Should Electronic Faucets Be Recommended in Hospitals?

Microbiological examinations of electronic faucets newly installed in a hospital kitchen revealed high bacteria counts andPseudomonas aeruginosaduring a 6-month period of observation. Our data suggest that the use of electronic faucets poses a potential risk for nosocomial infection in high-risk areas of hospitals.

Biofilm formation in an experimental water distribution system: the contamination of non-touch sensor taps and the implication for healthcare

Hospital tap water is a recognised source of Pseudomonas aeruginosa. U.K. guidance documents recommend measures to control/minimise the risk of P. aeruginosa in augmented care units but these are based on limited scientific evidence. An experimental water distribution system was designed to investigate colonisation of hospital tap components. P. aeruginosa was injected into 27 individual tap 'assemblies'. Taps were subsequently flushed twice daily and contamination levels monitored over two years. Tap assemblies were systematically dismantled and assessed microbiologically and the effect of removing potentially contaminated components was determined. P. aeruginosa was repeatedly recovered from the tap water at levels above the augmented care alert level. The organism was recovered from all dismantled solenoid valves with colonisation of the ethylene propylene diene monomer (EPDM) diaphragm confirmed by microscopy. Removing the solenoid valves reduced P. aeruginosa counts in the water to below detectable levels. This effect was immediate and sustained, implicating the solenoid diaphragm as the primary contamination source.

Outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit

Acinetobacter baumannii is a ubiquitous microrganism often able to colonize and survive in different environments. Currently it is one of the most common pathogens responsible for nosocomial infections, including outbreaks, especially in long-term care facilities. The aim of this study was to show the results of an environmental investigation and genotyping analysis of multidrug-resistant Acinetobacter baumannii associated with an outbreak in an intensive care unit of a tertiary hospital located in Northern Sardinia, Italy. Positive cultures of MDR Acinetobacter baumannii were reported during the month of June 2012, after the collection of biological samples from ten patients. Acinetobacter baumannii was isolated during the following environmental investigation from the headboard of two beds. All the strains were genotyped by performing multiplex PCR to identify the presence of genes encoding carbapenemases. The results showed specific bands of bla(OXA-51-like) gene and of the bla(OXA-23-like) gene. PFGE highlighted minimal differences in genomic fingerprints, while the cluster analysis grouped the isolated microorganisms into two closely related clusters, characterized by Dice's similarity coefficient equal to 95.1%. MLST showed that the strains belonged to ST31. The results of the study highlight the need, especially in high-risk areas, to adopt strict hygiene practices, particularly hand hygiene, and to ensure an appropriate turnover of personal protective equipment, which could be responsible for the spread of biological agents, such as MDR Acinetobacter baumannii.

Collective efforts, better engagement

In this article, Dr Mike Simmons, Public Health Microbiologist at Public Health Wales, and the clinical lead for Public Health Wales Microbiology Services to the Hywel Dda Health Board, examines and explains healthcare-associated infections, or HCAls. He also highlights some of the key implications for healthcare engineers and estates managers in their day-to-day roles, and stresses the importance of interaction and collaboration between estates professionals and their clinical, infection control, nursing, and other hospital counterparts, in both reducing the number of such infections, and creating environments unconducive to their spread.

A survey of preventive measures used and their impact on central line-associated bloodstream infections (CLABSI) in intensive care units (SPIN-BACC)

BACKGROUND

The Quebec central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) Surveillance Program saw a decrease in CLABSI rates in most ICUs. Given the surveillance trends observed in recent years, we aimed to determine what preventive measures have been implemented, if compliance to measures was monitored and its impact on CLABSI incidence rates.

METHODS

All hospitals participating in the Quebec healthcare-associated infections surveillance program (SPIN-BACC - n = 48) received a 77-question survey about preventive measures implemented and monitored in their ICU. The questionnaire was validated for construct, content, face validity, and reliability. We used Poisson regression to measure the association between compliance monitoring to preventive measures and CLABSI rates.

RESULTS

Forty-two (88%) eligible hospitals completed the survey. Two components from the maximum barrier precautions were used less optimally: cap (88%) and full sterile body drape (71%). Preventive measures reported included daily review of catheter need (79%) and evaluation of insertion site for the presence of inflammation (90%). Two hospitals rewired lines even if an infection was suspected or documented.In adult ICUs, there was a statistically significant greater decrease in CLABSI rates in ICUs that monitored compliance to preventive insertion measures, after adjusting for teaching status and the number of hospital beds (p = 0.036).

CONCLUSIONS

Hospitals participating to the SPIN-BACC program follow recommendations for CLABSI prevention, but only a minority locally monitor their application. Compliance monitoring of preventive measures for catheter insertion was associated with a decrease in CLABSI incidence rates.

Epidemiological characterization of P. aeruginosa isolates of intensive care units in Egypt and Saudi Arabia

This study aimed to characterize Pseudomonas aeruginosa isolates in 2 intensive care units in Egypt and Saudi Arabia. P. aeruginosa isolates from patients' and staff hands and environmental samples were typed using antibiotyping and ERIC-PCR. In Egypt, isolates from suction apparatus tubing and drainage containers (A7) and AV tubing (A8) were linked to those from patients who had these antibiotypes. In Saudi Arabia, isolates from suction apparatus tubing (A6) and AV tubing (A7) were linked to patients with the same antibiotypes. In Egypt, patients' isolates had ERIC VII, VIll and IX patterns linked to suction apparatus tubing, AV machine tubes and drainage containers. In Saudi Arabia, patients' isolates had ERIC VIII and XI patterns linked to suction apparatus tubing and AV machines. In Egypt and Saudi Arabia, ERIC typing gave higher discriminatory indices (0.801 and 0.785 respectively) than the antibiotyping (0.7123 and 0.728 respectively). ERIC was superior to antibiotyping and should be used in tracing sources of infection.

Hospital door handle design and their contamination with bacteria: a real life observational study. Are we pulling against closed doors?

OBJECTIVE

To determine whether microbial contamination of door handles in two busy intensive care units and one high dependency unit was related to their design, location, and usage.

DESIGN

Observational study of the number of viable bacteria on existing door handles of different design at defined entry/exit points with simultaneous data collection of who used these doors and how often.

SETTING

Two busy specialised intensive care units and one high dependency unit in a tertiary referral NHS neurological hospital.

MAIN OUTCOME MEASURES

Surface bacterial density on door handles with reference to design, location, and intensity of use.

RESULTS

We found a significant correlation between the frequency of movements through a door and the degree to which it was contaminated (p=<0.01). We further found that the door's location, design and mode of use all influenced contamination. When compared to push plate designs, pull handles revealed on average a five fold higher level of contamination; lever handles, however, displayed the highest levels of bacterial contamination when adjusted for frequency of use. We also observed differences in contamination levels at doors between clinical areas, particularly between the operating theatres and one of the ICUs.

CONCLUSIONS

Door handles in busy, "real life" high acuity clinical environments were variably contaminated with bacteria, and the number of bacteria found related to design, location, mode and frequency of operation. Largely ignored issues of handle and environmental design can support or undermine strategies designed to limit avoidable pathogen transmission, especially in locations designed to define "thresholds" and impose physical barriers to pathogen transmission between clinical areas. Developing a multidisciplinary approach beyond traditional boundaries for purposes of infection control may release hitherto unappreciated options and beneficial outcomes for the control of at least some hospital acquired infections.

Antibacterial performance of polydopamine-modified polymer surfaces containing passive and active components

A growing number of device-related nosocomial infections, elevated hospitalization costs, and patient morbidity necessitate the development of novel antibacterial strategies for clinical devices. We have previously demonstrated a simple, aqueous polydopamine dip-coating method to functionalize surfaces for a wide variety of uses. Here, we extend this strategy with the goal of imparting antifouling and antimicrobial properties to substrates, exploiting the ability of polydopamine to immobilize polymers and induce metal nanoparticle formation. Polydopamine was deposited as a thin adherent film of 4 nm thickness from alkaline aqueous solution onto polycarbonate substrates, followed by grafting of antifouling polymer polyethylene glycol and in situ deposition of silver nanoparticles onto the polydopamine coated polycarbonate substrates. Elemental and morphological surface analyses confirmed successful grafting of polyethylene glycol brushes onto polydopamine-coated substrates, as well as spontaneous silver nanoparticle formation for polydopamine-coated substrates incubated in silver-nitrate solutions. Sustained silver release was observed over at least 7 days from silver-coated substrates, and the release kinetics could be modulated via additional polydopamine overlayers. In vitro functional assays employing gram negative and positive strains demonstrated dual fouling resistance and antibacterial properties of the coatings due to the fouling resistance of grafted polyethylene glycol and antibacterial effect of silver, respectively. Polycarbonate substrates coated only with silver using a method similar to existing commercial coatings provided an antibacterial effect but failed to inhibit bacterial attachment. Taking into account the previously demonstrated substrate versatility of polydopamine coatings, our findings suggest that this strategy could be implemented on a variety of substrate materials to simultaneously improve antifouling and antimicrobial performance.

Varied skill set needed for AE (D) role

IHEEM's AE (D) Panel plays an important role in managing and administering the UK's only official register of such specialist personnel, and indeed it is the Panel that selects qualified candidates for registration, interviews those considered "the right material", and confers registered AE (D) status on those that Panel members feel have the right combination of professional experience and expertise, academic qualifications, and knowledge, to fulfil the role. HEJ editor Jonathan Baillie examines the history of the AE (D) register and Panel, and talks to the latter's chairman, Eric Thomas, to find out more.

A technical platform for future success

Authorising Engineers (Decontamination), a group of highly skilled individuals acknowledged as lacking an effective representative professional body over the past decade by Graham Stanton, the chairman of a new IHEEM Decontamination Technical Platform (DTP) established recently to promote their professional interests, have much both to contribute to, and to gain from, the new Platform, he, and the body's secretary, Brian Kirk, explained to HEJ editor Jonathan Baillie at a recent meeting in London.

[Genetic diversity of Legionella pneumophila serogroup 1 in hospital water distribution systems in Shanghai]

OBJECTIVE

To classify Legionella pneumophila serogroup 1 (LP1) isolated from the water distribution systems in hospitals of Shanghai by using genotying methods, and therefore to explore the genetic relationship between different genotypes.

METHODS

LP1 was isolated from 8 hospitals in Shanghai, and strains of LP1 were subtyped using pulse field gel electrophoresis (PFGE). Genotyping results of PFGE were classified as dendrogram, and cluster analysis was used to compare the genetic characteristics of different strains.

RESULTS

Twenty-four strains of LP1 were isolated from 193 water specimens. LP1 belonged to 6 PFGE genotypes, of which 21 belonged to 3 predominant genotypes. Different hospitals shared the same genotype, while some strains isolated from the same hospital had different genotypes.

CONCLUSION

The genetic characteristics are stable in environmental LP1. Molecular biology techniques should be added to epidemiological study for hospital acquired legionellosis due to the genetic diversity in one hospital.

[Identification and isolation of non-tuberculous mycobacteria from environmental samples]

Non-tuberculous mycobacteria (NTM) found frequently in tap water and environment cause important opportunistic infections in immunocompromised patients. The aim of this study was to isolate and identify non-tuberculous mycobacteria in soil, raw milk and water distribution system samples in Mersin (a province located at Mediterranean region of Turkey). A total of 101 water, 124 soil and 40 milk samples collected from the central part and suburban parts of Mersin during November 2003-May 2004 period were included in the study. Water samples were collected from 29 different water distribution systems; soil samples from different parks and gardens and milk samples from raw milks sold at different districts. After the samples were processed by homogenization and decontamination, acid-fast staining and culture into Löwenstein-Jensen medium were performed. Acid-fast bacilli isolated from culture medium were identified by using conventional methods, polymerase chain reaction (PCR)-RFLP (Restriction Fragment Length Polymorphism) and INNO-LIPA Mycobacteria methods. NTM were identified from 4.9% (5/101) of water samples and 0.8% (1/124) of soil samples by culture and PCR. No NTM were detected in the raw milk samples. Three of the NTM strains isolated from water samples were defined as Mycobacterium chelonae type III and two as Mycobacterium kansasii type II. One NTM strain isolated from soil was defined as Mycobacterium fortuitum. It was of note that two of the five NTM positive water samples were tap water samples collected from hospitals. It was concluded that NTM colonization/contamination of water and environment in the hospitals was a potential risk factor in terms of nosocomial infections. Thus surveillance cultures of the water systems and the medical devices in the hospital are necessary to fix the source of NTM, to identify and type the strains and to establish effective control measures such as sterilization, disinfection, maintenance and modernization of water systems.

Design for life

A team of designers has been charged with redesigning hospital equipment that will help combat infection. Their prototypes are now in production.

Age-old technologies jostle for position

With the focus on combating hospital-acquired infection never greater, debate over the respective merits of using silver ion and copper-based anti-microbial surface treatments to "beat the bugs" will no doubt continue as new study evidence emerges for each. Health Estate Journal highlights the contrasting claims made by both "sides", and reports on two recent studies in particular, one expounding the advantages of copper, and the other painting an equally positive picture for silver.

Use of atmospheric non-thermal plasma as a disinfectant for objects contaminated with methicillin-resistant Staphylococcus aureus

BACKGROUND

Health care-associated infections because of methicillin-resistant strains of Staphylococcus aureus (MRSA) are increasing worldwide despite current infection control measures. Novel methods for disinfection of MRSA would be useful.

METHODS

We tested the effectiveness of atmospheric, non-thermal plasma discharge at killing S aureus, including USA300 strains, and at disinfecting experimentally contaminated hospital pagers.

RESULTS

Exposure of S aureus to plasma at different concentrations and for varying lengths of time resulted in up to a 4- to 5-log(10) kill on tryptic soy agar plates within 10 minutes and was not toxic to epithelial cells. USA300 strains of MRSA were more resistant to plasma-based killing than other tested strains. Disinfection of hospital pagers experimentally coated with clinically relevant amounts of MRSA could be achieved in as little as 30 seconds.

CONCLUSION

Generation of plasma is a promising method for disinfection of objects or surfaces that warrants further study in hospital settings. The USA300 strains of S aureus may be more resistant to disinfection than other strains.

New AE (D) role should benefit patient safety

With all aspects of hospital hygiene under the spotlight, Jonathan Baillie examines the important new role of Authorising Engineer (Decontamination), explains, with the help of experienced sterilisation/decontamination specialist Mick Compton, how the role developed, and discusses the key part that IHEEM will play as the only current UK institute with the authority to register AE (D)s as a mark of their competence and skills.

Genetic diversity of Mycobacterium avium isolates recovered from clinical samples and from the environment: molecular characterization for diagnostic purposes

Isolation of Mycobacterium avium complex (MAC) organisms from clinical samples may occur in patients without clinical disease, making the interpretation of results difficult. The clinical relevance of MAC isolates from different types of clinical samples (n = 47) from 39 patients in different sections of a hospital was assessed by comparison with environmental isolates (n = 17) from the hospital. Various methods for identification and typing (commercial probes, phenotypic characteristics, PCR for detection of IS1245 and IS901, sequencing of the hsp65 gene, and pulsed-field gel electrophoresis) were evaluated. The same strain was found in all the environmental isolates, 21 out of 23 (91.3%) of the isolates cultured from urine samples, and 5 out of 19 (26.3%) isolates from respiratory specimens. This strain did not cause disease in the patients. Testing best characterized the strain as M. avium subsp. hominissuis, with the unusual feature that 81.4% of these isolates lacked the IS1245 element. Contamination of certain clinical samples with an environmental strain was the most likely event; therefore, characterization of the environmental mycobacteria present in health care facilities should be performed to discard false-positive isolations in nonsterile samples, mainly urine samples. Molecular techniques applied in this study demonstrated their usefulness for this purpose.