A pilot study into locating the bad bugs in a busy intensive care unit

Evaluation of ATP bioluminescence for monitoring surface hygiene in a hospital pharmacy cleanroom

The usefulness of the ATP bioluminescence method for monitoring surface hygiene was evaluated in a hospital pharmacy cleanroom. The sensitivity of the method was found to be appropriate for assessing the efficiency of cleaning and disinfection. ATP bioluminescence was superior to the traditional microbiological culture-based method for detecting unclean surfaces (p < .05).

An evaluation of buffered peracetic acid as an alternative to chlorine and hydrogen peroxide based disinfectants

This short report documents an in-use evaluation of three disinfectant solutions that was conducted within the operating theatre of a South Australian hospital to address a high occurrence of Clostridium difficile Infection (CDI). The disinfectants were all registered by the Therapeutic Goods Administration (TGA) and included a buffered peracetic acid, a chlorine-based disinfectant used at 1000 ppm, and a hydrogen peroxide-based disinfectant. The use of the chlorine and hydrogen peroxide disinfectants both caused a number of adverse staff reactions and increased safe-work related incident reporting. The peracetic acid-based product met all criteria for use, including staff acceptance, cleaning expectation, cost and efficacy requirements.

'Off the rails': hospital bed rail design, contamination, and the evaluation of their microbial ecology

Microbial contamination of the near-patient environment is an acknowledged reservoir for nosocomial pathogens. The hospital bed and specifically bed rails have been shown to be frequently and heavily contaminated in observational and interventional studies. Whereas the complexity of bed rail design has evolved over the years, the microbial contamination of these surfaces has been incompletely evaluated. In many published studies, key design variables are not described, compromising the extrapolation of results to other settings. This report reviews the evolving structure of hospital beds and bed rails, the possible impact of different design elements on microbial contamination and their role in pathogen transmission. Our findings support the need for clearly defined standardized assessment protocols to accurately assess bed rail and similar patient zone surface levels of contamination, as part of environmental hygiene investigations.

Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms

The efficacy of discharge cleaning and disinfection of high-touch surfaces of intensive care unit patient rooms in Brazil, Canada, the Netherlands, and the United States was evaluated and the effect of an educational intervention was determined. Significant site-to-site differences in cleaning regimens and baseline cleanliness levels were observed using ATP levels, colony-forming units, and reflective surface marker removal percent pass rates. An educational intervention that includes rapid feedback of the ATP measurements could significantly improve the quality of the cleaning and disinfection regimens.

Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

OBJECTIVE

to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit.

METHOD

a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm2 were found in culture; when ≥5 relative light units per cm2 were found at the ATP-bioluminescence assay.

RESULTS

720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods.

CONCLUSION

the methods did not present a good correlation, neither quantitative nor qualitatively.

Nosocomial outbreaks caused by Acinetobacter baumannii and Pseudomonas aeruginosa: Results of a systematic review

BACKGROUND

Large outbreaks of infection by Acinetobacter baumannii and Pseudomonas aeruginosa have been reported. This research compares characteristics of such outbreaks.

OBJECTIVES

Determination of risk factors for the occurrence and appropriate infection control measures.

DATA SOURCES

The Outbreak Database, PubMed, and reference lists of identified articles were used. Key words included nosocomial and (outbreak or epidemic) and (aeruginosa or baumannii).

STUDY ELIGIBILITY CRITERIA

Articles were included if they describe distinct outbreak(s) caused by A baumannii or P aeruginosa and were published between 2000 and 2015. There were no further restrictions with respect to language or type of article.

RESULTS

One hundred fifty outbreaks by A baumannii and 131 outbreaks by P aeruginosa were included, including multidrug-resistant strains in 113 Acinetobacter and 49 Pseudomonas outbreaks. Acinetobacter outbreaks were mainly reported from intensive care units, after use of antibiotics, during mechanical ventilation, and presented with a mortality rate of 47% compared with 23% by Pseudomonas. Resistance did not alter mortality by either species. Most infection control measures were implemented or enforced more often in Acinetobacter outbreaks.

CONCLUSIONS

These findings should support staff in infection control departments and on wards if an outbreak is suspected. Better adherence to the Outbreak Reports and Intervention Studies of Nosocomial Infection guidelines in outbreak reporting is necessary. A precise definition of multidrug resistance for Acinetobacter and Pseudomonas is lacking.

Characterization of microbial community composition, antimicrobial resistance and biofilm on intensive care surfaces

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.