Dissemination of a nonpathogenic viral DNA surrogate marker from high-touch surfaces in rooms of long-term care facility residents

A nonpathogenic DNA marker inoculated onto the television remote controls in rooms of 2 ambulatory long-term care facility (LTCF) residents disseminated to the hands of the LTCF residents, to high-touch surfaces in the room and on the ward, and to shared portable equipment. These findings suggest that contaminated high-touch surfaces in rooms of ambulatory LTCF residents are a potential source for widespread dissemination of pathogens.

Bare Below the Elbows: A Randomized Trial to Determine Whether Wearing Short-Sleeved Coats Reduces the Risk for Pathogen Transmission

Background

Physician’s white coats are frequently contaminated, but seldom cleaned. Therefore, in the UK, a “bare below the elbows” dress code policy includes a recommendation that personnel wear short sleeves. However, it has not been demonstrated that wearing short sleeves reduces the likelihood of pathogen transmission.

Methods

We conducted a randomized, cross-over trial involving simulated patient care interactions to test the hypothesis that transmission of pathogens occurs less frequently when personnel wear short- vs long-sleeved coats. Healthcare personnel were randomized to wear either long- or short-sleeved white coats while examining a mannequin contaminated with cauliflower mosaic virus DNA followed by examination of an uncontaminated mannequin. We compared the frequency of transfer of the DNA marker with the sleeves and/or wrists and with the uncontaminated mannequin. During work rounds, physicians were observed to determine how often the sleeves of white coats contacted patients or the environment.

Results

During work rounds and simulated examinations, the sleeve cuff of long-sleeved coats frequently contacted the patient/mannequin or environment. Contamination with the DNA marker was detected significantly more often on the sleeves and/or wrists when personnel wore long- vs short-sleeved coats (5 of 20, 25% vs 0 of 20, 0%; P = 0.02). In one of five (20%) instances of sleeve and/or wrist contamination, the DNA marker was transferred to the second mannequin. It was also observed that healthcare personnel were less likely to include their wrist in handwashing between simulations if they were wearing long-sleeved coats.

Conclusion

During simulations of patient care, the sleeve cuff of long-sleeved white coats frequently became contaminated with a viral DNA marker that could be transferred. These results provide support for the recommendation that healthcare personnel wear short sleeves to reduce the risk for pathogen transmission.

Disclosures

All authors: No reported disclosures.

Are Patients with Prior Clostridium difficile Infection (CDI) a Potential Source of Transmission during Hospital Admissions?

Background

Many patients with Clostridium difficile infection (CDI) continue to shed spores asymptomatically after completion of CDI therapy. However, the duration of shedding and the potential for transmission during subsequent healthcare exposures is unknown.

Methods

During a 6-month period, we collected perirectal, groin, and skin (chest/abdomen and hands) cultures for toxigenic C. difficile from patients with a prior history of CDI who were admitted to the hospital. We calculated the frequencies of perirectal and skin shedding of C. difficile at the time of admission, stratified by the time since the prior CDI diagnosis.

Results

Of 28 patients with a prior history of CDI enrolled in the study, 10 (36%) had positive perirectal cultures for toxigenic C. difficile upon admission, and 6 of 10 (60%) had positive skin cultures. The figure shows the percentages of CDI cases with positive perirectal, groin, or skin cultures, stratified by the time since the prior CDI diagnosis.

Conclusion

Patients with prior CDI often shed spores asymptomatically during hospital admissions. Further studies are needed to determine whether these carriers contribute significantly to transmission.

Disclosures

All authors: No reported disclosures.

Comparison of ethanol hand sanitizer versus moist towelette packets for mealtime patient hand hygiene

To facilitate patient hand hygiene, there is a need for easy-to-use products. In a survey of 100 patients, a single-use ethanol hand sanitizer packet took less time to access than a single-use moist towelette packet (3 vs 23 seconds) and was preferred by 74% of patients for mealtime hand hygiene. Performance of patient hand hygiene increased when a reminder was provided at the time of meal tray delivery.

Practical Approaches for Assessment of Daily and Post-discharge Room Disinfection in Healthcare Facilities

PURPOSE OF REVIEW

Cleaning and disinfection in healthcare facilities is essential to ensure patient safety. This review examines practical strategies used to assess and improve the effectiveness of daily and post-discharge manual cleaning in healthcare facilities.

RECENT FINDINGS

Effective implementation of cleaning interventions requires objective monitoring of staff performance with regular feedback on performance. Use of fluorescent markers to assess thoroughness of cleaning and measurement of residual ATP can provide rapid and objective feedback to personnel and have been associated with improved cleaning. Direct observation of cleaning and interviews with front-line staff are useful to identify variations and deficiencies in practice that may not be detected by other methods. Although not recommended for routine monitoring, cultures can be helpful for outbreak investigations. Monitoring and feedback can be effective in improving cleaning and disinfection in healthcare facilities. Ongoing commitment within institutions is needed to sustain successful cleaning and disinfection programs.

How well does transfer of bacterial pathogens by culture swabs correlate with transfer by hands?

In laboratory testing and in isolation rooms, pickup and transfer of health care-associated pathogens by premoistened rayon swabs correlated well with pickup and transfer by bare hands or moistened gloves. These results suggest that swab cultures provide a useful surrogate indicator of the risk for pathogen pickup and transfer by hands.

Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care

During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal.

Carbapenem-Resistant Enterobacter cloacae in Patients from the US Veterans Health Administration, 2006-2015

We analyzed carbapenem-resistant Enterobacteriaceae (CRE) trends among patients from the US Veterans Health Administration (VHA). After the emergence of CRE in the eastern United States, resistance rates remained stable in Klebsiella pneumoniae but increased in Enterobacter cloacae complex, suggesting a "second epidemic". VHA offers a vantage point for monitoring nationwide CRE trends.

Feasibility: An important but neglected issue in patient hand hygiene

BACKGROUND

Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products.

METHODS

A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use.

RESULTS

Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001).

CONCLUSIONS

Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents.

Evaluation of a Novel Alcohol-Based Surface Disinfectant for Disinfection of Hard and Soft Surfaces in Healthcare Facilities

We examined the efficacy of a new 1-step cleaner and disinfectant containing 30% ethanol that is applied as a spray. The product rapidly reduced vegetative bacterial pathogens on carriers and on hard and soft surfaces in healthcare settings, but it did not stain clothing.

Diagnostic testing methods for Clostridium difficile infection: A statewide survey of Ohio acute care hospitals

We surveyed Ohio acute care hospitals on laboratory testing used for diagnosis of Clostridium difficile infection (CDI). Of 146 hospitals surveyed, 109 (84%) used nucleic acid amplification tests (NAATs) as stand-alone diagnostic assays. Only 53 (42.4%) hospitals using NAATs had a mechanism in place to prevent repeat CDI testing.

Evaluation of an automated room decontamination device using aerosolized peracetic acid

Because manual cleaning is often suboptimal, there is increasing interest in use of automated devices for room decontamination. We demonstrated that an ultrasonic room fogging system that generates submicron droplets of peracetic acid and hydrogen peroxide eliminated Clostridium difficile spores and vegetative pathogens from exposed carriers in hospital rooms and adjacent bathrooms.

Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?

In a survey of 5 hospitals, we found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. Contact with objects on floors frequently resulted in transfer of pathogens to hands.

Effect of Vancomycin, Tylosin, and Chlortetracycline on Vancomycin-Resistant Enterococcus faecium Colonization of Broiler Chickens During Grow-Out

Broiler chickens may serve as reservoirs for human colonization by vancomycin-resistant Enterococcus (VRE). We examined the effects of vancomycin and two commonly used antimicrobial feed additives on VRE colonization in broiler chickens during grow-out. Chicks received unsupplemented feed or feed containing vancomycin, chlortetracycline, or tylosin from day of hatch to grow-out at 6 weeks. At 3 days of age, chicks received by crop gavage 10⁷ colony-forming units (CFUs) of a human or poultry VRE isolate. Cecal contents were monitored weekly for VRE, short-chain fatty acids (SCFAs), and bacterial denaturing gradient gel electrophoresis (DGGE) profile methods. Vancomycin promoted persistent and high-level colonization with human- and poultry-derived VRE to grow-out in comparison with controls, while treatment with chlortetracycline and tylosin did not. Colonization by the poultry isolate in control, chlortetracycline, and tylosin groups persisted throughout the grow-out period with low concentrations present at 6 weeks, whereas the human isolate decreased to an undetectable level by week 6. Vancomycin resulted in significant reductions in cecal acetic acid and butyric acid in comparison with controls, but chlortetracycline and tylosin did not. DGGE profiles contained two main clusters with all vancomycin profiles in a smaller cluster and all other profiles in a larger cluster. These results demonstrate that vancomycin, but not chlortetracycline or tylosin, disrupted the indigenous microbiota and SCFA patterns of broiler chickens and promoted colonization by VRE.

IMPACT OF TIGECYCLINE VERSUS OTHER ANTIBIOTICS ON THE FECAL METABOLOME AND ON COLONIZATION RESISTANCE TO CLOSTRIDIUM DIFFICILE IN MICE

Background:

The glycylcycline antibiotic tigecycline may have a relatively low propensity to promote Clostridium difficile infection in part because it causes less disruption of the indigenous intestinal microbiota than other broad-spectrum antibiotics. We used a mouse model to compare the effects of tigecycline versus other commonly used antibiotics on colonization resistance to C. difficile and on the metabolic functions of the intestinal microbiota.

Methods:

To assess in vivo colonization resistance to C. difficile, mice were challenged with oral C. difficile spores 1, 7, or 12 days after completion of 3 days of treatment with subcutaneous saline, tigecycline, ceftriaxone, piperacillin-tazobactam, or linezolid. Levels of bacterial metabolites in fecal specimens of mice treated with the same antibiotics were analyzed using non-targeted metabolic profiling by gas chromatograph (GC)/mass spectrometry (MS) and ultra-high performance liquid chromatography-tandem MS (UPLC-MS/MS).

Results:

All of the antibiotics disrupted colonization resistance to C. difficile when challenge occurred 2 days after treatment. Only piperacillin/tazobactam mice had disturbed colonization resistance at 7 days after treatment. All of the antibiotics altered fecal metabolites in comparison to controls, but tigecycline caused significantly less alteration than the other antibiotics, including less suppression of multiple amino acids, bile acids, and lipid metabolites.

Conclusions:

Tigecycline, linezolid, and ceftriaxone caused transient disruption of colonization resistance to C. difficile, whereas piperacillin/tazobactam caused disruption that persisted for 7 days post-treatment. Tigecycline caused less profound alteration of fecal bacterial metabolites than the other antibiotics, suggesting that the relatively short period of disruption of colonization resistance might be related in part to reduced alteration of the metabolic functions of the micro-biota.

Do medical students receive training in correct use of personal protective equipment?

BACKGROUND

Healthcare personnel often use incorrect technique for donning and doffing of personal protective equipment (PPE).

OBJECTIVE

We tested the hypothesis that medical students receive insufficient training on correct methods for donning and doffing PPE.

METHODS

We conducted a cross-sectional survey of medical students on clinical rotations at two teaching hospitals to determine the type of training they received in PPE technique. The students performed simulations of contaminated PPE removal with fluorescent lotion on gloves and were assessed for correct PPE technique and skin and/or clothing contamination. To obtain additional information on PPE training during medical education, residents, fellows, and attending physicians completed written questionnaires on PPE training received during medical school and on knowledge of PPE protocols recommended by the Centers for Disease Control and Prevention.

RESULTS

Of 27 medical students surveyed, only 11 (41%) reported receiving PPE training, and none had received training requiring demonstration of proficiency. During simulations, 25 of 27 (92.5%) students had one or more lapses in technique and 12 (44%) contaminated their skin with fluorescent lotion. For 100 residents, fellows and attending physicians representing 67 different medical schools, only 53% reported receiving training in use of PPE and only 39% selected correct donning and doffing sequence.

CONCLUSIONS

Our findings suggest that there is a need for development of effective strategies to train medical students in correct use of PPE.

ABBREVIATIONS

PPE: Personal protective equipment; MRSA: Methicillin-resistant Staphylococcus aureus; SARS: Severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; WHO: World Health Organization; CDC: Centers for Disease Control and Prevention; OSCE: Objective structured clinical examination.