Infection Prevention in Practice 5 (2023) 100291

Available online at www.sciencedirect.com

Infection Prevention in Practice

journal homepage: www.elsevier.com/locate/ipip

New patient privacy curtains to provide passive

infection prevention
Nicole M. Nelson a, Anna Aceto a, Gordon F. West a, *
a
Department of Nursing, Madigan Army Medical Center, Tacoma, WA, United States

A R T I C L E I N F O S U M M A R Y

Article history: Background: Cloth privacy curtains represent a potentially overlooked high touch surface.
Received 1 February 2023 Inconsistent cleaning schedules paired with frequent contact allow curtains to provide a
Accepted 5 June 2023 surface for the transmission of healthcare associated pathogens. Privacy curtains inte-
Available online 13 June 2023 grated with antimicrobial and sporicidal agents are shown to reduce the number of bac-
teria found on the surface of the curtains. The purpose of this initiative is to utilize
Keywords: antimicrobial and sporicidal privacy curtains to mitigate the transmission of healthcare
Curtains associated pathogens from curtains to patients.
Privacy curtain Methods: The pre/post-test study design compared the bacterial and sporicidal burden of
Cross infection cloth curtains to the bacterial and sporicidal burden of Endurocide curtains following 20-
Equipment contamination weeks of use within the inpatient setting of a large military medical hospital. The
Anti-bacterial agents Endurocide curtains were installed on two inpatient units in the organization. We also
Linen compared the overall costs associated with the two different types of curtains.
Results: The antimicrobial and sporicidal curtains had a significant reduction in bacterial
contamination (32.6 CFUs vs 0.56 CFUs, P < 0.05) after instillation on both units. There
were no additional hospital associated infections during the study period. In addition, the
direct cost savings of replacing the antimicrobial and sporicidal curtains is estimated to be
$20,079.38 annually with a reduction of 66.95 hours in environmental services workload.
Conclusion: These curtains represent a cost-effective intervention effective at reducing
CFUs with the potential to mitigate the transmission of hospital associated pathogens to
patients.
ª 2023 The Authors. Published by Elsevier Ltd
on behalf of The Healthcare Infection Society. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction tended to focus on device-related and surgical site infection

interventions. However, 67% of HAIs are not linked to these two
Despite years of work to reduce healthcare associated main focus areas suggesting a need to explore additional
infections (HAIs), estimates suggest 1 out of 31 patients will interventions to reduce HAIs [2]. In a clinical environment,
develop an HAI while hospitalized [1]. Prevention efforts have privacy curtains pose an unseen but serious risk to patients.
Privacy curtains are a high touch surface frequently utilized
preceding and immediately following the delivery of care.
* Corresponding author. Address: Madigan Army Medical Center These curtains can easily harbor bacteria that can be trans-
ATTN: MCHJ-ISI, CNSCI, Rm 1-57-7, Gordon West; 9040 Jackson Ave., ferred to patients increasing the risk for developing an HAI [3].
Tacoma, WA, 98431, United States. Tel.: þ1253 968 0981; fax: þ1253 Healthcare workers are tasked with the overall responsi-
968 2559. bility of limiting the exposure of HAIs to those under their care.
E-mail address: [email protected] (G.F. West).

https://doi.org/10.1016/j.infpip.2023.100291
2590-0889/ª 2023 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
2 N.M. Nelson et al. / Infection Prevention in Practice 5 (2023) 100291
Hand hygiene is the primary intervention healthcare workers level extending roughly 30 centimeters above and below to
utilize to reduce this risk. However, hand hygiene is variable sample the curtain surface with the most direct hand contact
with numerous studies identifying problems with the amount of and 20 centimeters in for a total of 1,200cm2. Both sides of the
product used, duration of hand hygiene, and overall com- curtain within this area were sampled as contact is made on
pliance with consistently performing hand hygiene as indicated both sides of the curtain when staff open and close the curtain.
[4]. Typically, when entering a patient’s room healthcare This contact occurs both before and after patient care. As each
workers perform hand hygiene, don gloves and then as needed curtain has two edges, sampling was done on the leading edge
reposition curtains to provide patient care. These actions alone defined as the edge staff use to open and close the curtain.
can place the patient at risk as studies have shown that there is Typically, the other edge has minimal contact as the edge
a high risk of gloves transferring bacteria from curtains to boarders the headwall of the patient bed preventing easy
patients [3]. Numerous studies have identified methicillin- entry/exit. Bacterial swabbing was preformed at baseline and
resistant Staphylococcus aureus, Vancomycin-resistant enter- once during the follow up period for a total of two swabs per
ococci, Clostridium difficile and many other nosocomial curtain. BBL CultureSwab EZ were used and swabs transferred
pathogens on hospital curtains [5e7]. Overall, these findings to lab for steaking once sampling was completed.
suggest privacy curtains are a potential vector for bacteria Utilizing standard microbiology techniques, swabs were
associated with HAIs that require additional interventions streaked onto a 5% blood agar plate and incubated for
beyond simple hand hygiene. approximately 24 hours. Each plate was manually counted and
Finally, hospital curtains are inconsistently changed the total number of colonies annotated. The acceptable
between patient admissions. Some hospital protocols limit countable range of a plate is 0e250 colony forming units
changing curtains to when they are visibly soiled or following (CFUs). Anything above 250 CFUs was considered too many to
the discharge of a patient on contact or droplet precautions count [10]. To ensure validity, two individuals performed
occupying that room [8]. Visual inspection is inadequate to counts on 50% of the pre/post plates. The total number of
determine the presence of bacteria as it cannot be seen and colonies were independently counted and then compared. To
bacteria are typically found on the majority of surfaces ensure validity of the counts, if the number of colonies varied
sampled within the healthcare environment [9]. Beyond tra- by more than 10% on the respective plate the two individuals
ditional cloth privacy curtains, antimicrobial curtains are now conducting the count where to review the plate collectively
available. These antimicrobial curtains have demonstrated and agreed on the number of colonies present.
the ability to effectively prevent as well as kill bacteria In collaboration with the environmental services depart-
introduced onto the curtains over an extended amount of time ment, the antimicrobial and sporicidal curtains were installed
[8]. As such, the objective of this project was to determine if in designated patient rooms when the room was not occupied.
there is a difference in bacterial colonization of antimicrobial The curtain installation date and the curtain change date were
and sporicidal privacy curtains compared to traditional cloth documented on each curtain label. Consistent with existing
curtains over a 20-week period of use. The long-term goal of guidance with cloth curtains, these curtains were changed if
this project is to demonstrate the feasibility of antimicrobial they were visibly soiled or damaged. Cloth curtains continued
and sporicidal privacy curtains with the goal of facility wide to be changed if a patient on contact or droplet precautions
implementation to mitigate the transmission of pathogens utilized the room. However, the antimicrobial and sporicidal
from curtains to patients potentially reducing HAIs within the curtains were not changed if the room was utilized for a patient
facility. on contact or droplet precautions.
Bacterial growth was quantified as CFUs. The Shapiro-Wilk
Methods test was used to determine if the data was normally dis-
tributed. The Mann-Whitney U test was used to determine the
This evidence-based practice initiative was conducted from significance of CFUs detected on the antimicrobial and spor-
July 2020 to February 2021 on an acute care and maternal child icidal curtains. A p-value < .05 indicated a statistically sig-
unit in a military treatment facility in the Pacific Northwest. nificant difference. All analyses were performed using R
This timeframe includes planning and executing the project. version 4.0.4 software. Ethical approval was not necessary for
The sampling period included baseline sampling followed by this study.
repeat sampling 20 weeks later. A combined total of 13 single Cost figures for this analysis were derived by consultation
or multi-bed patient rooms and two control rooms were with the hospital logistics division. The logistics division pro-
selected for this initiative; each room contained 2e9 cloth vided the cost per each cloth curtain. Additionally, the logistics
privacy curtains. division provided a cost per pound for commercial laundering
Within this facility, cloth privacy curtains are changed every services at the facility and the curtain was weighted to
six months or when visibly soiled, damaged or after the dis- determine the cost per curtain. The facility contracts house-
charge or transfer of a patient on contact or droplet pre- keeping services and was able to provide us with a cost per hour
cautions. Prior to this project, all rooms had standard cloth for services. This rate was utilized to provide cost estimates for
curtains. To ensure the research team could communicate the labor savings. We asked four different housekeepers how long
change with nursing and housekeeping, a schematic of patient it takes to change a privacy curtain and took the mean of these
rooms was utilized to identify which rooms received the anti- reported times to determine how long it takes to perform this
microbial and sporicidal curtains as well as identifying the task. Finally, we communicated with the facility infection
control curtains. control staff to monitor HAIs during this intervention period. No
To determine the presence of contamination on the cur- HAIs were reported at this facility during the intervention
tains, bacterial swabbing was performed at approximate waist period.
 N.M. Nelson et al. / Infection Prevention in Practice 5 (2023) 100291 3

Results Discussion

Twenty-five curtains were installed in the acute care and Similar to other studies, the antimicrobial and sporicidal
maternal child units and two control rooms had the standard curtains demonstrated a significant decrease in the number of
curtains. The mean CFU count prior to changing the curtains was bacteria after installation [8,11]. No healthcare associated
25 CFUs in the acute care unit and 55 CFUs in the maternal child infections were directly linked to curtains within our study.
unit. Disagreement beyond 10% did not occur on any of the Given the relatively low level of HAIs in our facility, this was
plates. Post implementation on the new curtains the mean CFU anticipated. Future work to directly link the source of HAIs in
count was less than 1 CFU on both units. Overall, antimicrobial patients is needed. However, this research will likely require
and sporicidal curtains had a significant reduction in bacterial prospective research enrolling high risk patients in studies
colonization (32.60 CFUs vs 0.56 CFUs, P < .05) compared to the sampling multiple surfaces and staff interacting with patients
previously installed cloth curtains. The cloth privacy curtains in to determine the potential source of infection. Our small study
the control rooms as expected experienced an increase in bac- suggests this intervention is very effective at eliminating the
teria over the study period but the difference was not statisti- potential for curtains to pose a risk to our patients within the
cally significant (32.25 CFUs vs. 67.25 CFUs, P ¼.15) pre/post two different units with the findings supporting the expansion
evaluation. None of the control room curtains were changed of these curtains to all inpatient areas.
during the study period. Two antimicrobial and sporicidal cur- Although direct observation of hand hygiene compliance
tain panels in the acute care unit were changed because they was not conducted for this study, these antimicrobial and
were visibly soiled; no curtains in the maternal child unit were sporicidal curtains provide a strategy that organizations can
changed. The infection control service did not identify any new utilize to mitigate the transmission of HAI pathogens to
hospital associated infections during the study. The COVID-19 patients from the hands of healthcare workers. It is well
pandemic occurred during data collection. The target units in established that hand hygiene is the best method to prevent
this study did not provide care to COVID-19 positive patients. HAIs. Despite this fact, hand hygiene rates tend to be under 50%
Workload was not specifically tracked over the study period but allowing these privacy curtains to be potential danger hanging
informal estimates suggest workload remained stable on the in plain site [12]. Efforts such as these new curtains could
labor and delivery setting and increased slightly on the tele- potentially decrease HAIs by significantly decreasing the
metry floor as the surgical unit these patients typically transition number of bacteria on the curtain that healthcare providers
to was converted to a COVID-19 floor resulting in more patients can transfer to the patient [13]. Our findings found a mean of
staying on this unit until discharge. less than 1 CFU on the curtains suggesting the real potential to
In Table I, the estimated direct and indirect costs of eliminate the potential for privacy curtains to serve as a vector
replacing the standard curtain with the antimicrobial and for HAIs.
sporicidal curtains was calculated during this study period. The While the potential to decrease HAIs should outweigh cost
estimated total cost savings for this study period is $7,722.84. issues, these new curtains have demonstrated consistent cost
Over 2 years this could provide additional savings to the savings with our findings [14]. The additional time could
organization for the purchase of new curtains, labor, and potentially allow environmental services an opportunity to
laundry cost. focus on other high priority sanitation efforts in the organ-
The frequency of curtain changes for the organization is ization. In addition, the curtains provide a safety advantage
every six months unless the curtains are visibly soiled, damaged because the environmental service team would not need to
or discharge of a patient on contact or droplet precautions. The climb a ladder as often to change the curtains [14]. In addition,
estimated time saved by environmental services for a curtain as these curtains continue to be used there is more opportunity
change in a contact or droplet precaution room after patient or evaluation of a recycling program for these curtains since
discharge is 26.25 hours. one of the selling points is that they can be recycled [15].

Table I
Cost comparison of antimicrobial and standard curtains
Antimicrobial curtain Standard curtain Total savings
Direct Costs Curtain Panels $1,564.70 $8, 432.14 $6,867.44
Indirect Costs
Curtain changes 2a 105 (7 rooms x3 panels x 20 weeks)b
Staff Cost $9.25 $485.63 $476.40
Laundering Costc $0 $379.05 (3.61 x 105) $379.05
Annual Cost Savings $20,079.38
Time to replace curtains
0.50 hours (15 min x2) 26.25 hours (15 min x105)
Annual Time Saved 66.95 hours
a
Combined number of curtains changed on the acute care and maternal units.
b
Average number of contact or droplet precaution curtains changed on the units per month.
c
Cost to launder standard curtain $3.61 per panel.
4 N.M. Nelson et al. / Infection Prevention in Practice 5 (2023) 100291
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