101
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Ledwoch K, Dancer S, Otter J, Kerr K, Roposte D, Rushton L, Weiser R, Mahenthiralingam E, Muir D, Maillard JY. Beware biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multi-centre study. J Hosp Infect 2018; 100:e47-e56. [DOI: 10.1016/j.jhin.2018.06.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/26/2018] [Indexed: 01/19/2023]
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102
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Wilson APR. The role of the environment in the spread of healthcare associated infections. J Hosp Infect 2018; 100:363-364. [PMID: 30267741 DOI: 10.1016/j.jhin.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Affiliation(s)
- A P R Wilson
- University College London Hospitals, London, UK.
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103
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Moremi N, Claus H, Silago V, Kabage P, Abednego R, Matee M, Vogel U, Mshana SE. Hospital surface contamination with antimicrobial-resistant Gram-negative organisms in Tanzanian regional and tertiary hospitals: the need to improve environmental cleaning. J Hosp Infect 2018; 102:98-100. [PMID: 30195721 DOI: 10.1016/j.jhin.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- N Moremi
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Bugando, Mwanza, Tanzania; Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany.
| | - H Claus
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - V Silago
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Bugando, Mwanza, Tanzania
| | - P Kabage
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Bugando, Mwanza, Tanzania
| | - R Abednego
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Bugando, Mwanza, Tanzania
| | - M Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - U Vogel
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - S E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Bugando, Mwanza, Tanzania
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104
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Examining the association between hospital-onset Clostridium difficile infection and multiple-bed room exposure: a case-control study. Infect Control Hosp Epidemiol 2018; 39:1068-1073. [PMID: 30060776 DOI: 10.1017/ice.2018.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine whether assignment to a multiple-bed room increased the risk of hospital-onset C. difficile diarrhea (HO-CDI). DESIGN Case-control study. SETTING San Francisco General Hospital and Trauma Center.PopulationAdult general medical and surgical inpatients. METHODS Consecutive cases of HO-CDI were identified between January 1, 2010, and December 31, 2015. To investigate the effect of multiple-bed room exposure both at admission and at the time of symptom onset, 2 sets of controls were selected from the general medical/surgical inpatient population using incidence density sampling. Conditional logistic regression was used to estimate the relationship between room assignment (single bed vs multiple beds) and the development of HO-CDI. RESULTS In total, 187 cases were identified and matched with 512 and 515 controls for the admission and at-diagnosis analyses, respectively. The adjusted rate ratio (RR) associated with the development HO-CDI associated with multiple-bed room exposure during the 7 and 14 days immediately prior to HO-CDI diagnosis were 1.08 (95% confidence interval [CI], 0.93-1.25; P=.31) and 0.96 (95% CI, 0.93-1.18; P=.12), respectively. Furthermore, no significant association was detected in the analysis of the first 7 and 14 days after case admission or among patients with Charlson comorbidity scores ≥4 in either period. CONCLUSION Assignment of patients to multiple-bed rooms on general medical and surgical wards was not associated with an increased risk in the development of HO-CDI. Future investigation should be performed with larger cohorts in multiple sites to more definitively address the question because this issue could have implications for patient room assignment and hospital design.
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105
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D'Accolti M, Soffritti I, Piffanelli M, Bisi M, Mazzacane S, Caselli E. Efficient removal of hospital pathogens from hard surfaces by a combined use of bacteriophages and probiotics: potential as sanitizing agents. Infect Drug Resist 2018; 11:1015-1026. [PMID: 30104889 PMCID: PMC6071622 DOI: 10.2147/idr.s170071] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Many hospital-acquired infections (HAIs) can be transmitted by pathogens contaminating hospital surfaces, not efficiently controlled by conventional sanitation, which can indeed contribute to the selection of MDR strains. Bacteriophages have been suggested as decontaminating agents, based on their selective ability to kill specific bacteria. However, there are no data on their stability in detergents and their potential use in routine sanitation. On the other hand, a probiotic-based sanitation system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably reduce pathogens on treated surfaces. However, its action is not specific and slow, being based on competitive antagonism. This work aimed to assess the effectiveness of a combined use of phages and PCHS in removing HAI-associated pathogens from different hard surfaces. Materials and methods The decontamination ability of phages in PCHS was tested in vitro and in situ, against drug-susceptible or resistant Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa strains, and using bacterial densities similar to those detected on hospital surfaces. Results Phages targeted efficiently all tested bacteria, maintaining their full activity when added to the PCHS detergent. Notably, the combined use of phages and PCHS not only resulted in a rapid reduction (up to >90%) of the targeted pathogens, but also, due to the stabilizing effect of probiotics, the pathogens were maintained at low levels (>99%) at later times too, when instead the effect of phages tends to diminish. Conclusion These results suggest that a combined biological system might be successfully used in hospital sanitation protocols, potentially leading to effective and safe elimination of MDR pathogens from the hospital environment.
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Affiliation(s)
- Maria D'Accolti
- CIAS Interdepartmental Centre, Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
| | - Irene Soffritti
- CIAS Interdepartmental Centre, Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
| | - Micol Piffanelli
- CIAS Interdepartmental Centre, Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
| | - Matteo Bisi
- CIAS Interdepartmental Centre, Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
| | - Sante Mazzacane
- CIAS Interdepartmental Centre, Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
| | - Elisabetta Caselli
- CIAS Interdepartmental Centre, Department of Medical Sciences, University of Ferrara, Ferrara, Italy, .,Section of Microbiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
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106
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Fernando SA, Gray TJ, Gottlieb T. Healthcare-acquired infections: prevention strategies. Intern Med J 2018; 47:1341-1351. [PMID: 29224205 DOI: 10.1111/imj.13642] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
Healthcare-acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health-care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi-resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence-based antimicrobial use; infection prevention strategies, to control MRO - particularly methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE) and, more recently, multi-resistant Gram-negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co-ordination at a national level. HAI prevention needs to be multi-modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.
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Affiliation(s)
- Shelanah A Fernando
- Department of Microbiology & Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Timothy J Gray
- Department of Microbiology & Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Thomas Gottlieb
- Department of Microbiology & Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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107
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Caselli E, Brusaferro S, Coccagna M, Arnoldo L, Berloco F, Antonioli P, Tarricone R, Pelissero G, Nola S, La Fauci V, Conte A, Tognon L, Villone G, Trua N, Mazzacane S. Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study. PLoS One 2018; 13:e0199616. [PMID: 30001345 PMCID: PMC6042698 DOI: 10.1371/journal.pone.0199616] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/11/2018] [Indexed: 01/05/2023] Open
Abstract
Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016-June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR = 0.44, CI 95% 0.35-0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70-96.3%), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc = 0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies. Trial registration-ISRCTN International Clinical Trials Registry, ISRCTN58986947.
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Affiliation(s)
- Elisabetta Caselli
- Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- CIAS Interdepartmental Research Centre, Departments of Medical Sciences and Architecture, University of Ferrara, Ferrara, Italy
- * E-mail:
| | | | - Maddalena Coccagna
- CIAS Interdepartmental Research Centre, Departments of Medical Sciences and Architecture, University of Ferrara, Ferrara, Italy
| | - Luca Arnoldo
- Department of Medicine, University of Udine, Udine, Italy
| | - Filippo Berloco
- Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Paola Antonioli
- Department of Infection Prevention Control and Risk Management, S. Anna University Hospital, Ferrara, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Gabriele Pelissero
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | | | - Vincenza La Fauci
- Department of Biomedical Sciences and Dental and Functional Images, University of Messina, Messina, Italy
| | | | - Lorenzo Tognon
- Ospedale di Santa Maria del Prato, Feltre (Belluno), Italy
| | - Giovanni Villone
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
| | - Nelso Trua
- Ospedale Sant’Antonio Abate, Tolmezzo (Udine), Italy
| | - Sante Mazzacane
- CIAS Interdepartmental Research Centre, Departments of Medical Sciences and Architecture, University of Ferrara, Ferrara, Italy
| | - for the SAN-ICA Study Group
- Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- CIAS Interdepartmental Research Centre, Departments of Medical Sciences and Architecture, University of Ferrara, Ferrara, Italy
- Department of Medicine, University of Udine, Udine, Italy
- Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
- Department of Infection Prevention Control and Risk Management, S. Anna University Hospital, Ferrara, Italy
- Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Azienda USL di Ferrara, Ferrara, Italy
- Department of Biomedical Sciences and Dental and Functional Images, University of Messina, Messina, Italy
- Ospedale di Santa Maria del Prato, Feltre (Belluno), Italy
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
- Ospedale Sant’Antonio Abate, Tolmezzo (Udine), Italy
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Near-patient environmental contamination of an intensive care unit with Vancomycin-resistant Enterococci (VRE) and Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL-E) before and after the introduction of chlorhexidine bathing for patients. Infect Control Hosp Epidemiol 2018; 39:1131-1132. [PMID: 29950192 DOI: 10.1017/ice.2018.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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109
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Kenters N, Gottlieb T, Hopman J, Mehtar S, Schweizer ML, Tartari E, Huijskens EGW, Voss A. An international survey of cleaning and disinfection practices in the healthcare environment. J Hosp Infect 2018; 100:236-241. [PMID: 29772262 DOI: 10.1016/j.jhin.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. AIM To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. METHODS The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. FINDINGS A total of 110 healthcare professionals, representing 23 countries, participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. CONCLUSIONS The survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide.
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Affiliation(s)
- N Kenters
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, Australia
| | - J Hopman
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - S Mehtar
- Unit of Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa
| | - M L Schweizer
- Department of Epidemiology, College of Public Health, Department of Internal Medicine, Iowa, USA
| | - E Tartari
- Infection Control Programme and WHO Collaborating Centre of Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - E G W Huijskens
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Voss
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Department of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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110
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Anderson DJ, Moehring RW, Weber DJ, Lewis SS, Chen LF, Schwab JC, Becherer P, Blocker M, Triplett PF, Knelson LP, Lokhnygina Y, Rutala WA, Sexton DJ. Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection). THE LANCET. INFECTIOUS DISEASES 2018; 18:845-853. [PMID: 29880301 DOI: 10.1016/s1473-3099(18)30278-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/27/2018] [Accepted: 04/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study. METHODS We did a prespecified secondary analysis of the results from the BETR Disinfection study, a pragmatic, multicentre, crossover cluster-randomised trial that assessed four different strategies for terminal room disinfection in nine hospitals in the southeastern USA. Rooms from which a patient with a specific infection or colonisation (due to the target organisms C difficile, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci (VRE), or multidrug-resistant Acinetobacter spp) was discharged were terminally disinfected with one of four strategies: standard disinfection (quaternary ammonium disinfectant, except for C difficile, for which 10% hypochlorite [bleach] was used; reference); standard disinfection and disinfecting ultraviolet light (UV-C), except for C difficile, for which bleach and UV-C was used (UV strategy); 10% hypochlorite (bleach strategy); and bleach and UV-C (bleach and UV strategy). We randomly assigned the sequence of strategies for each hospital (1:1:1:1), and each strategy was used for 7 months, including a 1-month wash-in period and 6 months of data collection. The prespecified secondary outcomes were hospital-wide, hospital-acquired incidence of all target organisms (calculated as number of patients with hospital-acquired infection with a target organism per 10 000 patient days), and hospital-wide, hospital-acquired incidence of each target organism separately. BETR Disinfection is registered with ClinicalTrials.gov, number NCT01579370. FINDINGS Between April, 2012, and July, 2014, there were 271 740 unique patients with 375 918 admissions. 314 610 admissions met all inclusion criteria (n=73 071 in the reference study period, n=81 621 in the UV study period, n=78 760 in the bleach study period, and n=81 158 in the bleach and UV study period). 2681 incidenct cases of hospital-acquired infection or colonisation occurred during the study. There was no significant difference in the hospital-wide risk of target organism acquisition between standard disinfection and the three enhanced terminal disinfection strategies for all target multidrug-resistant organisms (UV study period relative risk [RR] 0·89, 95% CI 0·79-1·00; p=0·052; bleach study period 0·92, 0·79-1·08; p=0·32; bleach and UV study period 0·99, 0·89-1·11; p=0·89). The decrease in risk in the UV study period was driven by decreases in risk of acquisition of C difficile (RR 0·89, 95% CI 0·80-0·99; p=0·031) and VRE (0·56, 0·31-0·996; p=0·048). INTERPRETATION Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE. Enhanced disinfection overcomes limitations of standard disinfection strategies and is a potential strategy to reduce the risk of acquisition of multidrug-resistant organisms and C difficile. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Rebekah W Moehring
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - David J Weber
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Sarah S Lewis
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Luke F Chen
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Michael Blocker
- Alamance Regional Medical Center, Burlington, NC, USA; Carolinas Medical Center, Charlotte, NC, USA
| | | | - Lauren P Knelson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University Medical Centre, Durham, NC, USA
| | - William A Rutala
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Daniel J Sexton
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Lemmen SW, Lewalter K. Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication. Infection 2018; 46:581-590. [PMID: 29796739 PMCID: PMC6182449 DOI: 10.1007/s15010-018-1137-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/29/2018] [Indexed: 12/26/2022]
Abstract
Purpose The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today. Methods A review of the literature. Results The classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures. Conclusions In summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.
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Affiliation(s)
- S W Lemmen
- Department of Infection Control and Infectious Diseases, Universtiy Hospital RWTH Aachen, 52074, Aachen, Germany.
| | - K Lewalter
- Department of Infection Control and Infectious Diseases, Universtiy Hospital RWTH Aachen, 52074, Aachen, Germany
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112
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The Role of Environmental Contamination in the Transmission of Nosocomial Pathogens and Healthcare-Associated Infections. Curr Infect Dis Rep 2018; 20:12. [PMID: 29704133 DOI: 10.1007/s11908-018-0620-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight the role of environmental contamination in healthcare-associated infections (HAIs) and to discuss the most commonly implicated nosocomial pathogens. RECENT FINDINGS Recent studies suggest that environmental contamination plays a significant role in HAIs and in the unrecognized transmission of nosocomial pathogens during outbreaks, as well as ongoing sporadic transmission. Several pathogens can persist in the environment for extended periods and serve as vehicles of transmission and dissemination in the hospital setting. Cross-transmission of these pathogens can occur via hands of healthcare workers, who become contaminated directly from patient contact or indirectly by touching contaminated environmental surfaces. Less commonly, a patient could become colonized by direct contact with a contaminated environmental surface. This review describes the role of environmental contamination in HAIs and provides context for reinforcing the importance of hand hygiene and environmental decontamination for the prevention and control of HAIs.
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113
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New insights on antimicrobial efficacy of copper surfaces in the healthcare environment: a systematic review. Clin Microbiol Infect 2018; 24:1130-1138. [PMID: 29605564 DOI: 10.1016/j.cmi.2018.03.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Hospital-acquired infections (HAIs) are a major public health issue. The potential of antimicrobial copper surfaces in reducing HAIs' rates is of interest but remains unclear. We conducted a systematic review of studies assessing the activity of copper surfaces (colony-forming unit (CFU)/surface, both in vitro and in situ) as well as clinical studies. In vitro study protocols were analysed through a tailored checklist developed specifically for this review, in situ studies and non-randomized clinical studies were assessed using the ORION (Outbreak Reports and Intervention studies Of Nosocomial infection) checklist and randomized clinical studies using the CONSORT guidelines. METHODS The search was conducted using PubMed database with the keywords 'copper' and 'surfaces' and 'healthcare associated infections' or 'antimicrobial'. References from relevant articles, including reviews, were assessed and added when appropriate. Articles were added until 30 August 2016. Overall, 20 articles were selected for review including 10 in vitro, eight in situ and two clinical studies. RESULTS Copper surfaces were found to have variable antimicrobial activity both in vitro and in situ, although the heterogeneity in the designs and the reporting of the results prevented conclusions from being drawn regarding their spectrum and activity/time compared to controls. Copper effect on HAIs incidence remains unclear because of the limited published data and the lack of robust designs. Most studies have potential conflicts of interest with copper industries. CONCLUSIONS Copper surfaces have demonstrated an antimicrobial activity but the implications of this activity in healthcare settings are still unclear. No clear effect on healthcare associated infections has been demonstrated yet.
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Abstract
Although progress has been made in decreasing health care-associated infections (HAI) in intensive care unit (ICU) patients, there has been an increase in HAI caused by drug-resistant pathogens, particularly those that contaminate the environment such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas spp, Acinetobacter spp, and Clostridium difficile. The ICU environment including sinks and medical equipment has been identified as being at risk for contamination and associated with cross-transmission of pathogens between the health care provider, the environment, and the patient. This article addresses the role of the ICU nurse as a team facilitator collaborating with environmental services, infection preventionists, and others to influence ICU design during preconstruction planning and unit environmental hygiene after construction to promote patient safety and prevent HAI associated with contaminated environments and equipment.
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115
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Dippenaar R, Smith J. Impact of pulsed xenon ultraviolet disinfection on surface contamination in a hospital facility's expressed human milk feed preparation area. BMC Infect Dis 2018; 18:91. [PMID: 29471796 PMCID: PMC5824443 DOI: 10.1186/s12879-018-2997-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressed human milk (EHM) feed preparation areas represent a potential source of unintentional nosocomial infection. Daily disinfection of environmental surfaces remains an essential intervention to mitigate nosocomial infections. The inefficiency of conventional cleaning and disinfection contributes to an increased risk for the acquisition of multi-drug resistant pathogens. "Non touch" technologies such as the pulsed xenon ultraviolet (PX-UVD) light device have documented sustained reduction in surface bacterial colonization and reduced cross contamination. METHODS The impact of a PX-UVD on surface colony forming units per square centimeter (cfu/cm2) in feed preparation areas was evaluated following its implementation as standard care. A quasi-experimental study was performed documenting bacterial colonization from 6 high risk feed preparation areas in a community care hospital in South Africa. Pre and post conventional cleaning neutralizing rinse swabs were collected fortnightly over a 16 week control period prior to the introduction of the PX-UVD and compared to a matching set of samples for the PX-UVD period. RESULTS A 90% reduction in total surface bioburden was noted from the control period (544 cfu/cm2) compared to the corresponding PX-UVD period (50 cfu/cm2). Sub -analysis of both the Pre-clean Control: Pre-clean PX-UVD counts as well as the Post-clean Control: Post-clean PX-UVD counts noted significant improvements (p < 0.001). A statistically significant improvement was noted between pre-and post-cleaning total surface bioburden following exposure to the PX-UVD (p = 0.0004). The introduction of the PX-UVD was associated with a sustained reduction in the pre clean bioburden counts with a risk trend (per week) 0.19, (95% CI [0.056, 0.67], p = 0.01). DISCUSSION The use of a PX-UVD as adjunct to standard cleaning protocols was associated with a significant decrease in surface bioburden. The study demonstrated the inefficiency of conventional cleaning. Persistence of potentially pathological species in both periods highlights current health sector challenges.
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Affiliation(s)
- Ricky Dippenaar
- Department of Neonatology, Netcare Blaauwberg & N1 City Hospital, Waterville Crescent, Sunningdale, Western Cape, 7441, South Africa.
| | - Johan Smith
- Department of Paediatrics & Child Health, Stellenbosch University & Tygerberg Children's Hospital, Tygerberg, Western Cape, 7505, South Africa
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Masse V, Hartley MJ, Edmond MB, Diekema DJ. Comparing and optimizing ultraviolet germicidal irradiation systems use for patient room terminal disinfection: an exploratory study using radiometry and commercial test cards. Antimicrob Resist Infect Control 2018; 7:29. [PMID: 29484174 PMCID: PMC5824448 DOI: 10.1186/s13756-018-0317-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Ultraviolet germicidal irradiation (UVGI) systems are gaining popularity, however objective comparisons of their characteristics are lacking. While environmental cultures and reduction of hospital-associated infections rates are excellent study endpoints, they are impractical for centers with limited resources who want to compare or optimize UVGI systems use. Methods We evaluated radiometry and commercial test cards, two simple and low cost tools, to compare 2 full size UVGI systems (Tru-D and Optimum-UV Enlight) and 2 small units (Lumalier EDU 435 and MRSA-UV Turbo-UV). Results Radiometry-derived output curves show that if both large devices emit enough energy to reach C. difficile lethal doses at 10 ft, the reduction in output in distance is almost perfectly logarithmic. In a patient room environment, Enlight and Tru-D performed similarly when compared using radiometry and commercial test cards. The two small devices reached C. difficile range around the bathroom with the device raised above the floor, but longer times are needed. Conclusions Despite different workflows and price points, no clear superiority emerges between Tru-D and Enlight. Bathroom disinfection should be dealt with separately from the main room and small, cheaper units can be used. Radiometry and commercial test cards are promising ways to compare UVGI systems, but further validation is needed using correlation with environmental cultures. Trial registration Not applicable.
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Affiliation(s)
- Vincent Masse
- 1Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, 200 Hawkins Drive # C512-GH, Iowa City, IA 52242 USA.,2Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec Canada
| | - Michael J Hartley
- 3Department of Hospital Administration, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Michael B Edmond
- 1Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, 200 Hawkins Drive # C512-GH, Iowa City, IA 52242 USA.,4Office of Clinical Quality Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Daniel J Diekema
- 1Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, 200 Hawkins Drive # C512-GH, Iowa City, IA 52242 USA.,5Department of Pathology, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA USA
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Caeiro JP, Garzón MI. Controlling infectious disease outbreaks in low-income and middle-income countries. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018; 10:55-64. [PMID: 32226321 PMCID: PMC7100832 DOI: 10.1007/s40506-018-0154-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
When an infectious disease outbreak is detected or suspected, a healthcare facility's infection control personnel should be notified and an outbreak control team formed that is pertinent to the size and severity of the outbreak and healthcare facility. Management of an infectious disease outbreak in a middle- or low-income country is challenging. Cost-effective recommendations that are easy to carry out and that have been stratified according to the type of infection and prevention and control intervention used are provided in this paper and constitute basic practices.
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Affiliation(s)
- Juan Pablo Caeiro
- Hospital Privado Universitario, Naciones Unidades 346, Córdoba, Argentina
| | - María I. Garzón
- Hospital Privado Universitario, Naciones Unidades 346, Córdoba, Argentina
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Kiernan M. Prevention is better than cure: The role of infection prevention in the control of antimicrobial resistance. J Infect Prev 2018; 18:275-276. [PMID: 29344096 DOI: 10.1177/1757177417739116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Martin Kiernan
- Richard Wells Research Centre, University of West London, UK
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119
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'No touch' technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Curr Opin Infect Dis 2018; 29:424-31. [PMID: 27257798 DOI: 10.1097/qco.0000000000000284] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This article reviews 'no touch' methods for disinfection of the contaminated surface environment of hospitalized patients' rooms. The focus is on studies that assessed the effectiveness of ultraviolet (UV) light devices, hydrogen peroxide systems, and self-disinfecting surfaces to reduce healthcare-associated infections (HAIs). RECENT FINDINGS The contaminated surface environment in hospitals plays an important role in the transmission of several key nosocomial pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., Clostridium difficile, Acinetobacter spp., and norovirus. Multiple clinical trials have now demonstrated the effectiveness of UV light devices and hydrogen peroxide systems to reduce HAIs. A limited number of studies have suggested that 'self-disinfecting' surfaces may also decrease HAIs. SUMMARY Many studies have demonstrated that terminal cleaning and disinfection with germicides is often inadequate and leaves environmental surfaces contaminated with important nosocomial pathogens. 'No touch' methods of room decontamination (i.e., UV devices and hydrogen peroxide systems) have been demonstrated to reduce key nosocomial pathogens on inoculated test surfaces and on environmental surfaces in actual patient rooms. Further UV devices and hydrogen peroxide systems have been demonstrated to reduce HAI. A validated 'no touch' device or system should be used for terminal room disinfection following discharge of patients on contact precautions. The use of a 'self-disinfecting' surface to reduce HAI has not been convincingly demonstrated.
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Poster DL, Miller CC, Obeng Y, Postek MT, Cowan TE, Martinello RA. Innovative Approaches to Combat Healthcare-Associated Infections Using Efficacy Standards Developed Through Industry and Federal Collaboration. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10730. [PMID: 31092964 DOI: 10.1117/12.2500431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nation-wide, healthcare-associated infections (HAIs) infect one in every 25 hospital patients, account for more than 100,000 deaths and increase medical costs by around $96-147B, each year. Ultraviolet-C (UV-C) antimicrobial devices are shown to reduce the incidence of many of these HAIs by 35% or more, through the deactivation of the pathogen's DNA chain following irradiation with a wavelength of ~254 nm. This irradiation does not kill the cells, per se but effectively prevents the cells from multiplying. Clinical case reductions of 30-70% in Clostridium difficile (C. diff.) have been reported with similar results for methicillin-resistant Staphylococcus aureus (MRSA), and others. The methodology works, but, the adoption of UV-C technology by the healthcare industry has been sporadic. This is largely due to the lack of definitive knowledge and uniform performance standards or measures for efficacy to help healthcare managers make informed, credible investment decisions. The leveling of the playing field with scientifically certifiable data of the efficacy of antimicrobial devices will enhance acceptance by the healthcare industry and public, at large, as well as facilitate science-based decision making. The National Institute of Standards and Technology (NIST) has engaged with the International Ultra Violet Association (IUVA) and its member companies and affiliates to explore ways to develop needed standards, determine appropriate testing protocols, and transfer the technology to help to reduce these inharmonious market conditions. Collaborative efforts are underway to develop science-based answers to the healthcare industry's questions surrounding standards and measures of device disinfection efficacy, as well as reliability, operations and durability. These issues were recently discussed at the IUVA 2018 America's Conference in Redondo Beach, CA in several panel sessions. A major output of the sessions was the formation of a formal IUVA Working Group for the development of antimicrobial standards and initiatives for the healthcare industry. The goal of this working group is to provide global guidance, with specific programs and deliverables, on the use of UV technologies and standards to combat HAIs and to further the stated aims of the IUVA on its outreach to the healthcare industry. This paper reviews the strong collaboration between NIST and its industry partners pursuing the development of standards, guidelines and guidance documents related to healthcare applications that include standard methods for validating performance of UV devices and test guidelines for efficacy measurements. In addition, an overview of the issues, problems, and a summary of the needs confronting future growth and success of the UV industry in the Nation's healthcare application space is provided.
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Affiliation(s)
- Dianne L Poster
- National Institute of Standards and Technology, Gaithersburg, Maryland, USA
| | - C Cameron Miller
- National Institute of Standards and Technology, Gaithersburg, Maryland, USA
| | - Yaw Obeng
- National Institute of Standards and Technology, Gaithersburg, Maryland, USA
| | - Michael T Postek
- National Institute of Standards and Technology, Gaithersburg, Maryland, USA
| | - Troy E Cowan
- Vision Based Consulting, Bethesda, Maryland, USA
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Mitchell BG, Farrington A, Allen M, Gardner A, Hall L, Barnett AG, Halton K, Page K, Dancer SJ, Riley TV, Gericke CA, Paterson DL, Graves N. Variation in hospital cleaning practice and process in Australian hospitals: A structured mapping exercise. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Identification of Clostridium difficile Reservoirs in The Patient Environment and Efficacy of Aerial Hydrogen Peroxide Decontamination. Infect Control Hosp Epidemiol 2017; 38:1487-1492. [DOI: 10.1017/ice.2017.227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVETo identify, using a novel enhanced method of recovery, environmental sites where spores of Clostridium difficile persist despite cleaning and hydrogen peroxide aerial decontamination.DESIGNCohort study.SETTINGTertiary referral center teaching hospital.METHODSIn total, 16 sites representing high-frequency contact or difficult-to-clean surfaces in a single-isolation room or bed area in patient bed bays were sampled before and after terminal or hydrogen peroxide disinfection using a sponge swab. In some rooms, individual sites were not present (eg, there were no en-suite rooms in the ICU). Swab contents were homogenized, concentrated by membrane-filtration, and plated onto selective media. Results of C. difficile sampling were used to focus cleaning.RESULTSOver 1 year, 2,529 sites from 146 rooms and 44 bays were sampled. Clostridium difficile was found on 131 of 572 surfaces (22.9%) before terminal cleaning, on 105 of 959 surfaces (10.6%) after terminal cleaning, and on 43 of 967 surfaces (4.4%) after hydrogen peroxide disinfection. Clostridium difficile persisted most frequently on floor corners (97 of 334; 29.0%) after disinfection. Between the first and third quarters, we observed a significant decrease in the number of positive sites (25 of 390 vs 6 of 256). However, no similar change in the number of isolates before terminal cleaning was observed.CONCLUSIONPersistence of C. difficile in the clinical environment was widespread. Although feedback of results did not improve the efficacy of manual disinfection, numbers of C. difficile following hydrogen peroxide gradually declined.Infect Control Hosp Epidemiol 2017;38:1487–1492
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No-Touch Disinfection Methods to Decrease Multidrug-Resistant Organism Infections: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2017; 39:20-31. [PMID: 29144223 DOI: 10.1017/ice.2017.226] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent studies have shown that using no-touch disinfection technologies (ie, ultraviolet light [UVL] or hydrogen peroxide vapor [HPV] systems) can limit the transmission of nosocomial pathogens and prevent healthcare-associated infections (HAIs). To investigate these findings further, we performed a systematic literature review and meta-analysis on the impact of no-touch disinfection methods to decrease HAIs. METHODS We searched PubMed, CINAHL, CDSR, DARE and EMBASE through April 2017 for studies evaluating no-touch disinfection technology and the nosocomial infection rates for Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and other multidrug-resistant organisms (MDROs). We employed random-effect models to obtain pooled risk ratio (pRR) estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled risk ratios for C. difficile, MRSA, VRE, and MDRO were assessed separately. RESULTS In total, 20 studies were included in the final review: 13 studies using UVL systems and 7 studies using HPV systems. When the results of the UVL studies were pooled, statistically significant reduction ins C. difficile infection (CDI) (pRR, 0.64; 95% confidence interval [CI], 0.49-0.84) and VRE infection rates (pRR, 0.42; 95% CI, 0.28-0.65) were observed. No differences were found in rates of MRSA or gram-negative multidrug-resistant pathogens. CONCLUSIONS Ultraviolet light no-touch disinfection technology may be effective in preventing CDI and VRE infection. Infect Control Hosp Epidemiol 2018;39:20-31.
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Escudero D, Cofiño L, Forcelledo L, Quindós B, Calleja C, Martín L. Control de una endemia de Acinetobacter baumannii multirresistente en la UCI. Recordando lo obvio. Med Intensiva 2017; 41:497-499. [DOI: 10.1016/j.medin.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 11/24/2022]
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Johani K, Abualsaud D, Costa DM, Hu H, Whiteley G, Deva A, Vickery K. Characterization of microbial community composition, antimicrobial resistance and biofilm on intensive care surfaces. J Infect Public Health 2017; 11:418-424. [PMID: 29097104 DOI: 10.1016/j.jiph.2017.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Organisms causing healthcare associated infections can be sourced from the inanimate environment around patients. Residing in a biofilm increases the chances of these organisms persisting in the environment. We aimed to characterise bacterial environmental contamination, genetically and physiologically, and relate this to general intensive care unit (ICU) cleanliness. METHODS Cleanliness was determined by adenosine triphosphate (ATP) measurements of 95 high-touch objects. Bacteriological samples were obtained from the same sites (n=95) and from aseptically removed sections (destructive samples, n=20). Bacterial enrichment culture was conducted using tryptone soya broth prior to plating on horse blood agar, MacConkey agar, and screening chromogenic agar for identification of multidrug resistance organism (MDRO). Bacterial load and microbial diversity were determined using quantitative PCR (qPCR) and next generation DNA sequencing respectively. Confocal laser scanning microscopy and scanning electron microscopy were used to visually confirm the biofilm presence. RESULTS Many intensive care surfaces (61%) were highly contaminated by biological soil as determined by ATP bioluminescence testing. The degree of biological soiling was not associated with bacterial contamination as detected by qPCR. Bacterial load ranged from 78.21 to 3.71×108 (median=900) bacteria/100cm2. Surface swabs from 71/95 sites (75%) were culture-positive; of these 16 (22.5%) contained MDRO. The most abundant genera were Staphylococcus, Propionibacterium, Pseudomonas, Bacillus, Enterococcus, Streptococcus and Acinetobacter. Biofilm was visually confirmed by microscopy on 70% (14/20) of items. CONCLUSION Bacterial biofilms and MDROs were found on ICU surfaces despite regular cleaning in Saudi Arabia, suggesting that biofilm development is not controlled by current cleaning practices.
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Affiliation(s)
- Khalid Johani
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Central Military Laboratories and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Danya Abualsaud
- Molecular Laboratory, Medical Microbiology, King Fahad Armed Forces Hospital, Saudi Arabia
| | - Dayane M Costa
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Faculty of Nursing, Federal University of Goias, Goiania, Goias, Brazil
| | - Honghua Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Anand Deva
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination. Infect Control Hosp Epidemiol 2017; 38:1147-1154. [DOI: 10.1017/ice.2017.181] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVETo determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.DESIGNWe completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.PARTICIPANTS AND SETTINGNurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.INTERVENTIONNurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.RESULTSIn total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).CONCLUSIONSAntimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.TRIAL REGISTRATIONClinicaltrials.gov Identifier: NCT 02645214Infect Control Hosp Epidemiol 2017;38:1147–1154
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Deshpande A, Donskey CJ. Practical Approaches for Assessment of Daily and Post-discharge Room Disinfection in Healthcare Facilities. Curr Infect Dis Rep 2017; 19:32. [PMID: 28770497 DOI: 10.1007/s11908-017-0585-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Abhishek Deshpande
- Department of Medicine, Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, OH, 44195, USA. .,Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106, USA
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Room Occupancy-Associated Transmission of MDRO, Clostridium difficile, or Norovirus: Results From a Room Surveillance Project. Infect Control Hosp Epidemiol 2017; 38:1130-1131. [PMID: 28689514 DOI: 10.1017/ice.2017.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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129
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Prevalence and risk factors for colonization by Clostridium difficile and extended-spectrum β-lactamase-producing Enterobacteriaceae in rehabilitation clinics in Germany. J Hosp Infect 2017; 98:14-20. [PMID: 28705583 DOI: 10.1016/j.jhin.2017.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rehabilitation clinics may vary widely in terms of type of care provided, duration of hospital stay, and case severity. Few data are available on prevalence of Clostridium difficile or extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonization in rehabilitation clinics in Germany. AIM This study investigated the frequency of intestinal colonization by these pathogens among patients in rehabilitation clinics of different specialization. METHODS In the scope of a point prevalence study, faecal samples and demographic and clinical data were collected in five rehabilitation clinics. Samples were screened for C. difficile and ESBL-E by culture. Isolates were characterized by polymerase chain reaction for C. difficile toxins A and B, for β-lactamase genes, and by molecular typing including pulsed-field gel electrophoresis and PCR-based ribotyping. FINDINGS Of 305 patients screened, 11.1% were colonized by toxigenic C. difficile and 7.5% by ESBL-E. Colonization rates differed markedly between facilities, ranging from 1.6% to 26.3% for C. difficile and from zero to 23.7% for ESBL-E. Prevalence of colonization by C. difficile and ESBL-E was higher in neurological rehabilitation clinics than in clinics with other specialties (P<0.001). Molecular typing revealed six patients from one neurological rehabilitation clinic harbouring a unique C. difficile strain (ribotype 017). CTX-M-15 was the most prevalent ESBL type. We detected several indistinguishable pairs of ESBL-E isolates within some facilities. CONCLUSION Significant differences were found in the prevalence of C. difficile and ESBL-E between rehabilitation clinics. Facilities providing specialized medical care for critically ill patients had higher prevalence rates. These results may help to delineate the requirements for infection prevention and control in rehabilitation clinics.
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A Multicenter Randomized Trial to Determine the Effect of an Environmental Disinfection Intervention on the Incidence of Healthcare-Associated Clostridium difficile Infection. Infect Control Hosp Epidemiol 2017; 38:777-783. [DOI: 10.1017/ice.2017.76] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVETo determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).DESIGNA multicenter randomized trial.SETTINGIn total,16 acute-care hospitals in northeastern Ohio participated in the study.INTERVENTIONWe conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.RESULTSOverall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.CONCLUSIONSAn environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.Infect Control Hosp Epidemiol 2017;38:777–783
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Clarivet B, Grau D, Jumas-Bilak E, Jean-Pierre H, Pantel A, Parer S, Lotthé A. Persisting transmission of carbapenemase-producing Klebsiella pneumoniae due to an environmental reservoir in a university hospital, France, 2012 to 2014. ACTA ACUST UNITED AC 2017; 21:30213. [PMID: 27168586 DOI: 10.2807/1560-7917.es.2016.21.17.30213] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
Abstract
In France, the proportion of episodes of carbapenemase-producing Enterobacteriaceae (CPE) with no recent stay or hospitalisation abroad is increasing. In this study, we investigate epidemiological links between apparently unrelated cases of OXA-48-producing Klebsiella pneumoniae (Kp OXA-48) colonisation or infection. We genotyped detected organisms by repetitive sequence-based PCR, and used a dynamic registry of cases and contacts to cross-reference patients' hospital stays. Between 1 November 2012 and 28 February 2014, 23 Kp OXA-48 cases were detected in a university hospital in Montpellier, of which 15 were involved in three outbreaks: outbreaks I and II occurred in November 2012 and outbreak III in October 2013. Molecular comparison of bacterial strains revealed clonal identity between cases involved in outbreaks II and III and four single cases. Cross-referencing of hospital stays revealed that these single cases and the index case of outbreak III had occupied the same room. Active case search among former occupants of that room found an additional Kp OXA-48 carrier. A clonal strain was isolated from the sink of that room. The epidemiological link between the contaminated room and outbreak II remained undetected. This study is a reminder that environmental reservoirs should be considered as a source of CPE transmission.
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Affiliation(s)
- Béatrice Clarivet
- Department of Infection Control and Prevention, University Hospital of Montpellier, France
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Anderson DJ, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett PF, Blocker M, Becherer P, Schwab JC, Knelson LP, Lokhnygina Y, Rutala WA, Kanamori H, Gergen MF, Sexton DJ. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017; 389:805-814. [PMID: 28104287 PMCID: PMC5935446 DOI: 10.1016/s0140-6736(16)31588-4] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/18/2016] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter. METHODS We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA. Rooms from which a patient with infection or colonisation with a target organism was discharged were terminally disinfected with one of four strategies: reference (quaternary ammonium disinfectant except for C difficile, for which bleach was used); UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C] light except for C difficile, for which bleach and UV-C were used); bleach; and bleach and UV-C. The next patient admitted to the targeted room was considered exposed. Every strategy was used at each hospital in four consecutive 7-month periods. We randomly assigned the sequence of strategies for each hospital (1:1:1:1). The primary outcomes were the incidence of infection or colonisation with all target organisms among exposed patients and the incidence of C difficile infection among exposed patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01579370. FINDINGS 31 226 patients were exposed; 21 395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22 426 exposure days in the reference group (51·3 per 10 000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10 000 exposure days; relative risk [RR] 0·70, 95% CI 0·50-0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10 000 exposure days; RR 0·85, 95% CI 0·69-1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10 000 exposure days; RR 0·91, 95% CI 0·76-1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10 000 exposure days; RR 1·0, 95% CI 0·57-1·75; p=0·997). INTERPRETATION A contaminated health-care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Deverick J Anderson
- Duke Infection Control Outreach Network, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
| | - Luke F Chen
- Duke Infection Control Outreach Network, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - David J Weber
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA
| | | | - Sarah S Lewis
- Duke Infection Control Outreach Network, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Patricia F Triplett
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA; High Point Regional Hospital, High Point, NC, USA
| | - Michael Blocker
- Alamance Regional Medical Center, Burlington, NC, USA; Carolinas Medical Center, Charlotte, NC, USA
| | | | | | - Lauren P Knelson
- Duke Infection Control Outreach Network, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - William A Rutala
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Hajime Kanamori
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Maria F Gergen
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Daniel J Sexton
- Duke Infection Control Outreach Network, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
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Jullian-Desayes I, Landelle C, Mallaret MR, Brun-Buisson C, Barbut F. Clostridium difficile contamination of health care workers' hands and its potential contribution to the spread of infection: Review of the literature. Am J Infect Control 2017; 45:51-58. [PMID: 28065332 DOI: 10.1016/j.ajic.2016.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) can be transmitted from patient to patient by the hands of health care workers (HCWs); however, the relative importance of this route in the spread of C difficile in the hospital is currently unknown. Our aim was to review studies examining HCWs' hand carriage and its potential role in CDI transmission. METHODS First, English-speaking references addressing HCWs' hand sampling obtained from the PubMed database were reviewed. Second, C difficile outbreaks definitely or probably implicating HCWs were retrieved from the Outbreak Database Web site (www.outbreak-database.com). Finally, cases of C difficile occurring in HCWs after contact with an infected patient were retrieved from PubMed. RESULTS A total of 11 studies dealing with HCWs' hand carriage were selected and reviewed. Between 0% and 59% of HCWs' hands were found contaminated with C difficile after caring for a patient with CDI. There were several differences between studies regarding site of hands sampling, timing after contact, and bacteriologic methods. Only 2 C difficile outbreaks implicating HCWs and 6 series of cases of transmission from patients to HCWs have been reported. CONCLUSIONS This review shows that HCWs' hands could play an important role in the transmission of C difficile. Hand hygiene and reduction of environmental contamination are essential to control C difficile transmission.
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Muzslay M, Moore G, Alhussaini N, Wilson A. ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections. J Hosp Infect 2017; 95:59-64. [DOI: 10.1016/j.jhin.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
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Semret M, Dyachenko A, Ramman-Haddad L, Belzile E, McCusker J. Cleaning the grey zones of hospitals: A prospective, crossover, interventional study. Am J Infect Control 2016; 44:1582-1588. [PMID: 27397907 DOI: 10.1016/j.ajic.2016.04.234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. In this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (GZ), on health care-acquired transmission rates. METHODS The intervention consisted of specific GZ cleaning by an extra cleaner (in addition to routine cleaning) on 2 structurally different acute care medical wards for a period of 6 months each, in a crossover design. Data on health care-acquired transmissions of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, and Clostridium difficile were collected during both periods. Adjusted incidence rate ratios (IRRs) using Poisson regression were calculated to compare transmission of pathogens between both periods on both wards. RESULTS During the intervention VRE transmission was significantly decreased (2-fold) on the ward where patients had fewer roommates; cleaning of GZ did not have any effect on the ward with multiple-occupancy rooms. There was no impact on methicillin-resistant S aureus transmission and only a nonsignificant decrease in transmission of C difficile. CONCLUSIONS Our data provide evidence that targeted cleaning interventions can reduce VRE transmission when rooming conditions are optimized; such interventions can be cost-effective when the burden of VRE is significant. Enhanced cleaning interventions are less beneficial in the context of room sharing where many other factors contribute to transmission of pathogens.
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Affiliation(s)
- Makeda Semret
- McGill University, Montreal, Quebec, Canada; St Mary's Hospital Centre, Montreal, Quebec, Canada.
| | | | | | - Eric Belzile
- St Mary's Hospital Centre, Montreal, Quebec, Canada
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Dramowski A, Whitelaw A, Cotton MF. Assessment of terminal cleaning in pediatric isolation rooms: Options for low-resource settings. Am J Infect Control 2016; 44:1558-1564. [PMID: 27561433 DOI: 10.1016/j.ajic.2016.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies have evaluated terminal cleaning in low-resource settings. METHODS Adequacy of pediatric isolation room terminal cleaning was evaluated using quantitative bacterial surface cultures, ATP bioluminescence assays, and fluorescent high-touch surface markers at Tygerberg Children's Hospital in South Africa (August 1, 2014-October 31, 2015). Cleaning adequacy was assessed by comparing pre- and postcleaning measurements. Influence of verbal feedback was determined by comparing cleaners' first and subsequent cleaning episodes. Cleaning methods were compared for cost, time, and feasibility. RESULTS Adequacy of terminal cleaning was evaluated in 25 isolation rooms after hospitalization for pulmonary tuberculosis (n = 13), respiratory (n = 5) and enteric viruses (n = 5), pertussis (n = 1), and methicillin-resistant Staphylococcus aureus (n = 1). Mean aerobic colony counts and mean ATP relative light units declined between pre- and postcleaning evaluations (39 ± 41 to 15 ± 30 [P < .001] and 72 ± 40 to 23 ± 11 [P < .001]). Fluorescent marker removal was initially poor, but improved significantly at subsequent cleaning episodes (17 out of 78 [22%] to 121 out of 198 [61%]; P < .001); mean aerobic colony counts and ATP values also declined significantly following feedback. Cost, time, and resources required for ATP and surface cultures far exceeded that required for fluorescent markers. CONCLUSIONS Adequacy of isolation room cleaning improved following feedback to cleaning staff. Fluorescent markers are an inexpensive option for cleaning evaluation and training in low-resource settings.
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa.
| | - Andrew Whitelaw
- Department of Medical Microbiology, Stellenbosch University and the National Health Laboratory Service, Cape Town, South Africa
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa
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Sifri CD, Burke GH, Enfield KB. Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens. Am J Infect Control 2016; 44:1565-1571. [PMID: 27692785 DOI: 10.1016/j.ajic.2016.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The purpose of this study was to determine the effectiveness of copper-impregnated composite hard surfaces and linens in an acute care hospital to reduce health care-associated infections (HAIs). METHODS We performed a quasiexperimental study with a control group, assessing development of HAIs due to multidrug resistant organisms (MDROs) and Clostridium difficile in the acute care units of a community hospital following the replacement of a 1970s-era clinical wing with a new wing outfitted with copper-impregnated composite hard surfaces and linens. RESULTS The study was conducted over a 25.5-month time period that included a 3.5-month washout period. HAI rates obtained from the copper-containing new hospital wing (14,479 patient-days; 72 beds) and the unmodified hospital wing (19,177 patient-days) were compared with those from the baseline period (46,391 patient-days). The new wing had 78% (P = .023) fewer HAIs due to MDROs or C difficile, 83% (P = .048) fewer cases of C difficile infection, and 68% (P = .252) fewer infections due to MDROs relative to the baseline period. No changes in rates of HAI were observed in the unmodified hospital wing. CONCLUSIONS Copper-impregnated composite hard surfaces and linens may be useful technologies to prevent HAIs in acute care hospital settings. Additional studies are needed to determine whether reduced HAIs can be attributed to the use of copper-containing antimicrobial hard and soft surfaces.
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Stiller A, Salm F, Bischoff P, Gastmeier P. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016; 5:51. [PMID: 27957323 PMCID: PMC5129243 DOI: 10.1186/s13756-016-0152-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/22/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The influence of the hospital's infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies. METHODS We searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French. RESULTS We identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms. CONCLUSION Implementation of single-patient rooms and easily accessible hand rub dispensers located near the patient's bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.
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Affiliation(s)
- Andrea Stiller
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Florian Salm
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
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Burke DG, Harrison MJ, Fleming C, McCarthy M, Shortt C, Sulaiman I, Murphy DM, Eustace JA, Shanahan F, Hill C, Stanton C, Rea MC, Ross RP, Plant BJ. Clostridium difficile carriage in adult cystic fibrosis (CF); implications for patients with CF and the potential for transmission of nosocomial infection. J Cyst Fibros 2016; 16:291-298. [PMID: 27908697 DOI: 10.1016/j.jcf.2016.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/18/2016] [Accepted: 09/22/2016] [Indexed: 01/29/2023]
Abstract
Clostridium difficile is an anaerobic Gram-positive, spore-forming, toxin-producing bacillus transmitted among humans through the faecal-oral route. Despite increasing carriage rates and the presence of C. difficile toxin in stool, patients with CF rarely appear to develop typical manifestations of C. difficile infection (CDI). In this study, we examined the carriage, toxin production, ribotype distribution and antibiotic susceptibility of C. difficile in a cohort of 60 adult patients with CF who were pre-lung transplant. C. difficile was detected in 50% (30/60) of patients with CF by culturing for the bacteria. C. difficile toxin was detected in 63% (19/30) of C. difficile-positive stool samples. All toxin-positive stool samples contained toxigenic C. difficile strains harbouring toxin genes, tcdA and tcdB. Despite the presence of C. difficile and its toxin in patient stool, no acute gastrointestinal symptoms were reported. Ribotyping of C. difficile strains revealed 16 distinct ribotypes (RT), 11 of which are known to be disease-causing including the hyper-virulent RT078. Additionally, strains RT002, RT014, and RT015, which are common in non-CF nosocomial infection were described. All strains were susceptible to vancomycin, metronidazole, fusidic acid and rifampicin. No correlation was observed between carriage of C. difficile or any characteristics of isolated strains and any recorded clinical parameters or treatment received. We demonstrate a high prevalence of hypervirulent, toxigenic strains of C. difficile in asymptomatic patients with CF. This highlights the potential role of asymptomatic patients with CF in nosocomial transmission of C. difficile.
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Affiliation(s)
- D G Burke
- APC Microbiome Institute, University College Cork, Ireland
| | - M J Harrison
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - C Fleming
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - M McCarthy
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - C Shortt
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - I Sulaiman
- Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - D M Murphy
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - J A Eustace
- Health Research Board, Clinical Research Facility, University College Cork, Ireland
| | - F Shanahan
- APC Microbiome Institute, University College Cork, Ireland
| | - C Hill
- School of Microbiology, University College Cork, Ireland
| | - C Stanton
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - M C Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - R P Ross
- APC Microbiome Institute, University College Cork, Ireland
| | - B J Plant
- Cork Adult CF Centre, Dept. of Medicine, Cork University Hospital, University College Cork, Ireland.
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Wigglesworth N, Xuereb D. Journal Watch. J Infect Prev 2016. [DOI: 10.1177/1757177416651955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Neil Wigglesworth
- Infection Prevention and Control, Guy’s and St Thomas’ NHS Foundation Trust, UK
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143
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Garvey M, Bradley C, Jumaa P. Environmental decontamination following occupancy of a burns patient with multiple carbapenemase-producing organisms. J Hosp Infect 2016; 93:136-40. [DOI: 10.1016/j.jhin.2016.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Clifford R, Sparks M, Hosford E, Ong A, Richesson D, Fraser S, Kwak Y, Miller S, Julius M, McGann P, Lesho E. Correlating Cleaning Thoroughness with Effectiveness and Briefly Intervening to Affect Cleaning Outcomes: How Clean Is Cleaned? PLoS One 2016; 11:e0155779. [PMID: 27196635 PMCID: PMC4873012 DOI: 10.1371/journal.pone.0155779] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
Objectives The most efficient approach to monitoring and improving cleaning outcomes remains unresolved. We sought to extend the findings of a previous study by determining whether cleaning thoroughness (dye removal) correlates with cleaning efficacy (absence of molecular or cultivable biomaterial) and whether one brief educational intervention improves cleaning outcomes. Design Before-after trial. Setting Newly built community hospital. Intervention 90 minute training refresher with surface-specific performance results. Methods Dye removal, measured by fluorescence, and biomaterial removal and acquisition, measured with culture and culture-independent PCR-based assays, were clandestinely assessed for eight consecutive months. At this midpoint, results were presented to the cleaning staff (intervention) and assessments continued for another eight consecutive months. Results 1273 surfaces were sampled before and after terminal room cleaning. In the short-term, dye removal increased from 40.3% to 50.0% (not significant). For the entire study period, dye removal also improved but not significantly. After the intervention, the number of rooms testing positive for specific pathogenic species by culturing decreased from 55.6% to 36.6% (not significant), and those testing positive by PCR fell from 80.6% to 53.7% (P = 0.016). For nonspecific biomaterial on surfaces: a) removal of cultivable Gram-negatives (GN) trended toward improvement (P = 0.056); b) removal of any cultivable growth was unchanged but acquisition (detection of biomaterial on post-cleaned surfaces that were contaminant-free before cleaning) worsened (P = 0.017); c) removal of PCR-based detection of bacterial DNA improved (P = 0.046), but acquisition worsened (P = 0.003); d) cleaning thoroughness and efficacy were not correlated. Conclusion At this facility, a minor intervention or minimally more aggressive cleaning may reduce pathogen-specific contamination, but not without unintended consequences.
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Affiliation(s)
- Robert Clifford
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Michael Sparks
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Eve Hosford
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Ana Ong
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Douglas Richesson
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Susan Fraser
- Department of Infectious Diseases and Infection Control, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, United States of America
| | - Yoon Kwak
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Sonia Miller
- Department of Infectious Diseases and Infection Control, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, United States of America
| | - Michael Julius
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Patrick McGann
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Emil Lesho
- Multidrug-resistant organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
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Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016; 5:10. [PMID: 27069623 PMCID: PMC4827199 DOI: 10.1186/s13756-016-0111-x] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/23/2016] [Indexed: 12/21/2022] Open
Abstract
Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer’s recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices. Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating “self-disinfecting” surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation. Newer “no-touch” (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These “no-touch” technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections. In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457 USA
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Hall L, Farrington A, Mitchell BG, Barnett AG, Halton K, Allen M, Page K, Gardner A, Havers S, Bailey E, Dancer SJ, Riley TV, Gericke CA, Paterson DL, Graves N. Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial. Implement Sci 2016; 11:44. [PMID: 27009342 PMCID: PMC4806497 DOI: 10.1186/s13012-016-0406-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325505
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Affiliation(s)
- Lisa Hall
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Alison Farrington
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
| | - Brett G Mitchell
- Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW, 2076, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Michelle Allen
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Katie Page
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Anne Gardner
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson, ACT, 2062, Australia
| | - Sally Havers
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Emily Bailey
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, Eaglesham Rd, East Kilbride, G75 8RG, UK
| | - Thomas V Riley
- School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Christian A Gericke
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.,School of Public Health, University of Queensland, Herston, QLD, 4006, Australia
| | - David L Paterson
- Wesley Medical Research, Wesley Hospital, PO Box 499, Toowong, QLD, 4066, Australia.,University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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Baluch A. State of the Globe: The Rippling Effect of Multidrug-Resistant Gram-negative Infections. J Glob Infect Dis 2016; 7:125-6. [PMID: 26752866 PMCID: PMC4693302 DOI: 10.4103/0974-777x.170494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aliyah Baluch
- Division of Infectious Diseases, Moffitt Cancer Center, Tampa, FL, USA
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