Bugged out

Could we suggest that anyone who has to go into hospital in the near future might like to wait until after they’ve recovered before they read on? Because this is an article all about superbugs – also known as hospital-acquired infections (HAIs) or healthcare-acquired infections (HCAIs) – and how specially formulated electrical accessories can help stop them spreading. It doesn’t make comfortable reading.

Some of these antimicrobial products have been around for years, but manufacturers have reported a surge in interest in the past six to 12 months. The reason for this is likely to be the Health and Social Care Act 2008, which came into force in July last year. The Act removes crown immunity from hospitals, making individual healthcare trusts liable – and allows patients to choose where they go for treatment.

This makes the subject of who has installed what products where rather a touchy one. For example, the Heart of England Trust, which carried out a comparison between a ward furnished with antimicrobial products and a standard ward (see box, over) does not want to say which hospital is kitted out with the antimicrobial gear.

“The trust is worried that when the public start to see the information, they will only want to go to that hospital and won’t want to go to others in the trust,” explains Linda McKeaveney, customer relationship manager for BioCote, which provides the antimicrobial technology for a wide range of products, including Crabtree Electric’s switches.

There also seems to be some uncertainty among infection control professionals about the effectiveness of some of these products. In another trust where antimicrobial electrical accessories had been installed as specified by the trust’s estate manager, infection control staff would not endorse the product.

And there is no Department of Health guidance. A spokesperson told us to contact each trust individually to find out what their guidelines on the use of such products were.

One consulting engineer, who did not want to be named, said:“You can do something on one job that gets condemned on another job. What one person sees as an infection risk, another one will skip over. It’s subjective rather than objective.”

The list of infections you could pick up from a hospital stay is terrifying. Everyone has heard of MRSA (methicillin-resistant Staphylococcus aureus), but there is a whole host of other bacteria which could be waiting to jump in your wounds or up your catheter.

There are lots of reasons why these types of infections have become such a problem in the UK. These include the higher number of very sick people such as cancer patients with poor immune systems, overprescription of antibiotics, volume of patients coming through wards and bigger hospital catchment areas. But dirty wards and poor hand hygiene – among healthcare workers and the public – are huge contributors to the problem.

It makes sense to try and tackle items that are most touched.Which is why a number of electrical accessory manufacturers started thinking about what they could do to help counter the spread of bacteria – and get one over on their competitors. Both Crabtree Electric and Jung launched antimicrobial switches and sockets back in 2005. Marshall Tufflex launched its antimicrobial trunking, Odyssey Bio, in January.

All these products have silver ions incorporated into the PVC at the time of moulding. These ions are released from the surface of the product when they come into contact with minute amounts of moisture, inhibiting bacteria’s ability to reproduce and killing them before they can hop on board the next person and start to multiply.

Firms such as BioCote have carried out research to back up these claims, and due to the nature of the healthcare market, they are careful never to claim anything that has not been scientifically proved.

Others have been less careful, and there does appear to be a certain amount of misinformation which may be why some trusts are reticent to talk about it.

For example, some manufacturers have been claiming that urea formaldehyde, the powder used in the moulds for standard electrical accessories, has inherent antimicrobial properties. While this is true, it is also true that such properties wear off after six to 12 months, whereas those products containing silver ions keep functioning for the life of the product.

Another issue is that some manufacturers are getting a bit carried away with what their product is effective against. For example, silver ion technology has not been proved to be effective against the hospital superbug C Difficil, which is a bacterium that turns itself into a spore as soon as it makes contact with oxygen.

Dave Garrett, marketing manager for Crabtree Electric, is also at pains to emphasise the importance of getting the chemical formulation just right.

“Any manufacturer could go out and add silver ions to the mould powder,” says Garrett. “With every single product we make, a percentage goes to an independent laboratory for testing to prove it is effective.”

Crabtree has worked in partnership with bedhead equipment maker Static Systems to supply antimicrobial accessories to a number of hospitals including Royal London,Walsaw Manor, Portsmouth and Derby.

Marshall Tufflex has seen its cabling management system installed at several hospitals in the south-west including the Derriford Hospital, Plymouth, where it covered 11 operating theatres.

Given that HCAIs cost the UK £1 billion a year, one would have thought it would be a no-brainer to install antimicrobial switches, but it seems there are cons as well as pros.

Cost, of course, could be a deterrent to some projects. Crabtree Electric charges about 25% more for its antimicrobial switches. Marshall-Tufflex, which developed its PVC formula with Doeflex-Vitapol, which produces UltraFresh antimicrobial PVC compounds, adds 10-20% onto the product.

Some infection control specialists are concerned cleaners will be less thorough if they think these products are killing microbes themselves, according to McKeaveney.

All the manufacturers reinforce the message that using antimicrobial products does not negate the need for a rigorous cleaning regime. Marshall Tufflex’s Odyssey Bio is a curved trunking which makes it more difficult for people to rest things on and therefore easier to clean. Any build-up of dirt or dust (which is made up largely of shed skin) can harbour bacteria.

To end on a more positive note, the Health Protection Agency reported last month that the number of MRSA cases was down 40% between April and June this year compared with the same period in 2008.

But with 509 cases reported, there is still plenty of room for improvement.