st. lukes antimicrobial performance
TRANSCRIPT
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Master In Management (MM 2012)
MANAGEMENT CONSULTANCY PROJECT
Aimecotex Proposal to St. Luke’s Medical Center
Antimicrobial Performance of Medical Textiles, reduce risk in patient environment.
Hemant Goenka
MM 2012
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Philippines Economy: -‐
One of the fastest growing South-‐East Asia economies, the Philippines is an archipelago
of 7107 islands, sub-‐divided into 17 administrative regions. A low-‐middle income
country, fast developing into high-‐income bracket, likes its ‘Asian Tiger’ neighbors. The
Average annual family income is as high as a r ound US$ 7000 in the National Capital
Region (where Manila is located), while families in the poorest regions earn less than
a third of this amount. With population of 94 Million in 2010, it is the 12th most
populated country in the world.
With high population, Philippines Communicable diseases continue to be major
causes of morbidity and mortality. Diseases such as tuberculosis and pneumonia are
major causes of death. Increase in occurrence of Malaria, Dengue and leprosy
remain a problem in a number of regions of the country.
Philippines Healthcare regulators: -‐
In 1941, the Department of Health was established as a separate legal entity created
from, Department of Health and Public Welfare. S tar t ing 1950s, there was a steady
and gradual improvement in patient care, medical education, and public health
comparable to other Southeast Asian developing countries. In 2009, the Philippines
had 1,796 licensed hospitals. CALABARZON has the highest number of hospitals, followed
by Central Luzon and National Capital Region (NCR) or Metro Manila. 29 new hospitals
were added between 2005 and 2009. The DOH was created for the below objective:-‐
• Developing health policies and programs;
• Enhancing partners’ capacity through technical assistance;
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• Leveraging performance for priority health programs among these partners;
• Developing and enforcing regulatory policies and standards;
• Providing specific programs that affect large segments of the population; &
Providing specialized and tertiary level care.
Distribution of licensed hospitals, 2005-‐2009
Region 2005 2006 2007 2008 2009 NCR 182 180 181 178 179 CAR 55 55 56 55 50 I -‐ Ilocos Region 124 122 118 121 121 II -‐ Cagayan Valley 77 87 86 87 90 III -‐ Central Luzon 197 195 201 197 197 IVA – CALABARZON 222 236 233 232 234 IVB – MIMAROPA 56 57 60 63 65 V -‐ Bicol Region 120 118 117 116 113 VI -‐ Western Visayas 82 85 86 86 86 VII -‐ Central Visayas 107 107 107 107 104 VIII -‐ Eastern Visayas 69 72 72 70 73 IX -‐ Zamboanga Peninsula 73 70 71 70 67 X -‐ Northern Mindanao 105 104 107 109 109 XI -‐ Davao Region 111 109 108 107 110 XII – SOCCSKSARGEN 97 93 103 103 106 CARAGA 53 63 55 57 58 ARMM 37 30 21 26 34 PHILIPPINES 1,767 1,783 1,782 1,784 1,796
Source of Raw Data: List of Hospitals and Other Facilities, BHFS-‐DOH (various years).
In Philippines Private hospitals d om ina t e a s the vital institutions that provide
health care services to the majority of the population. In 2009, 60% of the hospitals are
privately owned with regard to ut i l izat ion and 48% of the population who needed
inpatient care are confined in private hospitals (NSO; Macro International, 2009).
Though they are large contribution, these institutions are also influences and affected in
their viability, sustainability and investment by the political, social and economic
dynamics and uncertainty of the country.
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Private hospitals in Philippines operate as profit institutions, unlike a few for example, St.
Luke’s a non profit organization but is catering to the highly affluent class of the
population with state of art technology and modern facilities. Majority of sophisticated
private hospitals are located in Central Luzon and NCR. These areas have low incidence of
poverty. Most of the private hospitals are Phil Health accredited. The accreditation rate of
private hospitals concomitantly increases with hospital level. On the average expenditure
of patients confined in private hospitals is at least two to three times more than that of
the average expenditure of patients confined in public hospitals.
Most of the patients confined in private hospitals are more likely to utilize their Phil
Health benefits compared to patients in public hospitals. However, they represent the
affluent class of the population and are in the position to shoulder out-‐of-‐pocket expenditure,
which normally exceeds the safety nets of insurance coverage in case of serious illness.
Medical tourism promotion in the Philippines
The Philippines is exploring its next sunrise industry in the medical tourism. A study titled
“Philippine Medical Tourism Compendium 2011: Facts, Figures & Strategies” estimated
that during the period of 2006 to 2010 the country earned a total of $1.30 billion from
health care and wellness services. There is a projection that the Philippines has the
potential to earn as much as $1 billion in additional annual revenue by 2018 with proper
investment in healthcare infrastructures, liberal travel arrangements for medical tourists
and strategic and extensive international marketing promotions campaign.
The Philippines has a high potential to grab a larger market share in the global medical
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Industry. It has a competitive edge since these world-‐class healthcare services generally
cost lower than in most developed countries like the United States and Canada, Japan,
Korea etc. The Filipino’s command on English communication skills, and hospitable culture
adds competitive advantage that made the country one of the Business Process
Outsourcing (BPO) hubs in the world – is now helping to position as top global healthcare
providers. International research firm Deloitte, the research added, has identified the
Philippines as one of the emerging players in the multi-‐billion dollar industry, which
currently is dominated in Asia by Singapore, India, Malaysia and Thailand.
Hospital accreditation
THE health-‐care system in the Philippines is considered generally to meet global standards,
with hospitals and other medical centers in the country able to pass accreditation tests
given by international organizations.
Joint Commission International (JCI) has cited five Philippine hospitals for rendering the
best service to Filipino patients. They are Makati Medical Center, The Medical City in Pasig
City, St. Luke’s Medical Center (SLMC) in Quezon City and Fort Bonifacio and Chong Hua
Hospital in Cebu.
The honor is recognition of the qualification of hospital staff in the Philippines, Filipino
doctors and nurses are internationally competitive, with majority having work experience
in many hospitals in foreign countries.
The JCI is a medical commission that helps international health-‐care organizations; public-‐
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health agencies and health ministries evaluate, improve and demonstrate the quality of
patient care. It has accredited approximately 450 public and private health-‐care
organizations in 50 countries. Patient’s level of confidence and trust increases with
certified accreditation of Hospital, which are credible and provide high standards of health-‐
care service.
Now with a new hospital building in Fort Bonifacio Global City, St. Luke’s is expected to
reach a larger number of Filipinos who needs medical assistance. With its mission to
provide outstanding patient care, SLMC is reputedly and acknowledged healthcare leader
in Asia. St. Luke’s Medical center in located Fort Bonafacio City. According to the local
government-‐zoning map, it is situated in a highly upcoming urban commercial zone with
high density of residential settlements surrounding the hospital with high per capita
income. Within three to five kilometer radius of the hospital, the area is sprawling with
residents, commercial establishments and International schools of which the hospital can
tap.
The medical tourism industry in the Philippines is still in the early stage of development,
compared with its Asian counter-‐parts. It is engulfed with severe competition, since all the
major hospitals in metro manila provide more or less equal quality of service and
infrastructure. The hospitals in NCR need a differentiating factor from their competitors, as
there is not too much of differentiation with regards to the technology, equipment and
qualification of professionals associated with other institutions.
The hospitals today are not putting much emphasis on the very basic health and hygiene
factor of preventing contamination through hospital linen. The preventive measures on
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linen are comparatively much lower, than the other major expenses associated with the
healthcare, for example medical equipment’s and salary and wages of highly qualified
professionals. The stiff competition form other major hospitals are squeezing profits and
reducing bed space occupancy resulting in revenue losses. Hospitals today are looking for
value added facilities to gain patients confidence to prefer them against other hospitals. In
the case of St. Luke’s they face stiff competition from
• Makati Medical Center
• Asian Hospital and Medical Center
• The Medical City
• Cardinal Santos Medical Center
• Manila Doctors Hospital
• World Citi Medical Center
• UST Hospital
• Philippine General Hospital
There has to be a differentiating factor, which will provide a sense of additional confidence
among the client patients to select St. Luke’s against the other options, which are almost
equal in quality and standard of treatment. The additional confidence awareness may
encourage patients to even pay a premium to the hospital and the first choice for getting
admitted. Differentiation vide value creation can offer a relatively inexpensive business
strategy to hospitals seeking to grow, defend or hike prices in highly competitive market
place.
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The few major area’s of concern unnoticed today by local healthcare facility are: -‐
1) Unpopularity of Anti Microbial treated hospital linen, and confidence and protection
to patient against bacterial and fungal infections.
2) Contamination of linen while being transported or stored in warehouse.
3) Flexibility of local sourcing as per specification and requirements.
The current environment and medical industry in particular is challenged by the presence
of micro-‐organisms and their negative effects. It causes deterioration, defacement and
odors. The fabric surfaces can also act as a microbial "harbor", as they provide ideal
environments for the harmful microorganism proliferation. Education, media and Internet
today has resulted in heightened public concern and awareness about cross contamination
issues and infection control in general. This increase in public awareness is encouraging
antibacterial and antimicrobial consumer product demand for application in care facility’s
environment.
Healthcare industry must prepare an action plan for avoidance and control of
airborne, human, and surface-‐sourced microbial contaminants. Strategies for control of
microbes must be exercised in garments, beddings, linens, wipes, surgical fabrics, and
other textiles used. The microbial colonization of environmental surfaces and linen in
hospitals can produce infective, allergenic, and toxigenic risks for occupants. Traditional
disinfectant/sanitizer formulations do not provide sustained control of microbial
contamination, at low levels and their extended use is potentially hazardous to people
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and the environment. The application of chemical disinfectants to control microbial
colonization of hospital surfaces started in 1860’s, when Joseph Lister atomized a 5%
Phenol solution to control “hospital gangrene.” Ever since developments in disinfectant is
popular to provide an increasing toxic arsenal to destroy germs. Current methods of
Micro-‐aerosol dispersion, micro-‐encapsulation, and impregnation of the biocide into a
variety of polymeric resins, have been used to expand the capabilities of these agents and
to reduce toxic consequences for man and the environment.
Antimicrobial Treatment of Hospital linen will solve major problems and create value
creation for customers to give preference to St. Luke’s compared to other reputed
healthcare institutions.
Additional value I created when leveraged as a market strategy. Introduction of a customized product to gain the appreciation, confidence, popularity and acceptance of the end user, and its value creation among the target segment.
Incremental value is created when the improvement in product or service quality is one that provides the institution with an enduring point of differentiation compared to others in the same industry.
customer’s confidence and popularity and accptablity of the service almong the customers
The additional product or service quality must provide a compelling and relevant consumer benefit.
.
Value Creation
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Nosocomial infection today is a serious problem affecting health care facilities such as
hospitals and nursing homes. The cost associated with its treatment is expensive and
requires a multifaceted solution.
St. Luke’s and many hospitals spend a fortune to chemically disinfect the linen after use.
Every wash with treatment is costing around 29 Philippine Pesos per bed sheet. The linen
is sent to its Quezon City operations for laundry, on return may be contaminated again on
transit. The possibility of contamination is high when stored in the hospital warehouse for
a longer duration causing odor, and thereby transferring the harmful bacteria to the
patient. The net result is money wasted on the washing and treatment of the linen.
The antimicrobial Shield technology prevents contamination of hospital linen during
distribution, transportation and storage.
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Advantages of Antimicrobial treatment on Hospital Linen:
• Prevents blanket staining due to mold and mildew growth that occurs on damp
blankets prior to laundering.
• Controls blanket deterioration due to microbial growth that occurs on blankets
during storage.
• Controls odors caused by bacteria and fungus normally found in blankets.
• Provides 3 times more protection from microbes than an untreated blanket.
• Anti microbial property intact with linen even after 50 washes.
Patient Concern about Hospital: almost 80% patient expressed concern about presence of
bacteria when staying in hospital. Healthcare professional concern about hospital: Over
97% healthcare professional acknowledge concerns about the presence of bacteria in their
healthcare facility.
Patient Concern About Hospital
Healtcare Professional concern about Hospital
47.8
76.3
31.5 21.1 18.2
2.2 2.5 0.04
A survey of 20 Patient and 20 Healthcare professional each, in 5 Philippines hospital
Very Concerned Somewhat Concerned Not Very Concerned Not At All Concerned
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The above date shows that’s patient expect maximum concern while using Bed sheet 76%,
Pillows 73%, Mattress, Mattress pads and covers and bedspreads at72% and comforters
and blankets at 70%. Signifying the awareness and concern of patients against the
microbial attacks.
The Philippines garments and textile industry started from a cottage-‐type industry in the
early ‘50s. From then, it has expanded, strongly positioning itself as the country’s leading
0 10 20 30 40 50 60 70 80 90 100
Vinly bath mat
Toilet Flushing handle
Shower curtains
Wash basin
Toilet seats
Bath Towels
Bed Spreads
Comforters / Blankets
Pillows
Mattress pads and covers
Mattress
Bed Sheets
Doctors Tie
Doctors coat
Patient expect Antimicrobial protection in Hospital Furnishing and linen.
Total Somewhat Important Very Important
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non-‐traditional export. FromUS$36 million worth of garments and textiles exported in
1970, it has grown tremendously, reaching its first billion dollar in year 1987. The
Philippines government and the private sector undertook aggressive joint marketing
efforts, that helped sustain the industry’s performance through the ‘90s despite the Asian
crisis. In year 2000, the industry breached the three billion dollar mark. But lately the
industry is facing stiff competition from china, Bangladesh, Vietnam and Sri Lanka and the
factories and margins are shrinking at accelerated pace.
Philippines textile industry is a dominant in circular knitting technology and weaving
machines can be hardly found because of high investment and high labor cost. The
hospitals in the Philippines are consuming almost 95% of their linen in form of weaving,
resulting in importation of the product from neighboring countries, i.e. china, Indonesia
and Vietnam thereby killing the manufacturing. Thus with attempt to offer and promote
knitted fabric for Philippines healthcare, It will benefit the healthcare institute to source
good quality, regular and prompt supply of their merchandise locally, and be self sufficient.
On the other hand it will also support and revive, the sunset textile industry of the
Philippines.
The big advantage for Philippines healthcare industry to shift from use of woven fabric to
knitted fabric is the easy availability of ready stock, and to avoid dependence on imported
material. The consistency can be maintained in relation to price, quality and supply. If
locally produced, the basic raw material i.e. yarn can be sourced from a local yarn spinning
mill namely Indo-‐Phil Textile or Solid Textile Mills. The Circular Knitting, done locally can
help produce fabric as per personal specification and quality requirement. Local well-‐
equipped dyeing factories can perform the antimicrobial treatment and dyeing process. If
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all process is locally performed, every stage of development can be inspected, controlled
and monitored, to ensure high quality of the finished products. It will also improve the local
economy and provides employment to a vast population.
The healthcare linen industry is challenged by the presence of microorganisms and the
negative effects they cause. Deterioration, defacement and odors are all dramatic effects,
which occur from the microbial contamination of woven. They can also act as a "harbor" as
most they offer ideal environments for medically significant microorganisms. The ability to
replace woven fabric with knitted fabric and treating, them to resist to microbial
contamination has advantages in many healthcare applications. The health care industry is
challenged with providing, the best possible care for its patients and a safe environment for
health care workers. Microorganisms are the most prevalent and potent pollutants in the
indoor environment.
The business is designed as a team work, since not everything can be perfected by an
individual we have partnered with the best in their field to work together to come up with
a full proof solution to offer the best possible product. The Proposal is to source yarn from
a local Spinning Mill i.e. either Indo-‐Phil Textile or Solid Development. The construction of
high quality Single jersey, Pique or Interlock fabric will outsourced to circular knitting
machines. The second Partner in our business i.e. Blue Ocean Trading Inc. who is
responsible for the importation of the patented antimicrobial solution from the USA under
the FDA approved “Micro ban” Brand, they will be also coordinating with the Local Dye
house i.e. Saffron Philippines Inc. for the final finishing and antimicrobial treatment of the
fabric. The final stage sewing and stitching of the linen, will be performed by the
Philippines registered Bamboo Fiber Textile Inc., a reputed 100% (Export Oriented Unit)
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EOU, with operations in PEZA (Philippines Special Economic Zone). They have extensive
expertise in this industry and catering to major healthcare industry of Europe and USA for
last 15 years.
We are currently going to use virgin fiber yarn which may be slightly expensive, but in
future we have the option to use yarn made from recycle fiber which not only is highly
economic and providing cost benefit, but also environment friendly and complying with
environment protection campaign. In the current situation Philippines has no producer for
recycled yarn and thus has to be imported from Indonesia, China or Vietnam. The local
demand for the recycle fiber yarn may encourage the local spinning mills to manufacture
the same in the Philippines in near future.
This premium quality knit fabric is made of a soft spun yarn, cotton rich blend of 52%
Cotton, 48% Polyester. High cotton percentage provides absorption of moisture it provides
a soft, air-‐trapping layer between the mattress and body, while the fabric structure delivers
increased permeability for good airflow. The user is kept warmer and less likely to suffer
from skin shear or compression sores. The most ideal situation will be to use 100% cotton
Yarn, Cotton fiber being 100% natural product is most suitable and comfortable for human
contact, the risk is with relation to high price and volatility which the market of Philippines
may not be ready to absorb at this moment but eventually the application of which is
inevitable.
With respect to durability the knitted fabric structure eliminates, running or zippering if a
hole is accidentally made. And the extra stretchy material prevents slipping when bed is
raised and lowered. The elasticity of this material ensures a proper fit for almost all
hospital mattress depths. The contoured bottom sheet has "envelope" design corners that
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wrap deeply around the mattress for a smooth, secure fit that will not slip off and stretches
to accommodate mattress overlays. The semi-‐fitted top sheet is designed with two
contoured corners to keep the bed tidy and has a "Foot-‐Ease" fold at the end of the sheet
that provides extra foot room and reduces pressure on the heels. With saving point of view
the 2 ways stretch and Wrinkle resistant, avoids the extra cost of ironing. Thus is economic
with respect to power saving, time saving and convenient.
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The Fabric is treated with antimicrobial solution before the bleaching process at 90 degree
Centigrade to infuse the antimicrobial properties inside the fiber to maintain its
effectiveness even after 50 washes at 5% concentration, and 100 washes at 10%
concentration of the anti microbial solution. Since every step of the process is locally
performed the quality control can be monitored strictly unlike when ready fabric is
imported. Additional colored Reactive non bleeding dyeing process allowing them to be
used and washed with existing white sheets and pillowcases and other white linens,
without worrying about colors bleeding and discoloring the other linen.
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Biodegradable: -‐ In the capitalistic 3.0 economy (Profit, People, Planet) the planet plays a
vital role, hence the developed product needs to meet the minimum requirement of
protecting the environment. The product is 100% biodegradable. It contains no heavy
metal or toxic chemicals it is of composed of a silane quaternary ammonium salt. Silane
basically turns to sand, and ammonia is nitrogen, which transforms into fertilizer when
mixed with soil, during landfill. The solution is in compliance with EU BPD and global (US
EPA) regulations. The Healthcare industry today is subject to enterprise wide risk
management. As one of the risk assessment it has to ensure, they are using environment
friendly products i.e. biodegradable material to comply by their corporate social
responsibility, To avoid any unwanted allegation from the social media or social
organization to safeguard and protect their reputation.
With introduction of this new concept of Antimicrobial hospital linen produced from
knitted virgin or recycled fiber will allow St. Luke’s to provide value creation and attract
customers. It will encourage and improve the standard of the Philippines Health industry to
the level of the developed European and USA healthcare industry. It will hone and provide
competitive advantage to the emerging healthcare tourism industry in the Philippines.
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Republic of the Philippines Department of Science and Technology
INDUSTRIAL TECHNOLOGY DEVELOPMENT INSTITUTE Gen. Santos Ave., Bicutan, Taguig, Metro Manila
Tel. nos. 837-2071 to 82 (DOST Trunklines) Fax : 837-3167; 837-0032
I T DI______________________________________________________________________________________ Our Business is Industry
REPORT OF ANALYSIS STD-0503-003
Antimicrobial Activity-Dynamic Test of Surfaces ASTM E 2149
The Antimicrobial Activity-Dynamic Test of Surfaces ASTM E 2149 determines the effectiveness of fabric as a bactericidal antimicrobial. Method The antimicrobial activity of the Fabric was evaluated by the Antimicrobial Activity Dynamic Test of Surfaces ASTM E2149 for 105 CFU/ml of Escherichia coli ATCC 8739 and Candida albicans ATCC 10231. Plate counts are performed at zero hour and after 1 hour of inoculation at 370C. Test Article: Fabric (Jersey) Test Organism: Escherichia coli ATCC 8739 Candida albicans ATCC 10231 Sample Size: 2.00 +/- 0.01 g Pre-Wet Medium: 0.01% Triton 100X Inoculum Concentration: E. coli = 141 x 105 -208 x 105 CFU/ml C. albicans = 24 x 104 -137 x 104 CFU/ml
MICROORGANISM CONTACT TIME
SAMPLE INOCULUM LEVEL
CFU PERCENT REDUCTION
Treated 141 x 105 223 x 103 98.4% 0 hr Untreated 141 x 105 62 x 105 56.0% Treated 208 x 105 25.4 x 103 98.8%
Escherichia coli
1 hr Untreated 208 x 105 118.5 x 105 42.5%
0 hr Treated 137 x 104 224 x 103 83.6% Untreated 137x 104 117 x 104 14.2%
1 hr Treated 24 x 104 37 x 103 84.6%
Candida albicans
Untreated 24 x 104 180 x 103 25.0%
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Clinical Test Results of treated Antimicrobial Fabric.
TABLE II (Results)
AATCC Method 100, Antimicrobials on Fabrics1
AEM 5700 Antimicrobial Agent Treated Bed sheet
Microorganisms Sample %Reduction
Staphylococcus aureus Control 16
Gram (+) Bacteria Treated 2 100
Escherichia coli Control 0
Gram (-‐) Bacteria Treated 99.6
Klebsiella pneumonia Control 0
Gram (-‐) Bacteria Treated 100
Saccharomyces cerevisiae Control 0
Yeast Treated 99.9
1 DuPont FC-‐170 surfactant used, substituted for Rohm and Haas Triton X-‐100
2 Fabric was Hospital Bed sheet
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Overview: -‐
Antimicrobial agents are used to kill or limit growth of microorganisms. Antimicrobial
Shield, an antimicrobial agent composed of a silane quaternary ammonium salt, is featured
for its durability and efficacy against both gram-‐negative and gram-‐positive bacteria. This
research studied the effectiveness of the antimicrobial agent as a treatment for cotton
fabric. Cotton fabric samples were coated with the antimicrobial agent, and then tested
against three species of bacteria. The samples were shaken in a bacterial solution to allow
contact with the microbes, and the numbers of viable bacteria were counted. The data were
compared to the numbers of bacteria with untreated fabric. This research reveals that the
antimicrobial agent reduced the numbers of bacteria exposed to the treated cotton fabric.
Research: -‐
Ø The three types of bacteria were Escherichia coli, Staphylococcus epidermidis, and
Bacillus subtilus. For each test, the bacteria were grown in Tryptic Soy Broth (TSB)
for eighteen hours at room temperature. The bacteria were diluted in 0.003M
KH2PO4 to 72 percent transmission using a Vitek Colorimeter. For testing, the
bacteria were diluted 1:1000 to 1.5-‐3.0 x 105 cfu/mL. Then, 50mL aliquots of the
diluted bacteria were distributed into sterile 250mL flasks.
Ø The numbers of bacteria were determined by the pour plate method using Tryptic
Soy Agar (TSA). The control was plated at “0” contact time. The nine flasks were
agitated in a reciprocal shaker at 120 RPM. After one hour, all bacteria samples were
plated and incubated for 24 hours at 35°C.
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Results: -‐ It was discovered that the antimicrobial agent did exhibit the ability to kill the
three species of bacteria.
Acknowledgement: -‐ This research was conducted as part of the 2004 Spaceflight and Life
Sciences Training Program funded by the National Aeronautics and Space Administration.
The authors recognize the support of the Dynamac Corporation, the NASA Spaceflight and
Life Sciences Training Program Academic Partner Alliance and the United States
Department of Agriculture.
Above Graph: Comparison of all pure cultures used with and without the antimicrobial
agent
Best Care Always …..
Thank you!
0
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E.coli Staph Bacillus
Pres
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U/mL
(X 10
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Treated Untreated Control
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