Marianne Midttun, hygiene nurse at Herlev Hospital in Denmark, looks at the benefits of using Johnson & Johnson's GLOSAIR machines as part of a new successful multistage room decontamination routine.
Located 9km north-west of Copenhagen city centre, and famous for being one of the tallest buildings in the country, Herlev Hospital looks after about half of Denmark's capital region. It has 800 beds and 5,000 employees.
In 2011, the hospital had a problem with Clostridium difficile and needed to try a new approach to lowering the infection rate.
"We started by isolating every patient with diarrhoea," explains Herlev Hospital hygiene nurse Marianne Midttun.
"We cleaned more often and began to use chlorine. Once we had done this and devised better tests to diagnose C. difficile, we decided to do something extra."
Automated room decontamination was the next step and Midttun began to research different ways to achieve this. The decision was made to test an area decontamination machine.
"After using it for a trial period, we discovered that it was a good addition to the decontamination routine," Midttun says. "So we decided to widely implement such machines across the hospital.
"We chose Johnson & Johnson's GLOSAIR as the machines were small enough to be transported throughout the hospital and the disinfection time was three to four hours. There was also good communication with the company in terms of educating our staff to become users and super-users of the machines."
GLOSAIR machines spread hydrogen peroxide and silver cations in the form of a dry mist. When the machine is in use, hospitals must move patients from rooms, along with curtains, papers and anything else that can absorb the hydrogen peroxide, but electric equipment and furniture with a hard surface, such as beds and tables, can stay. The door is then taped up so that all of the dry mist remains inside.
Following the room being wiped down with soap and water, and these preparations, the decontamination can begin. Depending on the cubic capacity of the room, the diffusion of mist can take anywhere from a couple of minutes to 40 minutes. The machine is then left in the room for another two hours of contact time.
When the process is complete, the level of bioburden will be reduced to a safe level; the mist can reach and destroy bacteria, and other microorganisms throughout the room, including those in small, difficult to reach areas such as shelves and cupboards.
"The machine has had a positive effect because the staff see that it's a good thing to do something extra; to clean every single corner of the room," Midttun says. "We can't say it's just the machine that has solved our problems, but, together with all of the other things we are now doing to improve hospital hygiene, we have stopped the spread of Clostridium difficile."
Since it began to use the GLOSAIR machine two years ago, Herlev has seen a huge reduction in cases of the condition. Midttun is keen to stress that this is not solely a result of patient isolation or the machine, but that this combination has proved successful, and now hospital staff dare not remove any one element in a process that is clearly functioning well.
It has been so successful that Midttun has been responsible for taking the product to other hospitals in the capital region.
"Together with Johnson & Johnson, I visited the other hospitals in the region to tell them about GLOSAIR, show them how to use it and explain how to make it work in a hospital environment," she explains.
"The hospitals are all different; some are old, some are new and some are easier to work in than others. We educated and trained the super-users and, every time a new hospital was ready, we visited them to oversee their first decontamination using the machine. I was also always available on the phone to help them if they met unforeseen challenges."
All the hospitals in the capital region are now using GLOSAIR. Each month, Midttun collates data on how often they use the GLOSAIR machines.
She has also been contacted by other regions in Denmark that want to know how useful the GLOSAIR machine has been as part of the whole programme to reduce the number of Clostridium difficile patients.
"We wrote a protocol explaining how to get started with the machine - what you have to think about," Midttun says. "Every time I have been contacted, I have sent these papers out and talked to the hospitals on the phone to inform them about what they have to think about when starting this procedure.
"Everyone has their own way of doing things, so I tell them how to make the GLOSAIR machine work for them."