Reduction of HAIs with a Novel Yankauer Storage Solution

Abstract

The Yankauer suction instrument is the most widely used suction instrument in the world. It is used in many medical settings including emergency departments, operating rooms, procedure rooms, intensive care units, recovery rooms, ambulances, rehabilitation centers, skilled nursing facilities, dialysis centers, and doctor’s offices. It is commonly used to suction oral secretions and bodily fluids. Despite its popularity, the Yankauer remains awkward in its use. There is an ongoing problem concerning where to place it before, during, and after use on a patient. Currently, most medical providers attempt to use its original package as a protective covering. However, once the package is opened, it becomes an unreliable cover. Most often, the package falls off the Yankauer and onto the floor or gets lost in a patient’s bedding. It is not surprising that the Yankauer has the potential to cause gross contamination of the healthcare environment it is used in. Once the Yankauer has been used on a patient, it can contaminate the surfaces that it was placed on. These contaminated surfaces play an important role in the transmission of pathogens that cause healthcare-associated infections (HAI).

Introduction

HAIs affect 1.7 million patients annually in U.S. hospitals, causing nearly 99,000 deaths¹. The annual medical costs of HAIs to U.S. hospitals range from $28.4 to $45 billion dollars². An estimated 20–40% of HAIs have been attributed to cross infection via hands of healthcare workers who have been either contaminated directly by contact with an infected patient or by touching contaminated surfaces³.  It is important to note that pathogens such as norovirus and Clostridium difficile are relatively resistant to waterless alcohol-based antiseptics and surface disinfectants³.

As medical professionals, it is imperative that we focus on HAIs to keep our patients safe and to keep ourselves and our facilities out of legal trouble.  A heavy focus on HAIs have been placed in the forefront of treating a patient today by the Centers for Disease Control and Prevention (CDC), the Center for Medicare and Medicaid Services (CMS), and Joint Commissions  on Accreditation of Healthcare Organizations (JACHO). Facilities are now mandated to have infection control plans written out and documentation of the plans being followed.  Fines have been ensued for those facilities not complying with these new rules.¹ In addition, CMS no longer pays for treatment of certain HAIs contracted, leaving the facility and the medical provider to cover the costs. In recent years, a growing trend of lawsuits have been filed by patients suing medical professionals and their facilities for not keeping them safe from HAIs.¹

Studies and Findings

In a study conducted by Sole et al., (2002) on bacterial growth in secretions and on tonsil suction devices (such as Yankauer devices), specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation.⁴ Colonization was observed on 94% of the Yankauer devices within 24 hours. There were 47 observations made during the study period concerning where the Yankauer was located. The most common location (66%) of the device was on a shelf near the patient’s bedside (Figure 1). In addition, 21% of the devices were found freely hanging and were attached to the suction tubing and 13% were in the patient’s bed. The Yankauer was found uncovered most of the time (51%). It was also noted in the study that no standard for storing the Yankauer was found⁴.

Figure 1: Inappropriately stored Yankauer devices a) behind the canister and b) underneath the mattress.

Multiple studies have been conducted showing the relationship between environmental contamination and its contribution to HAIs. A study by Blythe et al., (1998) showed the ability of methicillin-resistant Staphylococcus aureus (MRSA) to contaminate hospital items such as mattresses and bed frames⁵.  According to a review by Boyce (2007), MRSA can remain viable for up to 14 days on Formica surfaces and up to nine weeks on cotton-blanket material⁶.  In the review, attention was brought to one healthcare worker who was infected with a strain of MRSA, but did not have direct contact with a patient infected with the same strain. The strain was found on environmental surfaces that the healthcare worker may have been in contact with. Thus, despite routine cleaning of environmental surfaces, MRSA is not always eliminated⁶. In addition, vancomycin-resistant enterococci (VRE) was shown to be capable of surviving from one week to two months on countertops, greater than seven days on fabric chairs, and a few days to more than three months on cloth and plastic surfaces. VRE was shown to be transmitted directly from contaminated equipment to patients⁶. These organisms all are readily transferred to Yankauer devices

Discussion

Interventions aimed at decreasing the number of HAIs should be at the forefront of any infection control plan. Knowing that contaminants can survive on environmental surfaces for days to months is a strong indicator that healthcare institutions need to have innovative products that prevent contamination from occurring. The Yankauer suction instrument transmitting contaminants to the workplace environment is an ongoing and common problem that has been riding under the radar of infection control departments, CMS, the CDC, and JACHO for many years. The millions of healthcare providers who have either used the Yankauer, or seen it being used, know all too well what a serious problem this is. It has been shown numerous times that the Yankauer suction instrument is a known culprit for spreading contaminants which in turn can cause HAIs.⁴ This is a serious and disturbing problem that has an easy solution.  Having a product such as the Yankaddy^TM (patent pending) in all healthcare settings where the Yankauer is used would allow medical providers a safe place to store the Yankauer before, during, and after use on a patient (figure 2). The Yankaddy^TM is a disposable retaining holster for the Yankauer suction instrument, specifically designed to fit onto its bracket with an adjustable arm and spring clamp. It gives the medical provider the freedom to have the Yankauer right at their fingertips where they need it, while also providing a one-handed method of use. It keeps the Yankauer contained to prevent contamination of the environment. This eliminates the need to place the Yankauer under the mattress or pillow, floor or slung across medical equipment with no protective covering. The Yankauer can now stay contained and be ready to use on a patient. Being a vigilant healthcare provider is one of the most important aspects of keeping our patients safe from harm.

Figure 2: Yankaddy device provides a location to safely store the Yankauer suction device.

References

1. Klevens RM, Edwards JR, Richards CL, et al.Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Pub Health Rep 2007;122:160-166.
2. Scott RD. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Accessed November 10, 2011.
3. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Closrtidium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25-33. Control and Prevention. MMWR Morb Mortal Wkly Rep. 1997;46:RR1-RR79.
4. Sole ML, Poalillo FE, Byers JF, Ludy JE. Bacterial growth in secretions and on suctioning equipment of orally intubated patients: A pilot study. Am J Critical Care 2002;11:141-149.
5. Blythe, D., Keenlyside, D., Dawson, S. J., & Galloway, A. (1998). Environmental contamination due to methicillin-resistant Staphylococcus aureus (MRSA). Journal of Hospital Infection, 38(1),
6. Boyce, J. M. (2007). Environmental contamination makes an important contribution to hospital infection. Journal of Hospital Infection, 65, 50-54.