HCWH urges hospitals to avoid antimicrobial furnishings for now

Health Care Without Harm (HCWH), Reston, Va., is urging health care systems and organizations to seek more evidence on the safety and efficacy of furnishings containing antimicrobials before purchasing or continuing to buy these products to reduce health care associated infections (HAIs).

In the report issued Tuesday, “Antimicrobials in Hospital Furnishings:Do They Help Reduce Healthcare-Associated Infections?”, HCWH says there is a dearth of evidence to support the use of antimicrobials included in a growing number of furnishing products.   

Although some antimicrobials reduce the microbial load on textiles and other environmental surfaces in laboratory settings, they have rarely been evaluated in well-designed clinical studies for their effectiveness in contributing to HAI reduction, according to the report.

Beyond their potential impact on HAIs, life-cycle safety concerns associated with the manufacture, use and disposal of antimicrobials also need careful research, the report says.

Furnishings includes items with surfaces such as tables, desks and countertops; built-in and modular casework; seating; beds; bedding; cubicle curtains; window coverings; panels and partitions; and storage and shelving.

In its advice to health care organizations HCWH recommends:

• Do not specify antimicrobials in furnishings unless they have undergone U.S. Environmental Protection Agency (EPA) evaluation and registration under the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) and have been shown to help reduce HAIs in a clinical setting as part of an integrated infection control program.

• Ask suppliers to disclose any antimicrobials added to materials and products, even if they are used for material preservation, odor control or other aesthetic reasons unrelated to health.

• Take the lead or collaborate in research addressing data gaps related to efficacy and risks associated with adding antimicrobials to furnishings.

• Examine antibiotic stewardship programs for opportunities to reduce the risk of generating antimicrobial resistance.

The report says that while hospital furnishings may ultimately prove to be efficacious in reducing HAIs, the benefits and risks associated with their use are largely unknown.

Ted Schettler, M.D., principal author of the HCWH report, says limited and inconclusive research has been conducted on the effectiveness of antimicrobials, including copper, in reducing HAIs. Research so far has focused on antimicrobial effectiveness in killing bacteria on high-touch points in clinical spaces.

Health risks and financial implications of adding antimicrobials to products in hospitals need evaluation through intensive research, Schettler says. That would help product designers, purchasers, infection preventionists and environmental services personnel make more informed purchasing decisions.

“Until results from that research become available, design and purchasing decisions will be based mostly on hope and unverified assumptions rather than objective data. Hope and assumptions are not a sufficient rationale,” the report says.

HAIs have been a difficult challenge for hospitals and are major causesof morbidity and mortality. Based on surveys of 183 acute care hospitals, the Centers for Disease Control and Prevention (CDC) estimates that there were about 722,000 HAIs in the United States in 2011. Approximately 75,000 hospital patients with HAIs died while hospitalized.

The potential financial repercussions of HAIs under the Affordable Care Act have intensified interest for hospitals to develop new strategies to reduce infections. Preventable readmissions can result in a financial penalty in reimbursement for all Medicare patients at that hospital.

The Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) authorizes and requires federal regulation of the distribution, sale, and use of pesticides to protect human health and the environment. Products that kill or repel bacteria or germs are considered pesticides, and must be registered with the EPA prior to distribution or sale. The EPA will not register a pesticide until it has been tested to show that it will not pose an unreasonable risk when used according to the directions.

Complicating the issue is the Treated Articles Exemption of FIFRA. Under the exemption, companies can avoid a lengthy pesticide registration process if they refrain from making explicit or implicit health benefit claims about the antimicrobial product and make clear that the biocide, if it is mentioned at all, is for protection of the treated item, the report says.