BEMI: An Emerging EVS Metric to Reduce the Risk of Getting Sick in a Hospital >>>

Reducing the risk of getting sick in a hospital as it relates to environmental surfaces, infectious and other illness, means understanding a simple formula: Risk = Hazard x Exposure + Vulnerability —e.g., where the hazard is pathogens, exposure is where people and pathogens meet, and vulnerability is individual resistance to pathogens.

While pathogens can’t be eliminated from hospitals and human vulnerability is impossible to quantify or control, we can control levels of exposure.

Collaborative research between the nonprofit 501c3 [pending] Indoor Exposure Index and Dr. Charles Gerba at the University of Arizona is laying groundwork for a “Bioload Exposure Metric Index” (BEMI) (pronounced “be my”) to foster EVS process improvements that are quantitatively linked to health outcomes—allowing for statements like, “This way of cleaning reduces the chances of becoming ill by ‘x’ percent.”

Quantitative Microbial Risk Assessment (QMRA) combined with ATP sampling will reframe the conversation around environmental surface cleaning to reduce exposure to pathogens and other contaminants, reduce the probability of getting sick, lower absenteeism and presenteeism, and provide quantifiable ROI for the hospital.

It will also lay the foundation for a minimally intensive and maximally effective disinfection regimen since methods using EPA-Registered disinfectants and other interventions such as UVC are dependent on effective cleaning.

Possible Application

Reducing exposure to bioload is key to Cleaning for Health as bioload carries various soils, including pathogens, chemical residues, and organic material.

While ATP is the go-to metric for detecting bioload on surfaces, ATP Meters use different scales for results, so it is the difference between before and after numbers, or the reduction in ATP, that matters —and this reduction in exposure might be represented by a 1-10 index number below.

BEMI Index Levels 1-10 (10 being best)

1– 0% Reduction in ATP
2– 10% Reduction in ATP
3– 20% Reduction in ATP
4– 30% Reduction in ATP
5– 40% Reduction in ATP
6– 50% Reduction in ATP
7– 60% Reduction in ATP
8– 70% Reduction in ATP
9– 80% Reduction in ATP
10– 90% Reduction in ATP

Since levels are associated with before and after cleaning processes, BEMI helps assess and improve cleaning.

BEMI Development Summary

The Bioload Exposure Metric Index (BEMI) is a developing metric, not yet finalized, that aims to quantify the level of potential bioload exposure from surfaces, particularly focusing on hygienic conditions and cleaning effectiveness. It uses ATP (adenosine triphosphate) sampling as a proxy for various contaminants, including organic, microbial, particulate, and chemical soils. The BEMI is envisioned as a scale from 1 to 10, where higher numbers indicate lower ATP concentrations and thus, better cleanliness.

Here’s a more detailed breakdown and summary:

• BEMI stands for Bioload Exposure Metric Index.
• It’s a tool under development to assess the cleanliness of surfaces based on the potential for bioload and other exposure.
• It’s not a universally accepted or standardized index yet, but is being developed by the Indoor Exposure Index, a nonprofit.

How it works:

• ATP Measurement:
  The core of BEMI relies on ATP bioluminescence testing. ATP is a molecule found in all living cells, so measuring its presence on surfaces indicates the level of organic material (including potential pathogens).
• Sampling and Averaging:
  Multiple surface samples are taken, and the ATP levels are measured. These measurements are then averaged to arrive at a single BEMI score for a specific area.
• 1-10 Scale:
  The BEMI is designed to be a 1-10 scale, with higher numbers representing cleaner surfaces and lower numbers indicating a greater potential for bioload and other exposure.

Why it’s useful:

• Better Terminology:
  While “ATP” readings are common and well-known for organic soil measurement, “BEMI” is unique and more descriptive as it addresses bioload measurement and exposure to bioload as a proxy for many types of surface contamination, including microbial.
• Quantifies Cleaning Effectiveness:
  It provides a quantifiable way to assess how well cleaning practices are working to reduce potential health risks.
• Proxy for Various Contaminants:
  ATP measurements, as the basis for BEMI, function as a proxy for a range of potential hazards, including pathogens.
• Supports Cleaning for Health:
  The BEMI is envisioned as a tool to support the broader concept of “Cleaning for Health,” which aims to minimize health risks associated with indoor environments.

Considerations:

Not a Definitive Standard:

The BEMI is still under development and not yet a universally recognized standard.

Context Matters:

The interpretation of a specific BEMI score should always be done within the context of the specific environment being assessed.

Further Research Needed:

More research and field data are needed.

Sidebar

Other Factors for Consideration

According to healthcare consultant, J. Darrel Hicks:

“BEMI-related ATP measurement should be performed immediately before and after the environment is cleaned/disinfected because surfaces are quickly and frequently recontaminated.”

“EVS is not currently responsible for cleaning/disinfecting every environmental surface in a patient’s room which is a factor in determining the effectiveness of BEMI programs, e.g., EVS does not clean/disinfect the near-patient surfaces (bed rails, nurse call/tv remote, overbed table) if the patient is in the bed for fear of wetting the patient’s personal items (denture cup, urinal, eyeglasses, newspaper, tissues, etc.) BEMI development should invite re-examining this practice to see how to improve the near-patient cleaning process.”

“BEMI must be linked to a reduction in HAIs or it will not matter.”

See also, Infection Control Today.

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