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Osman AH, Darkwah S, Kotey FCN, Odoom A, Hotor P, Dayie NTKD, Donkor ES. Reservoirs of Nosocomial Pathogens in Intensive Care Units: A Systematic Review. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241243239. [PMID: 38828046 PMCID: PMC11141231 DOI: 10.1177/11786302241243239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/14/2024] [Indexed: 06/05/2024]
Abstract
Background Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission. Method An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25th and 29th May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis. Results About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of Staphylococcus being the most predominant. Other prevalent microbes were Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Candida spp., Enterococcus sp., and Enterobacter sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included E. aerogenes, Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), E. coli, and K. pneumoniae. Multidrug-resistant (MDR) bacteria, such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing E. coli, and MDR Pseudomonas aeruginosa were commonly isolated on fomites in the ICUs. Conclusion Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with Staphylococcus being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.
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Affiliation(s)
- Abdul-Halim Osman
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Darkwah
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Fleischer C N Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Alex Odoom
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Prince Hotor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
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Jinadatha C, Navarathna T, Negron-Diaz J, Ghamande G, Corona BA, Adrianza A, Coppin JD, Choi H, Chatterjee P. Understanding the significance of microbiota recovered from health care surfaces. Am J Infect Control 2024; 52:220-224. [PMID: 38206212 DOI: 10.1016/j.ajic.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Microbial contamination of hospital surfaces remains despite adherence to routine disinfection. Our study demonstrates bioburden from various types of hospital high-touch surfaces and the pathogenicity of all bacteria recovered. METHODS Several high-touch hospital surfaces from a single medical-surgical unit were sampled and cultured using replicate organism detection and counting (RODAC) Tryptic Soy agar plates. Colonies were then subcultured to blood agar plates and speciated using MALDI-TOF. The local microbiology laboratory database was queried for any clinical isolate match with the environmental samples recovered. RESULTS Manikins, bed rails, and workstations-on-wheels were the most contaminated surfaces with the largest variety of bacteria isolated from manikins and bed rails. A total of 60 different types of pathogens were isolated, 18 of which were well-known pathogens, and 7 were classified as important in the health care setting by CDC. Our clinical microbiology laboratory identified 29 of 60 hospital surface bacteria in clinical isolates. Urine, soft tissue, and blood were the most common sources of clinical isolates. CONCLUSIONS Surfaces in the health care environment harbor both well-known and not-so-well-known human pathogens. Several not-so-well-known pathogens are skin flora or environmental bacteria, which in the right setting, can become pathogenic and cause diseases including meningitis, brain abscess, endocarditis, and bacteremia.
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Affiliation(s)
- Chetan Jinadatha
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Thanuri Navarathna
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Juan Negron-Diaz
- Department of Research, Central Texas Veterans Health Care System, Temple, TX; Department of Internal Medicine, Baylor Scott and White Health, Temple, TX
| | - Gautam Ghamande
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Brandon A Corona
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Andres Adrianza
- Department of Research, Central Texas Veterans Health Care System, Temple, TX; Department of Internal Medicine, Baylor Scott and White Health, Temple, TX
| | - John D Coppin
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Hosoon Choi
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Piyali Chatterjee
- Department of Research, Central Texas Veterans Health Care System, Temple, TX.
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Shek Daud NS, Dunn M, Moncayo-Nieto OL, Hay A. Is the combination of UV-C light and bleach less effective than bleach alone for intensive care unit surface disinfection? Infect Prev Pract 2023; 5:100307. [PMID: 38107241 PMCID: PMC10724481 DOI: 10.1016/j.infpip.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Chlorine-based disinfectants, such as bleach, are commonly used for cleaning in healthcare settings to prevent the transmission of nosocomial pathogens. To enhance the efficacy of disinfection, ultraviolet-C (UV-C) light systems have been proposed to supplement standard cleaning procedures. As bleach decomposes in UV light, we hypothesised that the use of UV-C light as an adjunct to manual cleaning with bleach, may decrease the efficacy of disinfection instead. Methods In the laboratory, stainless steel sheets and plastic keyboards were inoculated with Pseudomonas aeruginosa (∼106 CFU/ml) and subjected to treatment with either UV-C light only, bleach only or a combination of UV-C light and bleach. The residual bioburden (CFU/ml) was quantified through conventional microbiological techniques. Results were compared to non-exposed control surfaces and against each treatment strategy. Results On tested surfaces, there were statistically significant reductions in P. aeruginosa when surfaces were treated with UV-C light only (>2.5 log10 reduction), bleach only (>5.6 log10 reduction) and a combination of UV-C light and bleach (>6.3 log10 reduction) compared to positive control (P < 0.001, all treatment strategies). No significant differences were observed when surfaces were treated with the addition of UV-C light to bleach compared to treatment with bleach alone. Conclusion There was no difference in the efficacy of disinfection against P. aeruginosa with the combined treatment strategy of UV-C light and bleach compared to bleach alone under laboratory conditions. Further studies are warranted to elucidate the effectiveness of this technology on other healthcare-associated pathogens.
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Affiliation(s)
| | - Mark Dunn
- Edinburgh Medical School, Edinburgh, United Kingdom
| | | | - Alasdair Hay
- Edinburgh Medical School, Edinburgh, United Kingdom
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4
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Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. ..úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials. Am J Infect Control 2023; 51:A134-A143. [PMID: 37890944 DOI: 10.1016/j.ajic.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Hospital patient room surfaces are frequently contaminated with multidrug-resistant organisms. Since studies have demonstrated that inadequate terminal room disinfection commonly occurs, ..úno touch..Ñ methods of terminal room disinfection have been developed such as ultraviolet light (UV) devices and hydrogen peroxide (HP) systems. METHODS This paper reviews published clinical trials of ..úno touch..Ñ methods and ..úself-disinfecting..Ñ surfaces. RESULTS Multiple papers were identified including clinical trials of UV room disinfection devices (N.ß=.ß20), HP room disinfection systems (N.ß=.ß8), handheld UV devices (N.ß=.ß1), and copper-impregnated or coated surfaces (N.ß=.ß5). Most but not all clinical trials of UV devices and HP systems for terminal disinfection demonstrated a reduction of colonization/infection in patients subsequently housed in the room. Copper-coated surfaces were the only ..úself-disinfecting..Ñ technology evaluated by clinical trials. Results of these clinical trials were mixed. DISCUSSION Almost all clinical trials reviewed used a ..úweak..Ñ design (eg, before-after) and failed to assess potential confounders (eg, compliance with hand hygiene and environmental cleaning). CONCLUSIONS The evidence is strong enough to recommend the use of a ..úno-touch..Ñ method as an adjunct for outbreak control, mitigation strategy for high-consequence pathogens (eg, Candida auris or Ebola), or when there are an excessive endemic rates of multidrug-resistant organisms.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC
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Rutala WA, Boyce JM, Weber DJ. Disinfection, sterilization and antisepsis: An overview. Am J Infect Control 2023; 51:A3-A12. [PMID: 37890951 DOI: 10.1016/j.ajic.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection. METHODS We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics. RESULTS The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation. CONCLUSIONS When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - John M Boyce
- J.M. Boyce Consulting, Boyce Consulting, LLC, Middletown, CT
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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Amodeo D, Lucarelli V, De Palma I, Puccio A, Nante N, Cevenini G, Messina G. Efficacy of violet-blue light to inactive microbial growth. Sci Rep 2022; 12:20179. [PMID: 36424450 PMCID: PMC9691702 DOI: 10.1038/s41598-022-24563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
The increase in health care-associated infections and antibiotic resistance has led to a growing interest in the search for innovative technologies to solve these problems. In recent years, the interest of the scientific community has focused on violet-blue light at 405 nm (VBL405). This study aimed to assess the VBL405 efficiency in reducing microbial growth on surfaces and air. This descriptive study run between July and October 2020. Petri dishes were contaminated with P. aeruginosa, E. coli, S. aureus, S. typhimurium, K. pneumoniae and were placed at 2 and 3 m from a LED light source having a wavelength peak at 405 nm and an irradiance respectively of 967 and 497 µW/cm2. Simultaneously, the air in the room was sampled for 5 days with two air samplers (SAS) before and after the exposition to the VBL405 source. The highest microbial reduction was reached 2 m directly under the light source: S. typhimurium (2.93 log10), K. pneumoniae (2.30 log10), S. aureus (3.98 log10), E. coli (3.83 log10), P. aeruginosa (3.86 log10). At a distance of 3 m from the light source, the greatest reduction was observed for S. aureus (3.49 log10), and P. aeruginosa (3.80 log10). An average percent microbial reduction of about 70% was found in the sampled air after 12 h of exposure to VBL405. VBL405 has proven to contrast microbial growth on the plates. Implementing this technology in the environment to provide continuous disinfection and to control microbial presence, even in the presence of people, may be an innovative solution.
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Affiliation(s)
- Davide Amodeo
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Valentina Lucarelli
- grid.9024.f0000 0004 1757 4641Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Isa De Palma
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Puccio
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Nicola Nante
- grid.9024.f0000 0004 1757 4641Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gabriele Cevenini
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gabriele Messina
- grid.9024.f0000 0004 1757 4641Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Maloney B, McKerlie T, Nasir M, Murphy C, Moi M, Mudalige P, Naser NE, Duane B. The Environmental Footprint Of Single versus Reusable Cloths For Clinical Surface Decontamination: A Life Cycle Approach. J Hosp Infect 2022; 130:7-19. [PMID: 36115619 DOI: 10.1016/j.jhin.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
Global sustainability is a major health concern facing our planet today. The healthcare sector is a significant contributor to environmentally damaging activity. Reusable cloths should be considered as an environmentally friendly alternative to the predominantly used single-use surface wipes in cleaning and disinfection of environmental surfaces in healthcare settings. To understand its feasibility, a rapid review of current policies on surface decontamination in healthcare settings was conducted. A life cycle impact assessment (LCIA) was then carried out to compare the impact of reusable cotton and microfibre cloths versus conventional single-use cloths, with three compatible disinfectants. Seven countries were included in the rapid review of policies. For the LCIA, inputs, outputs, and processes across the life cycle were included, using EcoInvent database v3.7.1 and open LCIA software. Sixteen European-recommended environmental impact categories and eight human health categories were considered. Infection prevention policies examined do not require single-use wipes for cleaning and disinfection. The disinfectant with the highest environmental impact was isopropyl-alcohol. The most environmentally-sustainable option for clinical surface decontamination was the microfibre cloth when used with a quaternary ammonium compound. The least environmentally sustainable option was cotton with isopropyl-alcohol. Impacts were primarily attributed with the use of the disinfectant agent and travel processes.
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Affiliation(s)
- Brian Maloney
- School of Dental Science, Trinity College Dublin, Dublin, Ireland.
| | - Taylor McKerlie
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Malaika Nasir
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Caroline Murphy
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Michelle Moi
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Pavanee Mudalige
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | | | - Brett Duane
- Trinity College Dublin, Department of Child and Public Dental Health, Dublin, Ireland
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Efficacy of Disinfectants Usage at Daily Live Bird Markets in Four North-Western States of Nigeria. FOLIA VETERINARIA 2022. [DOI: 10.2478/fv-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Maintaining strict biosecurity measures are essential in preventing disease spread from live bird markets (LBMs), which serve as a major intermingling area for poultry from different sources. This study evaluated the efficacy of disinfectants used in daily live bird markets of four north-western states in Nigeria. Seven different disinfectants were identified as commonly used in the LBMs. They were analysed by suspension and surface disinfection tests against standard strains of Escherichia coli, Salmonella Enteritidis, and Staphylococcus aureus. Isolates from swab samples of birds’ cages in the LBMs were initially subjected to biochemical tests and, subsequently, susceptibility tests against commercial disinfectants. All of the 7 (100 %) disinfectants used in the LBMs killed/inhibited the growth of E. coli, S. Enteritidis, and S. aureus with the suspension test, while following the surface disinfection test, all 7 (100 %) killed/inhibited the growth of E. coli and S. Enteritidis but only 4 (57 %) killed/inhibited the growth of S. aureus. Seven (0.02 %) samples out of the 400 swabs were positive for E. coli comprising 1 (14 %), 2 (29 %), and 4 (57 %) from LBMs in Katsina, Kaduna, and Kano, respectively. There were varying growths of E. coli at different concentrations and exposure times. Six (17 %) of the LBMs sampled had and used disinfectants. E. coli was isolated from 1 (17 %) out of the 6 LBMs that had and used disinfectants and 5 (17 %) out of the 29 LBMs that did not have or use disinfect-ants. The standard organisms were most susceptible to orthobenzyl chlorophenol-based disinfectants and least susceptible to chlorophenol-based disinfectants. This study has shown the importance of the use of disinfect-ants in LBMs. There should be enforcement of disinfectants usage in LBMs for public safety.
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Bakke M. A Comprehensive Analysis of ATP Tests: Practical Use and Recent Progress in the Total Adenylate Test for the Effective Monitoring of Hygiene. J Food Prot 2022; 85:1079-1095. [PMID: 35503956 DOI: 10.4315/jfp-21-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT Rapid hygiene monitoring tests based on the presence of ATP have been widely used in the food industry to ensure that adequate cleanliness is maintained. In this study, the practical applications and limitations of these tests and recent technological progress for facilitating more accurate control were evaluated. The presence of ATP on a surface indicates improper cleaning and the presence of contaminants, including organic debris and bacteria. Food residues are indicators of insufficient cleaning and are direct hazards because they may provide safe harbors for bacteria, provide sources of nutrients for bacterial growth, interfere with the antimicrobial activity of disinfectants, and support the formation of biofilms. Residues of allergenic foods on a surface may increase the risk of allergen cross-contact. However, ATP tests cannot detect bacteria or allergenic proteins directly. To ensure efficient use of commercially available ATP tests, in-depth knowledge is needed regarding their practical applications, methods for determining pass-fail limits, and differences in performance. Conventional ATP tests have limitations due to possible hydrolysis of ATP to ADP and AMP, which further hinders the identification of food residues. To overcome this problem, a total adenylate test was developed that could detect ATP+ADP+AMP (A3 test). The A3 test is suitable for the detection of adenylates from food residues and useful for verification of hygiene levels. The A3 test in conjunction with other methods, such as microorganism culture and food allergen tests, may be a useful strategy for identifying contamination sources and facilitating effective hygiene management. HIGHLIGHTS
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Affiliation(s)
- Mikio Bakke
- Kikkoman Biochemifa Company, Marketing & Planning Division, 2-1-1 Nishi-shinbashi, Minato-ku, Tokyo 105-0003, Japan
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Rose LJ, Houston H, Martinez-Smith M, Lyons AK, Whitworth C, Reddy SC, Noble-Wang J. Factors influencing environmental sampling recovery of healthcare pathogens from non-porous surfaces with cellulose sponges. PLoS One 2022; 17:e0261588. [PMID: 35025906 PMCID: PMC8757884 DOI: 10.1371/journal.pone.0261588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
Results from sampling healthcare surfaces for pathogens are difficult to interpret without understanding the factors that influence pathogen detection. We investigated the recovery of four healthcare-associated pathogens from three common surface materials, and how a body fluid simulant (artificial test soil, ATS), deposition method, and contamination levels influence the percent of organisms recovered (%R). Known quantities of carbapenemase-producing KPC+ Klebsiella pneumoniae (KPC), Acinetobacter baumannii, vancomycin-resistant Enterococcus faecalis, and Clostridioides difficile spores (CD) were suspended in Butterfield's buffer or ATS, deposited on 323cm2 steel, plastic, and laminate surfaces, allowed to dry 1h, then sampled with a cellulose sponge wipe. Bacteria were eluted, cultured, CFU counted and %R determined relative to the inoculum. The %R varied by organism, from <1% (KPC) to almost 60% (CD) and was more dependent upon the organism's characteristics and presence of ATS than on surface type. KPC persistence as determined by culture also declined by >1 log10 within the 60 min drying time. For all organisms, the %R was significantly greater if suspended in ATS than if suspended in Butterfield's buffer (p<0.05), and for most organisms the %R was not significantly different when sampled from any of the three surfaces. Organisms deposited in multiple droplets were recovered at equal or higher %R than if spread evenly on the surface. This work assists in interpreting data collected while investigating a healthcare infection outbreak or while conducting infection intervention studies.
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Affiliation(s)
- Laura J. Rose
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollis Houston
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marla Martinez-Smith
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda K. Lyons
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carrie Whitworth
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sujan C. Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Judith Noble-Wang
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Sanguinet J, Edmiston C. Evaluation of dry hydrogen peroxide in reducing microbial bioburden in a healthcare facility. Am J Infect Control 2021; 49:985-990. [PMID: 33737038 DOI: 10.1016/j.ajic.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Standard manual cleaning and disinfection practices are often inadequate. Persistent contamination in the environment poses an infection risk that may be mitigated by no-touch disinfection systems. This study evaluates the efficacy of dry hydrogen peroxide (DHP) on microbial air and surface contamination as an adjunct to routine cleaning and disinfection in a large urban hospital. METHODS Surface samples were collected in five different hospital units, two pediatric and three adult, after manual cleaning on multiple days before and after DHP implementation. Air samples were also collected in each unit pre- and post-DHP use. Data outcomes were reported as colony forming units (CFU) with species identification. RESULTS The overall mean surface microbial burden was reduced by 96.5 percent for all units post-DHP compared to baseline (P < 0.001), with the greatest reductions achieved on privacy curtains (99.5 %). Mean microbial air sample counts were also reduced post-DHP compared to pre-DHP. CONCLUSIONS This study demonstrates that DHP was effective in reducing both air and surface microbial contamination in a variety of settings within a large, tertiary care hospital.
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12
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Investigating the Association between Outdoor Environment and Outdoor Activities for Seniors Living in Old Residential Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147500. [PMID: 34299950 PMCID: PMC8307385 DOI: 10.3390/ijerph18147500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/04/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
Many seniors live in old residential communities (ORCs) with low-quality outdoor environment (OE), which hinders the residents’ outdoor daily activities (ODAs). This paper empirically investigates the association of OE on ODAs for seniors living in ORCs. A questionnaire was designed and distributed in six central districts of Nanjing city. A total of 258 questionnaires was finally collected, of which 60.08%, 29.46%, 9.69%, and 0.78% respondents were scattered into four age groups (61–69, 70–79, 80–89, and ≥90), respectively. Based on reliability analysis, correlation analysis, and regression analysis, the results show that: (1) social activities are mainly associated with noise; (2) leisure activities are significantly associated with road accessibility, slip-resistance measures, greenery, and staff; (3) utilitarian-type activities are significantly associated with stairway accessibility, slip-resistance measures, greenery, and seating; (4) there is a significant association between nature-exposure activities and layout, greenery, and poor air quality. The findings could guide Chinese officials when renewing ORCs by addressing the most important outdoor environmental factors associated with ODAs.
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Bakke M, Sakurai K, Tanaka N, Saito W, Nishimoto K. Validation Study of LuciPacTM A3 Surface for Hygiene Monitoring through Detection of ATP, ADP, and AMP from Stainless Steel Surfaces: AOAC Performance Tested MethodSM 051901. J AOAC Int 2021; 103:1090-1104. [PMID: 33241327 DOI: 10.1093/jaoacint/qsz033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND The LuciPac A3 Surface Hygiene Monitoring System based on the detection of total adenylate, ATP+ADP+AMP (A3), has been developed by Kikkoman Biochemifa. OBJECTIVE This A3 swabbing assay kit was validated for Performance Tested MethodsSM (PTM) certification. METHODS The LuciPac A3 Surface Hygiene Monitoring System was evaluated for limit of detection (LOD) for each adenylate with pure analyte solutions, detection of food residues and microbial residues on stainless steel surfaces, interference by disinfectants, and selectivity of the method response. RESULTS Pure analyte studies performed by the method developer and the independent laboratory showed good linearity (R2 > 0.9854) and repeatability precision (RSDr < 20% for ≥2.5 fmol/assay). The LOD values for each adenylate were around 10 relative light units or 2.5 fmol/assay. The repeatability precision in the method developer laboratory for the matrix study (raw chicken breast, sliced deli ham, orange juice, yogurt, and apple pie) and the microbial study (Cronobacter sakazakii, Lactobacillus acidophilus, and Saccharomyces cerevisiae) were 8-30% and 10-35%, respectively. The repeatability precision of independent laboratory testing was 13-27% for orange juice and 16-43% for ham. Interference by several disinfectants indicate that rinsing is recommended to be performed after the use of sanitizing agents and before testing with LuciPac A3 Surface. Selectivity testing revealed that no positive interference and no inhibition were caused by adenylate analogues. Instrument variation, lot-to-lot consistency, accelerated stability (30°C, 5 weeks) were confirmed, and the method was shown to be robust against shaking time. CONCLUSIONS The LuciPac A3 Surface has been successfully validated. HIGHLIGHTS This A3 swabbing assay kit was qualified for PTM certification No. 051901.
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Affiliation(s)
- Mikio Bakke
- Kikkoman Biochemifa Company, 376-2 Kamihanawa, Noda, Chiba 278-0033, Japan
| | - Kenta Sakurai
- Kikkoman Biochemifa Company, 376-2 Kamihanawa, Noda, Chiba 278-0033, Japan
| | - Natsumi Tanaka
- Kikkoman Biochemifa Company, 376-2 Kamihanawa, Noda, Chiba 278-0033, Japan
| | - Wataru Saito
- Kikkoman Biochemifa Company, 376-2 Kamihanawa, Noda, Chiba 278-0033, Japan
| | - Kazunori Nishimoto
- Kikkoman Biochemifa Company, 376-2 Kamihanawa, Noda, Chiba 278-0033, Japan
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Jara BJ. Infection Prevention in the Era of COVID-19: 2021 Basic Procedure Review. J Nucl Med Technol 2021; 49:126-131. [PMID: 34083454 PMCID: PMC8712632 DOI: 10.2967/jnmt.121.262281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Infection prevention and control practices represent a vital behavioral skill set, especially in the era of COVID-19. Standard precautions, correct use of personal protective equipment, proper hand hygiene, and appropriate cleaning and disinfecting are necessary to prevent health-care-acquired infections in care facilities.
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Affiliation(s)
- Barbara J Jara
- Nuclear Diagnostic Products, Pharmalogic, Lansdowne, Pennsylvania
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15
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Artasensi A, Mazzotta S, Fumagalli L. Back to Basics: Choosing the Appropriate Surface Disinfectant. Antibiotics (Basel) 2021; 10:antibiotics10060613. [PMID: 34063833 PMCID: PMC8224088 DOI: 10.3390/antibiotics10060613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
From viruses to bacteria, our lives are filled with exposure to germs. In built environments, exposure to infectious microorganisms and their byproducts is clearly linked to human health. In the last year, public health emergency surrounding the COVID-19 pandemic stressed the importance of having good biosafety measures and practices. To prevent infection from spreading and to maintain the barrier, disinfection and hygiene habits are crucial, especially when the microorganism can persist and survive on surfaces. Contaminated surfaces are called fomites and on them, microorganisms can survive even for months. As a consequence, fomites serve as a second reservoir and transfer pathogens between hosts. The knowledge of microorganisms, type of surface, and antimicrobial agent is fundamental to develop the best approach to sanitize fomites and to obtain good disinfection levels. Hence, this review has the purpose to briefly describe the organisms, the kind of risk associated with them, and the main classes of antimicrobials for surfaces, to help choose the right approach to prevent exposure to pathogens.
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16
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Ação antimicrobiana do gás ozônio em superfícies e na aeromicrobiota. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao02712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Horsman S, Rynhoud H, Zhou X, Soares Magalhães RJ, Gibson JS, Meler E. Environmental Recovery of Nosocomial Bacteria in a Companion Animal Shelter Before and After Infection Control Procedures. Front Vet Sci 2021; 7:608901. [PMID: 33553281 PMCID: PMC7854535 DOI: 10.3389/fvets.2020.608901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
While the effects of cleaning and disinfection practices on the reduction of environmental nosocomial bacteria are well-established in human and large animal veterinary hospitals, how animal movements within animal health care facilities influence environmental bacterial recovery is poorly understood. During three consecutive weeks, 155 electrostatic wipes were collected from the environment pre- and post-cleaning only or following disinfection from seven target locations within an animal shelter. All samples were cultured, and isolates were identified using a matrix-assisted laser desorption ionization-time of flight mass spectrometry. Social network analysis of animal movements during the sampling period was performed to estimate the level of connectivity of the seven target locations. The relationship between bacterial levels and connectivity estimates of the target locations were investigated using a negative binomial regression model with a random effect of sampling areas. Overall, our results indicate a significant reduction in the total bacterial contamination with disinfection when compared to cleaning only [Coefficient (Coef.) = -1.72, 95% Confidence Interval (CI) = -3.09, -0.34, P = 0.015]. Higher total bacterial contamination was significantly more likely in sampled areas with less animal movement connectivity (Coef. = -0.32, 95% CI = -0.49, -0.15, P ≤ 0.001). Pseudomonas aeruginosa and ampicillin resistant Enterobacteriaceae (Escherichia coli, Enterobacter spp. and Klebsiella spp.) were present in the animal holdings and in the shelters' veterinary clinic environment at all sampling times. Our findings demonstrate that cleaning followed by disinfection practices are effective at reducing environmental bacterial levels. Areas with less animal connectivity are more likely to have a higher bacterial contamination. These areas could represent environmental reservoirs for bacterial infection and should be targeted with effective cleaning and disinfection protocols.
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Affiliation(s)
- Sara Horsman
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Hester Rynhoud
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Xiaoyan Zhou
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Ricardo J. Soares Magalhães
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Justine S. Gibson
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Erika Meler
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
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18
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The effectiveness of a nonalcoholic disinfectant containing metal ions, with broad antimicrobial activity. Sci Rep 2021; 11:1072. [PMID: 33441812 PMCID: PMC7806819 DOI: 10.1038/s41598-020-80443-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022] Open
Abstract
Disinfectants have different efficacies depending on their use and the target microorganism. This study aimed to evaluate the efficacy and safety of our new nonalcoholic disinfectant, which consists mainly of metal ions. According to the 17th revised Japanese Pharmacopoeia and ASTM international E1052 method, the bactericidal and virucidal efficacy of this new disinfectant against 13 microorganisms was evaluated by the in vitro quantitative suspension test. Additionally, the disinfectant cytotoxicity against multiple cell lines was examined. Then, a safety test using a human open patch test was performed with 26 healthy volunteers. This disinfectant showed strong bactericidal and virucidal activities: all microorganisms except enterovirus were inactivated very quickly. The infectivity of 12 microbial strains was eliminated within 5 min of disinfectant exposure. Additionally, this disinfectant showed little acute cytotoxicity in vitro. All volunteers were negative in the human open patch test. Our new disinfectant has a broad spectrum of microbial targets, is safe for human skin, and demonstrates no cytotoxicity. This disinfectant could prevent common microbial infections.
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19
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Boyce JM. A review of wipes used to disinfect hard surfaces in health care facilities. Am J Infect Control 2021; 49:104-114. [PMID: 32569612 DOI: 10.1016/j.ajic.2020.06.183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite a plethora of wipes available for use in health care facilities, there is a paucity of articles describing wipe composition, potential interactions between wipes and disinfectants, the manner in which wipes are used, and their relative efficacy. The purpose of this article is to provide an in-depth review of wipes used for disinfection of hard surfaces in health care settings. METHODS Comprehensive searches of the Pubmed database and Internet were conducted, and articles published from 1953 through September 2019 and pertinent on-line documents were reviewed. Bibliographies of relevant articles were reviewed. RESULTS Wipes vary considerably in their composition, and the disinfectants with which they are used. With reusable dry wipes, the ratio of wipe material to disinfectant and the amount of disinfectant absorbed by the wipe and delivered to surfaces is difficult to standardize, which may affect their efficacy. The manner in which wipes are used by health care personnel is highly variable, due in part to insufficient instructions for use and inadequate education of relevant personnel. CONCLUSIONS Additional research is needed regarding the best practices for using different types of wipes, improved methods for educating staff, and establishing the relative efficacy of wipes in reducing environmental contamination and health care-associated infections.
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Gentile D, Allbaugh RA, Adiguzel MC, Kenne DE, Sahin O, Sebbag L. Bacterial Cross-Contamination in a Veterinary Ophthalmology Setting. Front Vet Sci 2020; 7:571503. [PMID: 33426013 PMCID: PMC7785980 DOI: 10.3389/fvets.2020.571503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
The present study describes the prevalence of bacterial cross-contamination in a veterinary ophthalmology setting, a serious issue that can result in healthcare-associated (or nosocomial) infections among patients and staff. Retrospective (n = 5 patients) and prospective (n = 23 patients) studies evaluated bacterial isolates in companion animals presenting with ulcerative keratitis, sampling the patients' cornea and surrounding examination room, including the environment (exam table, countertop, floor) and ophthalmic equipment (slit lamp, transilluminator, direct ophthalmoscope, indirect headset, tonometer). Results of bacterial culture and antibiotic susceptibility testing were recorded, and degree of genetic relatedness was evaluated in six pairs of isolates (cornea + environment or equipment) using pulse-field gel electrophoresis (PFGE). Overall contamination rate of ophthalmic equipment, environment, and examination rooms (equipment + environment) was 42.9% (15/35 samples), 23.7% (9/38 samples) and 32.9% (24/73 samples), respectively. Methicillin-resistant Staphylococcus pseudintermedius (MRSP), a multi-drug resistant (MDR) pathogen with zoonotic potential, was isolated in 8.2% (6/73) of samples. The patient's cornea was likely the source of cross-contamination in 50% (3/6) of MRSP pairs as evaluated by PFGE; notably, two of the three similar bacterial strains did not have an exact match of their antibiotic susceptibility profiles, highlighting the importance of advanced diagnostics such as PFGE to assess cross-contamination in healthcare facilities. Future work could examine the contamination prevalence of specific equipment or the efficacy of cleaning protocols to mitigate cross-contamination in veterinary practice.
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Affiliation(s)
- Dominic Gentile
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Rachel A Allbaugh
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Mehmet C Adiguzel
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States.,Department of Microbiology, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey
| | - Danielle E Kenne
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Orhan Sahin
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Lionel Sebbag
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
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21
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Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf 2020; 30:271-282. [PMID: 33077512 DOI: 10.1136/bmjqs-2019-010740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sterile processing departments (SPDs) play a crucial role in surgical safety and efficiency. SPDs clean instruments to remove contaminants (decontamination), inspect and reorganise instruments into their correct trays (assembly), then sterilise and store instruments for future use (sterilisation and storage). However, broken, missing or inappropriately cleaned instruments are a frequent problem for surgical teams. These issues should be identified and corrected during the assembly phase. OBJECTIVE A work systems analysis, framed within the Systems Engineering Initiative for Patient Safety (SEIPS) model, was used to develop a comprehensive understanding of the assembly stage of reprocessing, identify the range of work challenges and uncover the inter-relationship among system components influencing reliable instrument reprocessing. METHODS The study was conducted at a 700-bed academic hospital in the Southeastern United States with two reprocessing facilities from October 2017 to October 2018. Fifty-six hours of direct observations, 36 interviews were used to iteratively develop the work systems analysis. This included the process map and task analysis developed to describe the assembly system, the abstraction hierarchy developed to identify the possible performance shaping factors (based on SEIPS) and a variance matrix developed to illustrate the relationship among the tasks, performance shaping factors, failures and outcomes. Operating room (OR) reported tray defect data from July 2016 to December 2017 were analysed to identify the percentage and types of defects across reprocessing phases the most common assembly defects. RESULTS The majority of the 3900 tray defects occurred during the assembly phase; impacting 5% of surgical cases (n=41 799). Missing instruments, which could result in OR delays and increased surgical duration, were the most commonly reported assembly defect (17.6%, n=700). High variability was observed in the reassembling of trays with failures including adding incorrect instruments, omitting instruments and failing to remove damaged instrument. These failures were precipitated by technological shortcomings, production pressures, tray composition, unstandardised instrument nomenclature and inadequate SPD staff training. CONCLUSIONS Supporting patient safety, minimising tray defects and OR delays and improving overall reliability of instrument reprocessing require a well-designed instrument tracking system, standardised nomenclature, effective coordination of reprocessing tasks between SPD and the OR and well-trained sterile processing technicians.
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Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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22
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Branch R, Amiri A. Environmental Surface Hygiene in the OR: Strategies for Reducing the Transmission of Health Care-Associated Infections. AORN J 2020; 112:327-342. [PMID: 32990964 DOI: 10.1002/aorn.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Health care-associated infections (HAIs) cost billions of dollars annually in the United States and cause patient morbidity and mortality. There is increasing evidence that environmental surfaces in the OR setting, including anesthesia work areas, can harbor pathogens that can lead to HAIs. Patient-care equipment used routinely in the OR, such as electrocardiograph wires, blood pressure cuffs, pulse oximetry probes, and monitor cables, can become contaminated with pathogens during surgical procedures; without proper cleaning and disinfection between procedures, these items pose a risk for pathogen transmission and subsequent patient infections. This article discusses the association between contaminated surfaces in the OR and the risk for HAIs. It is essential that perioperative nurses, environmental services personnel, anesthesia technicians, and anesthesia professionals properly disinfect environmental surfaces to prevent HAIs.
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23
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Saito W, Shiga K, Bakke M. Comparison of Detection Limits for Allergenic Foods between Total Adenylate (ATP+ADP+AMP) Hygiene Monitoring Test and Several Hygiene Monitoring Approaches. J Food Prot 2020; 83:1155-1162. [PMID: 32221524 DOI: 10.4315/jfp-20-017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022]
Abstract
ABSTRACT Validation and verification of cleaning and inspection methods are essential to prevent the spread of allergens via cross-contact. Among the hygiene monitoring tests used on-site, the ATP test is rapid and provides quantifiable results. Nevertheless, because a wide variety of foods contain significant amount of ADP and/or AMP due to the degradation of ATP, the ATP+ADP+AMP (A3) test is preferred for detecting food debris. Hence, the A3 test may be valuable in screening food debris that may contain residual allergens. In this study, the detection limits of the A3 test for 40 foods that are regulated in several countries as allergenic were compared with those of the other hygiene monitoring tests used on-site: the conventional ATP test with similar sensitivity for ATP, the protein swab test that detects as little as 50 μg of protein, and the lateral flow immunoassay (LFI). The A3 test demonstrated lower detection limits than did the ATP test. The detection sensitivity of the A3 test was greater than that of the protein swab test except for its use on gelatin (extracted protein). The cleaning validation performance using a stainless steel model in fish and meat revealed that the A3 test is efficient in verifying the levels of remaining food debris. Although LFI displayed the best sensitivities for 10 of 14 foods, it is not commercially available for some specific allergens; however, the A3 test can detect such food debris. Moreover, the detection limits of the A3 test were preferable or comparable to those of LFI for crustacean shellfish and for processed grains, with the exception of wheat flour and buckwheat. A field study in a food processing plant demonstrated that the amount of both A3 and milk protein (enzyme-linked immunosorbent assay) considerably decreased as the cleaning steps progressed. Therefore, the A3 test is effective in detecting the risk for allergen cross-contact after inadequate cleaning. HIGHLIGHTS
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Affiliation(s)
- Wataru Saito
- Kikkoman Biochemifa Company, Planning & Development Department, 376-2 Kamihanawa, Noda, Chiba 278-0033 Japan
| | - Kazuki Shiga
- Kikkoman Biochemifa Company, Planning & Development Department, 376-2 Kamihanawa, Noda, Chiba 278-0033 Japan
| | - Mikio Bakke
- Kikkoman Biochemifa Company, Planning & Development Department, 376-2 Kamihanawa, Noda, Chiba 278-0033 Japan
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24
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STANDARD OF INFECTION PREVENTION IN THE GASTROENTEROLOGY SETTING. Gastroenterol Nurs 2020; 43:E84-E97. [PMID: 32251230 DOI: 10.1097/sga.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Mitchell BG, McGhie A, Whiteley G, Farrington A, Hall L, Halton K, White NM. Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial. Infect Dis Health 2020; 25:168-174. [PMID: 32234296 DOI: 10.1016/j.idh.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Environmental cleaning is an important approach to reducing healthcare-associated infection. The aim of this short research paper is to describe changes in the efficacy of post-discharge cleaning by examining the amount of bio-burden on frequent touch points (FTPs) in patient areas, using a validated Adenosine Triphosphate (ATP) bioluminescence sampling method. In so doing, we present findings from a secondary outcome of a recent trial, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study. METHODS The REACH study used a prospective, stepped-wedge randomised cluster design. Cross sectional ATP sampling was conducted at three of the 11 participating hospitals. At each hospital, during the control and intervention phase of the study, six Frequent Touch Points (FTPs) were sampled: toilet flush, bathroom tap, inside bathroom door handle, patient call button, over bed tray table, and bed rails. RESULTS Across the three hospitals, 519 surfaces in 49 rooms (control phase) and 2856 surfaces in 251 rooms (intervention phase) were sampled. Bedroom FTP cleaning improved across all three hospitals. The cleaning of bathroom FTPs was generally high from the outset and remained consistent throughout the whole study period. Average cleaning outcomes for bathroom FTPs were consistently high during the control period however outcomes varied between individual FTP. Changes in cleaning performance over time reflected variation in intervention effectiveness at the hospital level. CONCLUSION Findings confirm improvement in cleaning in the FTPs in bedrooms, demonstrating improvements in discharge cleaning aligned with the improvements seen when using fluorescent marking technology as a marker of performance.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, 2258, Australia.
| | - Alexandra McGhie
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Greg Whiteley
- Whiteley Corporation, North Sydney, NSW, 2060, Australia; Western Sydney University, School of Medicine, Liverpool, NSW, 2010, Australia
| | - Alison Farrington
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia; School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Herston, Qld, 4006, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Nicole M White
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia; School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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26
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Hung IC, Chang HY, Cheng A, Chen MW, Chen AC, Ting L, Lai YH, Wang JT, Chen YC, Sheng WH. Implementation of human factors engineering approach to improve environmental cleaning and disinfection in a medical center. Antimicrob Resist Infect Control 2020; 9:17. [PMID: 31988745 PMCID: PMC6966902 DOI: 10.1186/s13756-020-0677-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Inadequate hospital cleaning may contribute to cross-transmission of pathogens. It is important to implement effective cleaning for the safe hospital environment. We conducted a three-phase study using human factors engineering (HFE) approach to enhance environmental cleanliness. Methods This study was conducted using a prospective interventional trial, and 28 (33.3%) of 84 wards in a medical center were sampled. The three-phases included pre-intervention analysis (Phase 1), implementing interventions by HFE principles (Phase 2), and programmatic analysis (Phase 3). The evaluations of terminal cleaning and disinfection were performed using the fluorescent marker, the adenosine triphosphate bioluminescence assay, and the aerobic colony count method simultaneously in all phases. Effective terminal cleaning and disinfection was qualified with the aggregate outcome of the same 10 high-touch surfaces per room. A score for each high-touch surface was recorded, with 0 denoting a fail and 10 denoting a pass by the benchmark of the evaluation method, and the total terminal cleaning and disinfection score (TCD score) was a score out of 100. Results In each phase, 840 high-touch surfaces were collected from 84 rooms after terminal cleaning and disinfection. After the interventions, the TCD score by the three evaluation methods all showed significant improved. The carriage incidence of multidrug-resistant organism (MDRO) decreased significantly from 4.1 per 1000 patient-days to 3.6 per 1000 patient-days (P = .03). Conclusion The HFE approach can improve the thoroughness and the effectiveness of terminal cleaning and disinfection, and resulted in a reduction of patient carriage of MDRO at hospitals. Larger studies are necessary to establish whether such efforts of cleanliness can reduce the incidence of healthcare-associated infection.
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Affiliation(s)
- I-Chen Hung
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
| | - Hao-Yuan Chang
- 2School of Nursing, National Taiwan University, No.1, Sec. 1, Jen Ai Rd, Taipei City, 100 Taiwan.,3Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Aristine Cheng
- 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Wen Chen
- 3Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - An-Chi Chen
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
| | - Ling Ting
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
| | - Yeur-Hur Lai
- 2School of Nursing, National Taiwan University, No.1, Sec. 1, Jen Ai Rd, Taipei City, 100 Taiwan.,5Department of Nursing, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd, Taipei City, 106 Taiwan
| | - Jann-Tay Wang
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan.,4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee-Chun Chen
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan.,4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,6Department of Medical Education, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
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Sloane PD, Zimmerman S, Nace DA. Progress and Challenges in the Management of Nursing Home Infections. J Am Med Dir Assoc 2020; 21:1-4. [DOI: 10.1016/j.jamda.2019.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 01/08/2023]
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Effect of thermal control of dry fomites on regulating the survival of human pathogenic bacteria responsible for nosocomial infections. PLoS One 2019; 14:e0226952. [PMID: 31881059 PMCID: PMC6934310 DOI: 10.1371/journal.pone.0226952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
We monitored the survival of human pathogenic bacteria [Escherichia coli (ATCC), extended-spectrum β-lactamase-producing E. coli (Clinical isolate), New Delhi metallo-β-lactamase-producing E. coli (clinical isolate), Staphylococcus aureus (ATCC)] on dry materials (vinyl chloride, aluminum, plastic, stainless steel) at distinct temperatures (room temperature or 15°C–37°C). These bacteria favored a lower temperature for their prolonged survival on the dry fomites, regardless of the material type. Interestingly, when mixed with S. aureus, E. coli survived for a longer time at a lower temperature. Cardiolipin, which can promote the survival of S. aureus in harsh environments, had no effect on maintaining the survival of E. coli. Although the trends remained unchanged, adjusting the humidity from 40% to 60% affected the survival of bacteria on dry surfaces. Scanning electron microscopic analysis revealed no morphological differences in these bacteria immediately before or after one day of dry conditions. In addition, ATP assessment, a method used to visualize high-touch surfaces in hospitals, was not effective at monitoring bacterial dynamics. A specialized handrail device fitted with a heater, which was maintained at normal human body core temperature, successfully prohibited the prolonged survival of bacteria [Enterococcus faecalis (ATCC), E. coli (ATCC), Pseudomonas aeruginosa (ATCC), S. aureus (ATCC), Acinetobacter baumannii (clinical isolate), and Serratia marcescens (clinical isolate)], with the exception of spore-forming Bacillus subtilis (from our laboratory collection) and the yeast-like fungus Candida albicans (from our laboratory collection)] on dry surfaces. Taken together, we concluded that the tested bacteria favor lower temperatures for their survival in dry environments. Therefore, the thermal control of dry fomites has the potential to control bacterial survival on high-touch surfaces in hospitals.
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Self-Disinfecting Copper Beds Sustain Terminal Cleaning and Disinfection Effects throughout Patient Care. Appl Environ Microbiol 2019; 86:AEM.01886-19. [PMID: 31704675 DOI: 10.1128/aem.01886-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022] Open
Abstract
Microbial burden associated with near-patient touch surfaces results in a greater risk of health care-associated infections (HAIs). Acute care beds may be a critical fomite, as traditional plastic surfaces harbor the highest concentrations of bacteria associated with high-touch surfaces in a hospital room's patient zone. Five high-touch intensive care unit (ICU) bed surfaces encountered by patients, health care workers, and visitors were monitored by routine culture to assess the effect U.S. Environmental Protection Agency (U.S. EPA)-registered antimicrobial copper materials have on the microbial burden. Despite both daily and discharge cleaning and disinfection, each control bed's plastic surfaces exceeded bacterial concentrations recommended subsequent to terminal cleaning and disinfection (TC&D) of 2.5 aerobic CFU/cm2 Beds with self-disinfecting (copper) surfaces harbored significantly fewer bacteria throughout the patient stay than control beds, at levels below those considered to increase the likelihood of HAIs. With adherence to routine daily and terminal cleaning regimes throughout the study, the copper alloy surfaces neither tarnished nor required additional cleaning or special maintenance. Beds encapsulated with U.S. EPA-registered antimicrobial copper materials were found to sustain the microbial burden below the TC&D risk threshold levels throughout the patient stay, suggesting that outfitting acute care beds with such materials may be an important supplement to controlling the concentration of infectious agents and thereby potentially reducing the overall HAI risk.IMPORTANCE Despite cleaning efforts of environmental service teams and substantial compliance with hand hygiene best practices, the microbial burden in patient care settings often exceeds concentrations at which transfer to patients represents a substantial acquisition risk for health care-associated infections (HAIs). Approaches to limit HAI risk have relied on designing health care equipment and furnishings that are easier to clean and/or the use of no-touch disinfection interventions such as germicidal UV irradiation or vapor deposition of hydrogen peroxide. In a clinical trial evaluating the largest fomite in the patient care setting, the bed, a bed was encapsulated with continuously disinfecting antimicrobial copper surfaces, which reduced the bacteria on surfaces by 94% and sustained the microbial burden below the terminal cleaning and disinfection risk threshold throughout the patient's stay. Such an intervention, which continuously limits microbes on high-touch surfaces, should be studied in a broader range of health care settings to determine its potential long-range efficacy for reducing HAI.
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Influence of Outdoor Living Environment on Elders’ Quality of Life in Old Residential Communities. SUSTAINABILITY 2019. [DOI: 10.3390/su11236638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The population is getting older in Mainland China, which presents a huge challenge of how to support these increasing elders to enjoy a high quality of life (QoL). Due to the limited nursing institutions and Chinese traditional culture, aging in place is the most common choice for elders. Up to now, most elders in cities are living in old residential communities (ORCs) rather than new ones. Poor quality of outdoor living environment (OLE) in these ORCs cannot well support the daily life of the elders, especially for those with physical problems. A questionnaire study was conducted to explore the influence of OLE on the QoL of elders living in ORCs. A total of 107 questionnaires were completed by both elderly residents in ORCs (45.79% were male and 54.21% were female). The data was analyzed by a mix of reliability analysis, correlation analysis, and regression analysis. The results showed that physical health of elders was influenced by distance, safety, greenery, seat, recreational facilities; psychological health was predicted by width, height, and greenery; social relationship was affected by distance, safety, and recreational facilities. Based on the research results, recommendations were proposed to property management service providers and local governments, including providing more seats at a reasonable height, setting handrails alongside the long ramp, installing folding seats along building stairs, and so on.
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Ragusa R, Giorgianni G, Faro G, Lazzara A, Bellia MA, Marranzano M. Are Visitors Dangerous Carriers of Pathogens in The Hospital? an Observational Study in an University Hospital in Sicily. Hosp Top 2019; 97:80-86. [PMID: 31124745 DOI: 10.1080/00185868.2019.1616511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.
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Affiliation(s)
- Rosalia Ragusa
- a Health Technology Assessment Committee, University Hospital "G. Rodolico," Catania , Italy
| | - Gabriele Giorgianni
- b School of Specialization in Hygiene, University of Catania , Catania , Italy
| | - Giuseppina Faro
- c Department of Advanced Medical, Surgical and Advanced Sciences , University of Catania , Catania , Italy
| | - Antonio Lazzara
- d Medical Directorate Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele , Catania , Italy
| | | | - Marina Marranzano
- f Department of Advanced Medical, Surgical and Advanced Sciences , University of Catania , Catania , Italy
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BAKKE M, SUZUKI S, KIRIHARA E, MIKAMI S. Evaluation of the total adenylate (ATP + ADP + AMP) test for cleaning verification in healthcare settings. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E140-E146. [PMID: 31312743 PMCID: PMC6614569 DOI: 10.15167/2421-4248/jpmh2019.60.2.1122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/28/2019] [Indexed: 11/16/2022]
Abstract
Introduction Evaluation of cleaning methods is the first step in the prevention of healthcare-associated infections. ATP hygiene monitoring tests are widely used for assessing the effectiveness of cleaning procedures. The test is easy to use and gives immediate results, however, ATP can be metabolized and degraded to ADP and AMP. Recently, a total adenylate [ATP + ADP + AMP(A3)] monitoring test has been developed. Our objective was to evaluate the usefulness of the A3 test for cleaning verification in healthcare settings. Methods The detection sensitivities of the ATP and the A3 tests were compared using blood, and debris derived from gloved-hand method and endoscopes immediately after endoscopic examination. The performance of the A3 test in monitoring cleanliness of high touch surfaces in the hospital and endoscopes at each cleaning step was also evaluated. Results For the hemolysate, the measurement values of the A3 test were stable, although ATP was promptly degraded. In debris from hands, the amount of A3 was 20 times higher than that of ATP. The detection sensitivities of the A3 test on residues derived from gastroscopes and colonoscopes were 3 and 8 times higher, respectively, than those from the ATP test. A field study indicated that a large number of microorganisms tend to show high A3 values on high touch surfaces in the hospital and on endoscopes. Conclusions The A3 test showed higher detection sensitivities than the conventional ATP test for organic debris associated with healthcare settings.
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Affiliation(s)
- M. BAKKE
- Kikkoman Biochemifa Company, Planning & Development Department, Japan
- Correspondence: Mikio Bakke, Kikkoman Biochemifa Company, Planning & Development Department, 376-2 Kamihanawa, Noda, Chiba 278-0033, Japan - Tel. + 81 471235827 - Fax + 81 471235813 - E-mail:
| | - S. SUZUKI
- Kikkoman Corporation, Research & Development Division, Japan
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Rutala WA, Weber DJ. Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach. Am J Infect Control 2019; 47S:A96-A105. [PMID: 31146858 DOI: 10.1016/j.ajic.2019.01.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.
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Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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Teska PJ, Li X, Gauthier J. Wet contact time directly impacts antimicrobial efficacy of Environmental Protection Agency-registered disinfectants. Am J Infect Control 2019; 47:474-476. [PMID: 30527280 DOI: 10.1016/j.ajic.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
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Assessment of focused multivector ultraviolet disinfection withshadowless delivery using 5-point multisided sampling ofpatientcare equipment without manual-chemical disinfection. Am J Infect Control 2019; 47:409-414. [PMID: 30502110 DOI: 10.1016/j.ajic.2018.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the performance of a focused multivector ultraviolet (FMUV) system employing shadowless delivery with a 90-second disinfection cycle for patient care equipment inside and outside the operating room (OR) suite without manual-chemical disinfection. METHODS A 5-point multisided sampling protocol was utilized to measure the microbial burden on objects inside and outside the OR environment in a 3-phase nonrandomized observational study. Surface sampling was performed pre- and postdisinfection in between cases (IBCs) to assess the performance of manual-chemical disinfection. FMUV system performance was separately assessed pre- and postdisinfection before the first case and IBCs. Additionally, visibly clean high-touch objects were sampled outside the OR, and the microbial burden reductions after FMUV disinfection were quantified without manual-chemical disinfection. RESULTS Manual-chemical disinfection reduced the active microbial burden on sampled objects IBCs by 52.8%-90.9% (P < .05). FMUV reduced the active microbial burden by 92%-97.7% (P < .0001) before the firstcase and IBCs combined, and 96.3%-99.6% (P < .0001) on objects outside the OR without chemical disinfection. CONCLUSIONS Five-point multisided sampling proved effective for assessing disinfection performance on all exterior sides of equipment. FMUV produced significant overall reductions of the microbial burden on patient care equipment in all study phases and independent of manual cleaning and chemical disinfection.
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Albert NM, Bena JF, Ciudad C, Keleekai-Brapoh N, Morrison SL, Rice K, Slifcak E, Runner JC. Contamination of reusable electroencephalography electrodes: A multicenter study. Am J Infect Control 2018; 46:1360-1364. [PMID: 29997036 DOI: 10.1016/j.ajic.2018.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reusable electroencephalography cup electrodes and lead wires (rEEGs-CELWs) could be a source of microorganisms capable of causing hospital-acquired infections. The purpose of this study was to investigate for bacterial species of cleaned rEEGs-CELWs. METHODS This microbiologic evaluation involved 4 epilepsy monitoring units where rEEGs-CELWs were swabbed for bacteria using standard techniques. Analyses involved descriptive statistics and logistic regression (across sites). RESULTS Of 124 swabs, 31 (25.0%; range, 13.3%-43.3%) showed positive bacterial cultures, without between-site differences (P = .17). Bacteria were labeled by risk for hospital-acquired infection: no risk, potential risk (primarily in immunocompromised patients), and at risk (associated with infections and antibiotic resistance). At-risk bacteria species were Staphylococcus epidermidis (38.7%), Staphylococcus capitis subsp ureolyticus (3.2%), and Staphylococcus haemolyticus (9.6%). Potential-risk species were Micrococcus spp (22.6%), Acinetobacter lwoffii (6.5%), Staphylococcus hominis subsp hominis (6.5%), and Staphylococcus warneri (6.5%). Bacillus (9.6%) was the only no-risk species. Of 18 antibiotics tested on positive cultures, resistant bacteria were found in a median of 1 (range, 0-11) positive culture, equating to a 6.7% (range, 0%-61.1%) resistant antibiotic rate; no microorganisms were resistant to all antibiotics tested. CONCLUSIONS Bacteria that were potential risk or at risk for infection were found on 22.6% of cleaned rEEGs-CELWs. Use of single-use electrodes and research on scalp infection and infection reduction interventions are warranted.
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Armellino D, Dowling O, Newman SB, Schwarz RB, Jacobs M, Cifu-Tursellino K, Di Capua JF. Remote Video Auditing to Verify OR Cleaning: A Quality Improvement Project. AORN J 2018; 108:634-642. [PMID: 30480793 DOI: 10.1002/aorn.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There are many sources of contamination in the perioperative environment. Patient experience can be negatively affected by the presence of environmental contamination, especially if it is the cause of a surgical site infection. Perioperative and environmental services staff members and leaders are tasked with ensuring a clean and safe environment for their patients while maintaining an awareness of time and budgetary constraints. In addition, leaders are responsible for the competency of their staff members and must address performance issues when needed. New technological advances designed to streamline monitoring and reporting processes related to OR cleanliness are available for use. This article describes the quality improvement project that one multifacility organization completed related to the use of remote video auditing and the positive effect it had on the organization's environmental contamination.
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Application of a fluorescent marker with quantitative bioburden methods to assess cleanliness. Infect Control Hosp Epidemiol 2018; 39:1296-1300. [PMID: 30221609 DOI: 10.1017/ice.2018.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Improvement of environmental cleaning in hospitals has been shown to decrease in-hospital cross transmission of pathogens. Several objective methods, including aerobic colony counts (ACCs), the adenosine triphosphate (ATP) bioluminescence assay, and the fluorescent marker method have been developed to assess cleanliness. However, the standard interpretation of cleanliness using the fluorescent marker method remains uncertain. OBJECTIVE To assess the fluorescent marker method as a tool for determining the effectiveness of hospital cleaning. DESIGN A prospective survey study. SETTING An academic medical center. METHODS The same 10 high-touch surfaces were tested after each terminal cleaning using (1) the fluorescent marker method, (2) the ATP assay, and (3) the ACC method. Using the fluorescent marker method under study, surfaces were classified as totally clean, partially clean, or not clean. The ACC method was used as the standard for comparison. RESULTS According to the fluorescent marker method, of the 830 high-touch surfaces, 321 surfaces (38.7%) were totally clean (TC group), 84 surfaces (10.1%) were partially clean (PC group), and 425 surfaces (51.2%) were not clean (NC group). The TC group had significantly lower ATP and ACC values (mean ± SD, 428.7 ± 1,180.0 relative light units [RLU] and 15.6 ± 77.3 colony forming units [CFU]/100 cm2) than the PC group (1,386.8 ± 2,434.0 RLU and 34.9 ± 87.2 CFU/100 cm2) and the NC group (1,132.9 ± 2,976.1 RLU and 46.8 ± 119.2 CFU/100 cm2). CONCLUSIONS The fluorescent marker method provided a simple, reliable, and real-time assessment of environmental cleaning in hospitals. Our results indicate that only a surface determined to be totally clean using the fluorescent marker method could be considered clean.
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Design-oriented regression models for H2O2 decontamination processes in sterile drug product manufacturing considering rapidity and sterility. Int J Pharm 2018; 548:466-473. [DOI: 10.1016/j.ijpharm.2018.06.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/06/2018] [Accepted: 06/25/2018] [Indexed: 11/21/2022]
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Antimicrobial activity of a continuous visible light disinfection system. Infect Control Hosp Epidemiol 2018; 39:1250-1253. [PMID: 30160225 DOI: 10.1017/ice.2018.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated the ability of high-intensity visible violet light with a peak output of 405 nm to kill epidemiologically important pathogens. The high irradiant light significantly reduced both vegetative bacteria and spores at some time points over a 72-hour exposure period.
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Enhanced disinfection leads to reduction of microbial contamination and a decrease in patient colonization and infection. Infect Control Hosp Epidemiol 2018; 39:1118-1121. [PMID: 30060770 DOI: 10.1017/ice.2018.165] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this prospective study, we monitored 4 epidemiologically important pathogens (EIPs): methicillin-resistane Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant (MDR) Acinetobacter to assess the effectiveness of 3 enhanced disinfection strategies for terminal room disinfection against standard practice. Our data demonstrated that a decrease in room contamination with EIPs of 94% was associated with a 35% decrease in subsequent patient colonization and/or infection.
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Kanamori H, Rutala WA, Weber DJ. The Role of Patient Care Items as a Fomite in Healthcare-Associated Outbreaks and Infection Prevention. Clin Infect Dis 2018; 65:1412-1419. [PMID: 28520859 DOI: 10.1093/cid/cix462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/11/2017] [Indexed: 01/28/2023] Open
Abstract
Patient-care items can serve as a source or reservoir for healthcare-associated pathogens in hospitals. We reviewed healthcare- associated outbreaks from medical equipment and provide infection prevention recommendations. Multiple healthcare-associated outbreaks via a contaminated patient-care item were identified, including infections with multidrug-resistant organisms. The type of patient care items implicated as a fomite causing healthcare-associated infections (HAIs) has changed over time. Patient populations at risk were most commonly critically ill patients in adult and neonatal intensive care units. Most fomite related healthcare-associated outbreaks were due to inappropriate disinfection practices. Repeated healthcare-associated outbreaks via medical equipment highlight the need for infectious disease professionals to understand that fomites/medical devices may be a source of HAIs. The introduction of new and more complex medical devices will likely increase the risk that such devices serve as a source of HAIs. Assuring appropriate cleaning and disinfection or sterilization of medical equipment is necessary to prevent future fomite-associated outbreaks.
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Affiliation(s)
- Hajime Kanamori
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
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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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Abstract
Isopropyl alcohol and ethyl alcohol have been used as low-level disinfectants in healthcare settings for many years. Recent studies have found that ethyl alcohol inhibits protein synthesis in Escherichia coli by direct effects on ribosomes and RNA polymerase and that 60%-70% solutions have in vitro efficacy against murine norovirus, Ebola virus, and several coronaviruses. Alcohol prep pads or towelettes containing isopropyl or ethyl alcohol and water have been used primarily for disinfection of small noncritical items due to a concern regarding their rapid evaporation rates and associated short contact times. Sterile alcohol solutions are used mostly for disinfection of compounding pharmacies and controlled areas. One new Environmental Protection Agency (EPA)-registered cleaner/disinfectant formulation differs from other alcohol-based disinfectants by virtue of having a 30-second contact time for multiple pathogens and a toxicity rating of category IV. Multiple disinfectants containing ethyl alcohol and/or isopropyl alcohol combined with other active agents such as quaternary ammonium or phenolic compounds are widely used for disinfecting environmental surfaces in healthcare facilities. Infect Control Hosp Epidemiol 2018;39:323-328.
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Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment. AORN J 2017; 106:494-501. [DOI: 10.1016/j.aorn.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/17/2022]
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Kriegel J, Tuttle-Weidinger L, Schiefer L, Schwarz S. Management of support processes in Austrian hospitals: Integrated network of primary care processes and support processes. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1343759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johannes Kriegel
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Linda Tuttle-Weidinger
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Lisa Schiefer
- Department of Anesthesiology and Perioperative Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Stefan Schwarz
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
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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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Estillore AD, Trueblood JV, Grassian VH. Atmospheric chemistry of bioaerosols: heterogeneous and multiphase reactions with atmospheric oxidants and other trace gases. Chem Sci 2016; 7:6604-6616. [PMID: 28567251 PMCID: PMC5450524 DOI: 10.1039/c6sc02353c] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/17/2016] [Indexed: 12/20/2022] Open
Abstract
Once airborne, biologically-derived aerosol particles are prone to reaction with various atmospheric oxidants such as OH, NO3, and O3.
Advances in analytical techniques and instrumentation have now established methods for detecting, quantifying, and identifying the chemical and microbial constituents of particulate matter in the atmosphere. For example, recent cryo-TEM studies of sea spray have identified whole bacteria and viruses ejected from ocean seawater into air. A focal point of this perspective is directed towards the reactivity of aerosol particles of biological origin with oxidants (OH, NO3, and O3) present in the atmosphere. Complementary information on the reactivity of aerosol particles is obtained from field investigations and laboratory studies. Laboratory studies of different types of biologically-derived particles offer important information related to their impacts on the local and global environment. These studies can also unravel a range of different chemistries and reactivity afforded by the complexity and diversity of the chemical make-up of these particles. Laboratory experiments as the ones reviewed herein can elucidate the chemistry of biological aerosols.
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Affiliation(s)
- Armando D Estillore
- Department of Chemistry & Biochemistry , University of California San Diego , La Jolla , California 92093 , USA . ; ; Tel: +1-858-534-2499
| | - Jonathan V Trueblood
- Department of Chemistry & Biochemistry , University of California San Diego , La Jolla , California 92093 , USA . ; ; Tel: +1-858-534-2499
| | - Vicki H Grassian
- Department of Chemistry & Biochemistry , University of California San Diego , La Jolla , California 92093 , USA . ; ; Tel: +1-858-534-2499.,Scripps Institution of Oceanography and Department of Nanoengineering , University of California San Diego , La Jolla , California 92093 , USA
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