safety?

One company recommends that their biocidal curtains are changed after patients with known or suspected infectious agents, including MROs especially in the higher risk settings. Whist another company make no such recommendation. The cost of regular replacement will surely not be insubstantial in some settings, especially the more acute services. As mentioned, if the testing does not include a number of important pathogens then can it be reasonably assumed that the agents not tested for will be controlled or eliminated with the biocidal curtains in place?

It is accepted that the manufacturers clearly recommend that biocidal curtains should be changed if there is evidence of soiling. The question must be asked, though, who will validate this process? If curtains are left hanging for very prolonged periods (potentially substantially longer than standard cloth curtains), has the risk of this been established or even fully considered?

I am not suggesting that biocidal curtains represent a ‘less safe’ environment than cloth curtains; indeed this would appear patently untrue. I think, however, that a number of facilities and staff within them are seeing these curtains as the ‘holy-grail’ of a prevention/control measure. I would certainly suggest that there is a place for enhanced research and subsequent publication in peer reviewed literature to add to the body of current knowledge.

Just some thoughts!

Cheers
Rachel

Rachel Thomson

Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au

Hi All,

Have a small issue – Disposable curtains/screens!

Would appreciate feedback from areas that are using the disposable curtain/screens in their facilities

The issue is around cost of linen vs disposable curtains/screens.

We have trialed & like what we have but those who watch the pennies are questioning their use.

Originally we brought them into our ED because the poor terminal cleaning staff were frantic with attending the cleaning ( which involves the replacement of curtains).
The NUM of ED was indicating at this particular incident -that there were three ambulances waiting to off load patients onto ED beds which were being held up by the terminal cleaning required.

Amongst other actions taken regarding this issue in ED-was the implementation of the disposable curtains.

Now the question being asked is who else in other health areas has disposable curtains/screens & where are they ( ie high risk areas).

Much appreciate any assistance with this.

Thank you

Vicki Denyer

Clinical Nurse Consultant | Infection Prevention & Control Unit
Lismore Base Hospital
Tel 02 6620 2385 | vicki.denyer@ncahs.health.nsw.gov.au

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