Putting the technologies to the test
Find out more about how each of the winning products is being evaluated with the case studies on this page. Products are listed in alphabetical order.
Air-cleansing technologies - evaluated by The Royal Free Hospital, London
How effective are air cleansing technologies in helping to beat HCAIs? With three of the winning products in the Smart Solutions competition falling into this category, it is hoped the evaluation at The Royal Free Hospital in London will go some way towards answering this question.
All three products are designed to kill airborne microbes but each is based on a different technology. The AD (air disinfection unit) from Inov8 Science Ltd uses hydroxyl radicals - often referred to as the ’open air factor’ - to destroy germs, replicating the way in which nature disinfects the air in open spaces. AirManager from Quest International relies on a process known as close-coupled field technology while the Medixair from GE Healthcare uses ultraviolet light.
Kerry Williams, the lead microbiologist at the Royal Free, and Ed James, consultant microbiologist, were in charge of the evaluation on site. They helped to devise the protocol, engaged with staff and arranged access for representatives from each of the three companies to set up the equipment. Kerry also helped with the laboratory analysis.
The evaluation took place within two wards dedicated to care of the elderly, the first containing four side rooms and the second containing four four-bed bays. Each of the three different products was allocated a side room with the fourth side room remaining empty as a control area. This arrangement was replicated in the second ward within the bays. Microbial samples were taken once a day at the very minimum in each of the eight areas and sent for analysis.
Bryan Griffiths, Smart Solutions project director, says: “We had to be sure that routine activities which disturb the air and throw up debris - such as changing the beds in the morning - were not unduly influencing the results so in most cases samples were taken three times a day.
“However to do that in eight different areas over the course of the 16-week trial and then analyse the results adds up to a significant amount of work. Good co-ordination between the infection control team and the lab staff was vital to the success of the evaluation to enable us to build a body of evidence.”
From the left are Robyn Smith, Ed James and Kerry Williams
The list of people taking part from the Royal Free included:
Kerry Williams – lead microbiologist
Ed James – consultant microbiologist
Robyn Smith - consultant microbiologist
Enat Yeneta – admin support
Hannah Wilson - air sampling
Chrissie Davison-Tosh – air and surface sampling
Catriona Stapleton – surface sampling, ward liaison and questioning
Moira O’Connor – surface sampling, ward liaison and questioning
Vicky Pang – surface sampling
Glenn Salazar – surface sampling
Alan Truman – air sampling, surface sampling
Esha Abrol – surface sampling, air sampling
Zora Laattoe – air sampling, laboratory
Vicky Miari – laboratory
Formula 429 - evaluated by Barts and The London NHS Trust
'Fogging' in action - the process achieves floor to ceiling coverage
Chemspec Europe Ltd claims the Formula 429 cleaning fluid when used in a fogging process kills a wider range of microbes than traditional cleaning products, even when used in small quantities. It aims to provide an alternative decontamination method to steam cleaning or other existing deep-cleaning techniques.
The product was put to the test over a 12-week period at Barts and The London NHS Trust in several different patient areas, including four-bed bays, side rooms and sluice rooms. The product was ‘fogged’ using an ultra low volume fogging process into each location - floor to ceiling coverage was achieved.
Dr Arthur Tucker, Principal Clinical Scientist, was the principal investigator based at Barts Hospital, along with Martina Cummins, the Nurse Consultant in infection control, They helped to develop the protocol for the evaluation and arranged for access to the clinical areas, while Dr Mark Wilks, Clinical Scientist and Dr Elizabeth Sheridan, Consultant Microbiologist, determined the type of microbiology tests required.
Emma Malpeli, project manager from the Smart Solutions team, explained: “In total over 120 fogging episodes were carried out during the 12 weeks and microbiology samples were taken before and after fogging to determine what microbes were present. ‘Turnaround’ times were also recorded to see how soon rooms could be reoccupied after fogging – the Smart Solutions evaluations don’t just look at how effective the product is but also how practical it is to use in a real life hospital environment.
“ISS Damage Control provided the fogging service and, once we had decided on the protocol, were very quick to get it into operation. Thanks are due in particular to ISS supervisors Jamie Hutton and Mick Plummer. Although they hadn’t worked in a hospital before they took everything in their stride and provided a professional service throughout the duration of the evaluation.
“A special commendation should also go to the hard-working laboratory team Tim Lineham and Eleonora Yusuf Adam. At one point we had to increase fogging and sampling activity quite significantly which had a real impact on their workload, but they made sure that they stayed on top of the microbiology results for us.”
The list of people taking part included:
Dr Arthur Tucker - Principal clinical scientist and senior lecturer, Barts and The London NHS Trust
Martina Cummins – Nurse consultant in infection control, Barts and The London NHS Trust
Dr Mark Wilks – Clinical scientist, Barts and The London NHS Trust
Tim Linehan – Senior biomedical scientist, Barts and The London NHS Trust
Eleonora Yusuf Adam - Senior biomedical scientist, Barts and The London NHS Trust
Dr Elizabeth Sheridan – Consultant microbiologist, Barts and The London NHS Trust
Julie Roberts – National sales and marketing manager, Chemspec Europe Ltd
ISS Damage Control – Regional manager Keith Whittaker, supervisors Jamie Hutton, Mick Plummer and Helano Da Silva Matos, technicians Sean Kershaw, Graham Waddington and Alec Creek
MedMat - evaluated by Bristol Community Health
MedMat, an innovative dual-layered clinical dressing field, aims to provide a sterile environment for wound dressings and other clinical procedures, whatever the location – so ideally evaluations needed to be carried out at a range of sites, both in hospital and within the community.
Bristol Community Health was able to offer access to a variety of different clinical staff working in many different settings, to evaluate the dressing field specifically relating to user perception of impact on infection-related issues. The MedMat system was deployed by the podiatry and wound care services, in neighbourhood healthcare centres and even healthcare services within a local prison, amongst others.
The evaluation took place over a 12-week period, with Wendy Briggs from Bristol Community Health as the principal investigator, assisted by her colleague Debra Nicholson.
Charlotte Butterfield from the product’s developer Ergomedica Ltd and Karen Park from the distribution firm Sunlight Clinical Solutions carried out training with staff at the different locations and ensured all were kept well supplied with Medmats for the duration of the evaluation.
Emma Malpeli from the Smart Solutions team said: “Wendy played a key role in the evaluation, particularly in view of the variety of locations involved. She co-ordinated everything from a local perspective in Bristol, from persuading staff to commit to the project in the first place and putting a system in place for the return of evaluation forms, to arranging training and access to the prison.
Wendy Briggs added: “We work across a wide area and in lots of different locations. We are aware that healthcare-associated infections can be a problem in any healthcare setting, not just hospitals, and are keen to try out any innovation that might help combat them. We thought Smart Solutions was a good opportunity to do so. All too often community settings do not have the chance to take part in initiatives like this, yet a great deal of care is carried out at this level.
“We are lucky here in having teams who were keen to be involved - getting ‘buy-in’ from them was fundamental to the evaluation. One benefit has been that working together on this has brought us much closer together and created a greater sense of team spirit.”
The list of people taking part included:
Charlotte Butterfield, director, Ergomedica Ltd
Karen Park, product manager, Sunlight Clinical Solutions
Wendy Briggs, infection prevention and control specialist practitioner, Bristol Community Healt
Debra Nicholson, infection prevention and control specialist practitioner, Bristol Community Health
Podiatry - Kizzy Harris, Katharine Siedle, Rachel Steeper, Oonagh Wilson, Laura Flook, Tony Joyc
South Bristol Intermediate Care Centre - Vicky Connor, Anna McColl, Caroline Ling, Katharine Abbot, Jayne McKean
Treatment room nurses - Sarah Wakely, Francesca Rabaiotti, Dianna Phibben, Jenny Pink
Wound care service - Sue Murphy, Gail Powell, Val Hellier, Leita Temple
HMP Horfield - Faye Jefferies
District Nurses Brooklea Health Centre - Simon Hall, Sheila Cains, Monica Adinolfi, Amy McCabe, Therese Trollope, Natalie Stuart, Noreen Smith, Sharon Belcher
Amelia Nutt Nurses - Angela York, Elaine Clifford
Nanopool - evaluated by Southport & Ormskirk Hospital NHS Trust
Nanopool’s award-winning coating technology can be applied to a range of surfaces. The company claims it makes them easier and quicker to clean and also provides long-term anti-bacterial protection. The coating is already used in industries such as food production, hotels and healthcare.
Evaluations took place at Southport and Formby District General Hospital under the watchful eye of Martin Kiernan, nurse consultant for the prevention and control of infection. Martin, who is also president of the Infection Prevention Society, helped to identify suitable wards and develop the protocol.
He also made sure samples were taken on a regular basis and tested using the ATP (Adenosine Triphosphate) method, an established way to gauge the level of microbes on a surface and measure the effectiveness of cleaning techniques.
Within the selected wards, high-contact surfaces such as bedside tables and dressing trolleys were identified and split into two groups. The coating was then applied by Neil McClelland of Nanopool to surfaces in one group with those in the other group remaining uncoated.
James Corden, project manager with the Smart Solutions team, said: “To establish a baseline, samples were taken regularly over a three-week period prior to the surfaces being coated with Nanopool. Once coating had taken place, staff continued to take samples over the course of 12 weeks, to enable us to compare the results.
“It was of course important that the evaluation were not skewed by any changes in the cleaning routine. The trust’s site services manager Lynn Shaw liaised with the cleaning team to ensure that they followed exactly the same procedures before and after coatings were applied. The successful completion of the evaluation was a result of everyone, from consultants to cleaners, working together to make it happen.”
The list of people taking part included:
Martin Kiernan – nurse consultant for the prevention and control of infection, Southport and Formby District General Hospital
Neil McClelland – project manager UK for Nanopool GmbH
Beverley Harrison – R&D manager, Southport & Ormskirk Hospital NHS Trust
Dr Judith Bowley – consultant medical microbiologist, Southport & Ormskirk Hospital NHS Trust
Lynn Shaw – site services manager, Southport & Ormskirk Hospital NHS Trust
Sheena Walker – matron, Southport & Ormskirk Hospital NHS Trust
TwistDx - evaluated by Central Manchester University Hospitals NHS Foundation Trust
It is known that two or three per cent of the population carry the organism that leads to MRSA infections. Up to now there has been no quick and reliable way to detect carriers when they are admitted to hospital. Even if patients are screened on admission, existing tests take around 24 hours to produce a result by which time the bug could have spread to others on the ward.
TwistDx claims its new test can accurately identify MRSA carriers within just 15 minutes. The evaluation was carried out at Manchester Royal Infirmary under the supervision of consultant microbiologist Dr Andy Dodgson.
Many patients currently admitted to the infirmary are tested for MRSA using conventional methods, but for the purposes of the evaluation it was agreed that on certain wards, a second swab would be taken at the same time and tested using the TwistDx method.
James Corden, project manager with the Smart Solutions team, explained: “The trial was in two parts. As MRSA strains can vary on a regional basis, the TwistDX scientists first analysed existing MRSA samples from the hospital and fine-tuned the test to ensure it could detect the strains prevalent in the North West.
“In the second phase, samples were taken from nearly 6,000 patients admitted to the hospital over a 12-week period. The results were analysed using both the TwistDx method and the standard MRSA test currently used in the hospital and the results compared.”
Julie Cawthorne, the infirmary’s nurse consultant in infection control, helped to identify suitable wards and develop the protocol for the evaluations, while her colleague Frederico Tabios played a key role in training staff in the new swabbing techniques and ensuring sufficient patients were recruited to the trial. Matthew Forest from TwistDx was involved in setting up the sampling systems and training lab staff in the use of the new equipment. Laboratory microbiologists Tracey Eden and Sonja Nunes were responsible for efficiently processing the collected samples and their dedication was a key factor in the timely completion of the trial.
James Corden adds: “Organising the collection and analysis of samples on this scale in a busy hospital proved a complex task and the fact that we succeeded was thanks to the commitment and co-operation of everyone involved. ”
The list of people taking part included:
Dr Andrew Dodgson – consultant microbiologist, Central Manchester University Hospitals NHS Foundation Trust
Frederico Tabios – infection prevention and control nurse specialist, Central Manchester University Hospitals NHS Foundation Trust
Julie Cawthorne – nurse consultant in infection control, Central Manchester University Hospitals NHS Foundation Trust
Tracy Eden – biomedical scientist, Health Protection Agency
Sonja Nunes – medical laboratory assistant, Central Manchester University Hospitals NHS Foundation Trust
Bernard Wood – laboratory manager, Central Manchester University Hospitals NHS Foundation Trust
Elizabeth Muir – administration manager, Central Manchester University Hospitals NHS Foundation Trust
Matthew Forrest – senior scientist, TwistDx
UV lighting - evaluated by Royal Liverpool & Broadgreen University Hospitals NHS Trust
Matron Joyce Johnson and housekeeper Agnes Dickinson
Ultraviolet lighting can reveal contamination that is invisible to the naked eye. It is used by forensic scientists to detect trace evidence but can also be used to check cleaning procedures, identify problem areas and train cleaning staff.
UV lamps from UV Light Technology Ltd are being trialled in Royal Liverpool and Broadgreen Hospitals. They are being used to assess the cleanliness of surfaces on wards before and after cleaning over a period of six months. A new ward joins the project every two weeks until a total of 10 have been recruited to the study.
The housekeepers have been systematically assessing the cleanliness of nine surfaces before and after cleaning on a daily basis on their wards and feeding back results to nursing and domestic staff. At the end of each week information collected from each ward is returned to the principal investigator Rebecca Molyneux, the trust’s nurse consultant infection prevention and control.
Housekeepers from the participating wards meet weekly with Mrs Molyneux to review progress, discuss issues identified during the past week and provide mutual support.
Apart from visual inspection, Adenosine triphosphate (ATP) bioluminescence swabs are being used to test surfaces for evidence of microbial contamination or contamination with food, drink or bodily fluids that may encourage microbial growth. Senior biomedical scientist Paul Roberts is providing microbiology support for sampling to identify specific micro-organisms.
Bryan Griffiths, Smart Solutions project director, said: “Ward housekeepers supported by their matrons and ward managers have played a significant role in helping to get this project up and running. Thanks are due to all who have contributed to the evaluation.”
The list of people taking part includes:
Rebecca Molyneux - Nurse Consultant Infection Prevention and Control, Royal Liverpool & Broadgreen University Hospitals NHS Trust
Housekeepers from medical, surgical and specialist services for older people wards including Agnes Dickinson, Kate Seasman, Michelle Mullen, Gail Barnes, Carol McShane and Michelle Guy
Matrons Joyce Johnson, Joan Gowar, Debbie Ashley, Anita Nasser, Karen Parker and Jackie Martin
Maria Jones - Hotel Services Contract Monitoring Officer
Audrey Reeves - ISS / Mediclean Manager
Paul Roberts - Senior Biomedical Scientist, Liverpool University Biomedical Research Centre
From left are Maria Jones, Karen Parker, Carol McShane, Paul Roberts, Kate Seasman, Amanda Mulhaney, Gail Barnes, Anita Nasser, Michelle Mullen, Audrey Reeves and Rebecca Molyneux