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Xie A, Sax H, Daodu O, Alam L, Sultan M, Rock C, Stewart CM, Perry SJ, Gurses AP. Environmental cleaning and disinfection in the operating room: a systematic scoping review through a human factors and systems engineering lens. Infect Control Hosp Epidemiol 2024; 45:880-889. [PMID: 38477015 DOI: 10.1017/ice.2023.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To synthesize evidence and identify gaps in the literature on environmental cleaning and disinfection in the operating room based on a human factors and systems engineering approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model. DESIGN A systematic scoping review. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 4 databases (ie, PubMed, EMBASE, OVID, CINAHL) for empirical studies on operating-room cleaning and disinfection. Studies were categorized based on their objectives and designs and were coded using the SEIPS model. The quality of randomized controlled trials and quasi-experimental studies with a nonequivalent groups design was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. RESULTS In total, 40 studies were reviewed and categorized into 3 groups: observational studies examining the effectiveness of operating-room cleaning and disinfections (11 studies), observational study assessing compliance with operating-room cleaning and disinfection (1 study), and interventional studies to improve operating-room cleaning and disinfection (28 studies). The SEIPS-based analysis only identified 3 observational studies examining individual work-system components influencing the effectiveness of operating-room cleaning and disinfection. Furthermore, most interventional studies addressed single work-system components, including tools and technologies (20 studies), tasks (3 studies), and organization (3 studies). Only 2 studies implemented interventions targeting multiple work-system components. CONCLUSIONS The existing literature shows suboptimal compliance and inconsistent effectiveness of operating-room cleaning and disinfection. Improvement efforts have been largely focused on cleaning and disinfection tools and technologies and staff monitoring and training. Future research is needed (1) to systematically examine work-system factors influencing operating-room cleaning and disinfection and (2) to redesign the entire work system to optimize operating-room cleaning and disinfection.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugo Sax
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Oluseyi Daodu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Lamia Alam
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Marium Sultan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Clare Rock
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shawna J Perry
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Department of Emergency Medicine, University of Florida, Jacksonville Medical Center, Jacksonville, Florida, United States
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Johns Hopkins Whiting School of Engineering Malone Center for Engineering in Healthcare, Baltimore, Maryland, United States
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Fickenscher MC, Stewart M, Helber R, Quilligan EJ, Kreitenberg A, Prietto CA, Gardner VO. Operating room disinfection: operator-driven ultraviolet 'C' vs. chemical treatment. Infect Prev Pract 2023; 5:100301. [PMID: 37575675 PMCID: PMC10412461 DOI: 10.1016/j.infpip.2023.100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background In operating room (OR) surfaces, Nosocomial pathogens can persist on inanimate surfaces for long intervals and are highly resistant to traditional surface cleaning. Aim This study compares traditional chemical operating room terminal disinfection to a unique operator-driven device that emits germicidal UV light at short distance onto vertical and horizontal surfaces. Methods A randomized crossover analogous protocol assigned 40 end-of-day operating rooms into either group A (chemical then UVC treatments) or group B (UVC then chemical treatments). Initial Staphylococcal cultures were obtained prior to disinfection treatment, after the first treatment, and after the second treatment at 16 most commonly contaminated sites to represent overall room contamination. Success was defined as no growth and failure as 1 or more colony forming units. Thoroughness of chemical treatment vs UVC treatment was compared and used to determine if the second treatment was additive to the first treatment within each group. Findings The operator driven UVC device outperformed chemical treatment in reducing the number of contaminated sites in the OR by more than half (P<0.001). Operator-driven UVC reduced contaminated sites after chemical treatment by nearly half (P<0.001). In contrast, chemical treatment after operator-driven UVC did not significantly reduce the number of contaminated sites. The mean employee time of disinfection for chemical treatment was 49 minutes and for the operator-driven UVC emitter 7.9 minutes (P<0.001). Conclusions This study demonstrates that addition of an operator-driven UVC emitter to OR rooms between cases could be helpful in overall decreasing the number of contaminated sites.
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Affiliation(s)
| | - Madeline Stewart
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Ryan Helber
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Edward J. Quilligan
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Arthur Kreitenberg
- Department of Orthopedic Surgery, Center for Orthopedic & Sports Excellence, Los Angeles, CA, United States
| | - Carlos A. Prietto
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Vance O. Gardner
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
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Jennings JM, Johnson RM, Brady AC, Stuckey WP, Pollet AK, Dennis DA. Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field. Arthroplast Today 2022; 17:53-57. [PMID: 36032796 PMCID: PMC9399380 DOI: 10.1016/j.artd.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Periprosthetic joint infection may result from pathogen to patient transmission within the environment. The purpose of this study is to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean. Methods Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as “clean” (>75%), “partially clean” (26%-74%), or poorly cleaned (<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study. Results A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P < .001. Only the OR back table (75%) had a rating of clean. Partially clean areas included Mayfield table (72%), overhead lights (70.1%), infusion pump (61.1%), clock reset button (58.3%), table remote control (50%), tourniquet machine (50%), and the OR table (33.3%). Poorly cleaned surfaces included anesthesia medication cart (21.8%), door handles (20.8%), phone (16.7%), electrocautery unit (16.7%), foot pedal (16.7%), anesthesia cart (16.2%), nurses’ station (14.1%), and supply cabinet doors (6%). Conclusions Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed.
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Affiliation(s)
- Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Corresponding author. Colorado Joint Replacement, 2535 S. Downing St Suite 100, Denver, CO 80210, USA. Tel.: +1 720 524 1367.
| | | | | | | | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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4
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Influence of a visible-light continuous environmental disinfection system on microbial contamination and surgical site infections in an orthopedic operating room. Am J Infect Control 2019; 47:804-810. [PMID: 30638672 DOI: 10.1016/j.ajic.2018.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND A growing body of research has demonstrated that manual cleaning and disinfection of the operating room (OR) is suboptimal. Residual environmental contamination may pose an infection risk to the surgical wound. This study evaluates the impact of a visible-light continuous environmental disinfection (CED) system on microbial surface contamination and surgical site infections (SSI) in an OR. METHODS Samples from 25 surfaces within 2 contiguous ORs sharing an air supply were obtained after manual cleaning on multiple days before and after a visible-light CED system installation in 1 of the ORs. Samples were incubated and enumerated as total colony-forming units. SSIs in both ORs, and a distant OR, were tracked for 1 year prior to and 1 year after the visible-light CED system installation. RESULTS There was an 81% (P = .017) and 49% (P = .015) reduction in total colony-forming units after the visible-light CED system installation in the OR in which the system was installed, and in the contiguous OR, respectively. In the OR with the visible-light CED system, SSIs decreased from 1.4% in the year prior to installation to 0.4% following installation (P = .029). CONCLUSIONS A visible-light CED system, used in conjunction with manual cleaning, resulted in significant reductions in both microbial surface contamination and SSIs in the OR.
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Xie A, Rock C, Hsu YJ, Osei P, Andonian J, Scheeler V, Keller SC, Cosgrove SE, Gurses AP. Improving daily patient room cleaning: an observational study using a human factors and systems engineering approach. IISE Trans Occup Ergon Hum Factors 2018; 6:178-191. [PMID: 31555756 DOI: 10.1080/24725838.2018.1487348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background While playing a critical role in preventing healthcare-associated infections, patient room cleaning is often unsatisfactorily performed. To improve patient room cleaning, a human factors and systems engineering (HFSE) approach is needed to understand the complex cleaning process and associated work system factors. Purpose We conducted an observational study to assess the performance of environmental care (EVC) associates during daily patient room cleaning and identify work system factors influencing their performance. Methods This study was conducted in eight adult medicine inpatient units at a large urban academic medical center. An HFSE researcher shadowed 10 day-shift EVC associates performing daily patient room cleanings and used a semi-structured observation form to collect quantitative data (e.g., duration of room cleaning, orders for surface cleaning) and qualitative data (e.g., challenges to patient room cleaning). Descriptive statistics (e.g., median, interquartile range) were reported for cleaning performance, and bivariate and regression analyses were conducted to identify factors influencing cleaning performance. We also performed link analyses of the workflow of EVC associates and qualitative analyses of observer notes to identify challenges to daily patient room cleaning. Results We observed 89 patient room cleanings. Median duration of cleaning a room was 14 minutes, and median percentage of surfaces cleaned in a room was 63%. High-touch surfaces that were frequently missed during daily cleaning included the bedrails, telephone, patient and visitor chairs, and cabinet. Work system factors that could influence cleaning performance included the type of unit, the presence of the patient and family members in the room, cleaning patterns and orders of EVC associates, and interruptions EVC associates encountered while cleaning. Conclusions Daily patient room cleaning was influenced by a number of work system factors. To improve daily patient room cleaning, multifaceted interventions are needed to address these system-level factors.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clare Rock
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.,Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
| | - Yea-Jen Hsu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Patience Osei
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Andonian
- Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
| | - Verna Scheeler
- Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sara C Keller
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sara E Cosgrove
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.,Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,The Malone Center for Engineering in Health Care, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD.,Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD.,Civil Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
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6
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DeBaun B. Looking Forward-Infection Prevention in 2017. AORN J 2017; 104:531-535. [PMID: 27890059 DOI: 10.1016/j.aorn.2016.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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Spencer M, Vignari M, Bryce E, Johnson HB, Fauerbach L, Graham D. A model for choosing an automated ultraviolet-C disinfection system and building a case for the C-suite: Two case reports. Am J Infect Control 2017; 45:288-292. [PMID: 28024852 DOI: 10.1016/j.ajic.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022]
Abstract
Environmental disinfection has become the new frontier in the ongoing battle to reduce the risk of health care-associated infections. Evidence demonstrating the persistent contamination of environmental surfaces despite traditional cleaning and disinfection methods has led to the widespread acceptance that there is both a need for reassessing traditional cleaning protocols and for using secondary disinfection technologies. Ultraviolet-C (UV-C) disinfection is one type of no-touch technology shown to be a successful adjunct to manual cleaning in reducing environmental bioburden. The dilemma for the infection preventionist, however, is how to choose the system best suited for their facility among the many UV-C surface disinfection delivery systems available and how to build a case for acquisition to present to the hospital administration/C-suite. This article proposes an approach to these dilemmas based in part on the experience of 2 health care networks.
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Affiliation(s)
| | - Michelle Vignari
- Thompson Health and the University of Rochester Medical Center, Rochester, NY
| | - Elizabeth Bryce
- Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Denise Graham
- Public health and government relations consultant, Marietta, GA
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8
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Role of Ultraviolet Disinfection in the Prevention of Surgical Site Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:255-266. [DOI: 10.1007/978-3-319-56017-5_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Determining high touch areas in the operating room with levels of contamination. Am J Infect Control 2016; 44:1350-1355. [PMID: 27160980 DOI: 10.1016/j.ajic.2016.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. METHODS Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. RESULTS The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. CONCLUSIONS Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room.
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Goebel U, Gebele N, Ebner W, Dettenkofer M, Bürkle H, Hauschke D, Schulz-Stübner S. Bacterial Contamination of the Anesthesia Workplace and Efficiency of Routine Cleaning Procedures. Anesth Analg 2016; 122:1444-7. [DOI: 10.1213/ane.0000000000001220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yezli S, Barbut F, Otter JA. Surface contamination in operating rooms: a risk for transmission of pathogens? Surg Infect (Larchmt) 2015; 15:694-9. [PMID: 25317716 DOI: 10.1089/sur.2014.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of surface contamination in the transmission of nosocomial pathogens is recognized increasingly. For more than 100 years, the inanimate environment in operating rooms (e.g., walls, tables, floors, and equipment surfaces) has been considered a potential source of pathogens that may cause surgical site infections (SSIs). However, the role of contaminated surfaces in pathogen acquisition in this setting generally is considered negligible, as most SSIs are believed to originate from patients' or healthcare workers' flora. METHODS A search of relevant medical literature was performed using PubMed to identify studies that investigated surface contamination of operating rooms and its possible role in infection transmission. RESULTS Despite a limited number of studies evaluating the role of surface contamination in operating rooms, there is accumulating evidence that the inanimate environment of the operating room can become contaminated with pathogens despite standard environmental cleaning. These pathogens can then be transmitted to the hands of personnel and then to patients and may result in SSIs and infection outbreaks. CONCLUSION Contaminated surfaces can be responsible for the transmission of pathogens in the operating room setting. Further studies are necessary to quantify the role of contaminated surfaces in the transmission of pathogens and to inform the most effective environmental interventions. Given the serious consequences of SSIs, special attention should be given to the proper cleaning and disinfection of the inanimate environment in operating rooms in addition to the other established infection control measures to reduce the burden of SSIs.
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Affiliation(s)
- Saber Yezli
- 1 Bioquell (UK) Ltd ., Andover, Hampshire, United Kingdom
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12
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Sipes C, Baker JD. Technology in the OR: AORN Members' Perceptions of the Effects on Workflow Efficiency and Quality Patient Care. AORN J 2015; 102:289.e1-19. [PMID: 26323230 DOI: 10.1016/j.aorn.2015.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 05/05/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Abstract
This collaborative study sought to describe technology used by AORN members at work, inclusive of radio-frequency identification or barcode scanning (RFID), data collection tools (DATA), workflow or dashboard management tools (DASHBOARD), and environmental services/room decontamination technologies (ENVIRON), and to identify the perceived effects of each technology on workflow efficiency (WFE) and quality patient care (QPC). The 462 respondents to the AORN Technology in the OR survey reported use of technology (USE) in all categories. Eleven of 17 RFID items had a strong positive correlation between the designated USE item and the perceived effect on WFE and QPC. Five of the most-used technology items were found in the DATA category. Two of the five related to Intraoperative Nursing Documentation and the use of the Perioperative Nursing Data Set. The other three related to Imaging Integration for Radiology Equipment, Video Camera Systems, and Fiber-optic Systems. All three elements explored in the DASHBOARD category (ie, Patient Update, OR Case, OR Efficiency) demonstrated approximately 50% or greater perceived effectiveness in WFE and QPC. There was a low reported use of ENVIRON technologies, resulting in limited WFE and QPC data for this category.
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Hefzy EM, Wegdan AA, Abdel Wahed WY. Hospital outpatient clinics as a potential hazard for healthcare associated infections. J Infect Public Health 2015; 9:88-97. [PMID: 26264392 DOI: 10.1016/j.jiph.2015.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/21/2015] [Accepted: 06/23/2015] [Indexed: 11/17/2022] Open
Abstract
Healthcare acquired infections are no longer confined to the hospital environment. Recently, many reported outbreaks have been linked to outpatient settings and attributed to non-adherence to recommended infection-prevention procedures. This study was divided into two parts: The first is a descriptive cross-sectional part, to assess the healthcare personnel's knowledge and compliance with Standard Precautions (SP). The second is an intervention part to assess the role of health education on reducing the level of environmental and reusable medical equipment bacterial contamination. Assessment of the doctors' and nurses' knowledge and compliance with SP was performed using a self-administered questionnaire. Assessment of environmental cleaning (EC) and reusable medical equipment disinfection has been performed using aseptic swabbing method. The extent of any growth was recorded according to the suggested standards: (A) Presence of indicator organisms, with the proposed standard being <1cfu/cm(2). These include Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus, MRSA), Enterococci, including vancomycin-resistant Enterococci (VRE) and various multidrug-resistant Gram-negative bacilli. (B) Aerobic colony count, the suggested standard is <5cfu/cm(2). The effect of health education intervention on cleaning and disinfection had been analyzed by comparing the difference in cleaning level before and after interventional education. Good knowledge and compliance scores were found in more than 50% of participants. Primary screening found poor EC and equipment disinfection as 67% and 83.3% of stethoscopes and ultrasound transducers, respectively, were contaminated with indicator organisms. For all indicator organisms, a significant reduction was detected after intervention (p=0.00). Prevalence of MRSA was 38.9% and 16.7%, of the total S. aureus isolates, before and after intervention, respectively. Although 27.8% of the total Enterococcus isolates were VRE before intervention, no VRE isolates were detected after intervention. These differences were significant. Development and monitoring of the implementation of infection prevention policies and training of HCP is recommended.
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Affiliation(s)
- Enas M Hefzy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | - Ahmed A Wegdan
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Wafaa Y Abdel Wahed
- Department of Public Health and Community Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Relationships among cleaning, environmental DNA, and healthcare-associated infections in a new evidence-based design hospital. Infect Control Hosp Epidemiol 2015; 36:1130-8. [PMID: 26152338 DOI: 10.1017/ice.2015.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Hospital environments influence healthcare-associated infection (HAI) patterns, but the role of evidenced-based design (EBD) and residual bacterial DNA (previously thought to be clinically inert) remain incompletely understood. METHODS In a newly built EBD hospital, we used culture-based and culture-free (molecular) assays, pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) to determine: (1) patterns of environmental contamination with target organisms (TOs) and multidrug-resistant (MDR) target organisms (MDR-TOs); (2) genetic relatedness between environmentally isolated MDR-TO and those from HAIs; and (3) correlation between surface contamination and HAIs. RESULTS A total of 1,273 high-touch surfaces were swabbed before and after terminal cleaning during 77 room visits. Of the 2,546 paired swabs, 47% had cultivable biomaterial and 42% had PCR-amplifiable DNA. The ratios of TOs detected to surfaces assayed were 85 per 1,273 for the culture-based method and 106 per 1,273 for the PCR-based method. Sinks, toilet rails, and bedside tables most frequently harbored biomaterial. Although cleaned surfaces were less likely to have cultivable TOs than precleaned surfaces, they were not less likely to harbor bacterial DNA. The rate of MDR-TOs to surfaces swabbed was 0.1% (3/2546). Although environmental MDR-TOs and MDR-TOs from HAIs were genetically related by PFGE, WGS revealed that they were unrelated. Environmental levels of cultivable Enterococcus spp. and E. coli DNA were positively correlated with infection incidences (P<.04 and P<.005, respectively). CONCLUSION MDR-TOs were rarely detected during surveillance and were not implicated in HAIs. The roles of environmental DNA and EBD, particularly with respect to water-associated fixtures or the potential suppression of cultivable environmental MDR-TOs, warrant multicenter investigations.
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Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Munoz-Price LS. The Use of a Novel Technology to Study Dynamics of Pathogen Transmission in the Operating Room. Anesth Analg 2015; 120:844-7. [DOI: 10.1213/ane.0000000000000226] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Munoz-Price LS, Fajardo-Aquino Y, Arheart KL. Ultraviolet Powder versus Ultraviolet Gel for Assessing Environmental Cleaning. Infect Control Hosp Epidemiol 2015; 33:192-5. [DOI: 10.1086/663713] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We compared cleaning rates associated with use of a white ultraviolet (UV) powder versus a transparent UV gel among units with various degrees of previous experience with UV powder. The study outcome was the presence of discordant cleaning (removal of powder without the removal of gel, or vice versa). We found higher frequency of discordance in high-experience units (31%) than in no-experience units (8%) (P<.001). In 92% of discordant findings, the powder was removed but not the gel (P< .001). These findings suggest preferential cleaning of visible UV targets among units with high levels of previous experience with powder.Infect Control Hosp Epidemiol 2012;33(2):192-195
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Munoz-Price LS, Birnbach DJ, Lubarsky DA, Arheart KL, Fajardo-Aquino Y, Rosalsky M, Cleary T, DePascale D, Coro G, Namias N, Carling P. Decreasing Operating Room Environmental Pathogen Contamination through Improved Cleaning Practice. Infect Control Hosp Epidemiol 2015; 33:897-904. [DOI: 10.1086/667381] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective.Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the proportion of environmental surfaces within operating rooms from which pathogenic organisms were recovered.Design.Prospective environmental study using feedback with UV markers and environmental cultures.Setting.A 1,500-bed county teaching hospital.Participants.Environmental service personnel, hospital administration, and medical and nursing leadershipResults.The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95% confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last month of observations (P < .0001). Nevertheless, the percentage of samples from which pathogenic organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of surfaces during the follow-up period (P = .998). However, the percentage of surfaces from which gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period (P = .015).Conclusions.Feedback using Gram staining of environmental cultures and UV markers was successful at improving the degree of cleaning in our operating rooms.
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Spencer M, Edmiston CE. The Role of the OR Environment in Preventing Surgical Site Infections. AORN J 2014; 100:603-8. [DOI: 10.1016/j.aorn.2014.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/16/2014] [Indexed: 11/17/2022]
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Munoz-Price LS, Riley B, Banks S, Eber S, Arheart K, Lubarsky DA, Birnbach DJ. Frequency of interactions and hand disinfections among anesthesiologists while providing anesthesia care in the operating room: induction versus maintenance. Infect Control Hosp Epidemiol 2014; 35:1056-9. [PMID: 25026624 DOI: 10.1086/677154] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We evaluated the behaviors of anesthesiologists during induction and maintenance of anesthesia. Contacts with surfaces occurred a mean (±standard error) of 154.8 ± 7.7 and 60 ± 3.1 times per hour during induction and maintenance, respectively (P < .0001). Hand hygiene events were 1.8 ± 0.27 per hour during induction versus 1.19 ± 0.27 during maintenance (P = .018).
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Affiliation(s)
- L Silvia Munoz-Price
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Ramphal L, Suzuki S, McCracken IM, Addai A. Improving hospital staff compliance with environmental cleaning behavior. Proc AMIA Symp 2014; 27:88-91. [PMID: 24688183 PMCID: PMC3954653 DOI: 10.1080/08998280.2014.11929065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Reducing the incidence of healthcare-associated infections requires proper environmental cleanliness of frequently touched objects within the hospital environment. An intervention was launched in June 2012 and repeated in February 2013 and August 2013 to increase hospital room cleanliness with repeated education and training of nursing and environmental services staff to reduce healthcare-associated infections at Cook Children's Medical Center. Random rooms were tested, staff were trained about proper cleaning, rooms were retested for surface cleanliness, and preintervention and postintervention values were compared. The percentage of cleaned surfaces improved incrementally between the three trials-with values of 20%, 49%, and 82% showing that repeat training favorably changed behavior in the staff (P = 0.007). During the study period, during which other infection control interventions were also introduced, there was a decline from 0.27 to 0.21 per 1000 patient days for Clostridium difficile infection, 0.43 to 0.21 per 1000 patient days for ventilator-associated infections, 1.8% to 1.2% for surgical site infections, and 1.2 to 0.7 per 1000 central venous line days for central line-associated bloodstream infections.
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Affiliation(s)
- Lilly Ramphal
- Cook Children's Hospital, Fort Worth, Texas (Ramphal); and the Departments of Environmental Health (Ramphal, Addai) and Biostatistics (Suzuki, McCracken), the University of North Texas School of Public Health. Dr. Ramphal is now with Blue Cross Blue Shield
| | - Sumhiro Suzuki
- Cook Children's Hospital, Fort Worth, Texas (Ramphal); and the Departments of Environmental Health (Ramphal, Addai) and Biostatistics (Suzuki, McCracken), the University of North Texas School of Public Health. Dr. Ramphal is now with Blue Cross Blue Shield
| | - Izah Mercy McCracken
- Cook Children's Hospital, Fort Worth, Texas (Ramphal); and the Departments of Environmental Health (Ramphal, Addai) and Biostatistics (Suzuki, McCracken), the University of North Texas School of Public Health. Dr. Ramphal is now with Blue Cross Blue Shield
| | - Amanda Addai
- Cook Children's Hospital, Fort Worth, Texas (Ramphal); and the Departments of Environmental Health (Ramphal, Addai) and Biostatistics (Suzuki, McCracken), the University of North Texas School of Public Health. Dr. Ramphal is now with Blue Cross Blue Shield
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Munoz-Price LS, Lubarsky DA, Arheart KL, Prado G, Cleary T, Fajardo-Aquino Y, Depascale D, Eber S, Carling P, Birnbach DJ. Interactions between anesthesiologists and the environment while providing anesthesia care in the operating room. Am J Infect Control 2013; 41:922-4. [PMID: 24074540 DOI: 10.1016/j.ajic.2013.03.306] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
We describe 1,132 contacts between anesthesiologists and the operating room. Objects most commonly touched included anesthesia machines and keyboards. Only 13 hand hygiene events were witnessed during 8 hours of observations. Line insertions, bronchoscopies, or blood exposures were not followed by hand hygiene. Stopcocks were accessed 66 times and only disinfected on 10 (15%) of these occasions.
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Affiliation(s)
- L Silvia Munoz-Price
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL; Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, FL; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL; Jackson Memorial Hospital, Miami, FL.
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Yavuz SŞ, Tarçın O, Ada S, Dinçer F, Toraman S, Birbudak S, Eren E, Yekeler I. Incidence, aetiology, and control of sternal surgical site infections. J Hosp Infect 2013; 85:206-12. [PMID: 24035582 DOI: 10.1016/j.jhin.2013.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/22/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Since sternal surgical site infections (SSIs) can be life-threatening, every effort should be made to reduce their rate of occurrence. AIM To measure the rate of sternal SSIs after open heart surgery and to define the efficacy of infection control interventions in reducing this rate. METHODS Surveillance of sternal SSIs was carried out prospectively for adult patients who underwent sternotomy between 2005 and 2012. Infection control interventions that were undertaken during the study period at different time intervals were prophylaxis with cefazolin or vancomycin, surveillance of sternal SSIs and feedback, preoperative nasal Staphylococcus aureus screening and decolonization with mupirocin, isolation of patients infected with or colonized by meticillin-resistant S. aureus, appropriate management of perioperative blood glucose level and chlorhexidine/alcohol usage for skin antisepsis. FINDINGS There were 479 sternal SSIs in 18,460 patients during the study period (2.59%). The most frequent causes of sternal SSIs were coagulase-negative staphylococci (CoNS) (36%) and S. aureus (31%). Infection control interventions reduced the rate of sternal SSIs from 3.63% in 2005 to 1.65% in 2012 (P < 0.0001). CONCLUSION Our study shows that the rate of sternal SSIs can be decreased with proper infection control interventions. However, the interventions that were undertaken were effective only in reducing the rate of sternal SSIs caused by S. aureus. It is time to find interventions to control sternal SSIs caused by CoNS, the pathogen responsible for most sternal SSIs in hospitals where S. aureus SSIs are successfully controlled.
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Affiliation(s)
- S Ş Yavuz
- Infection Control Committee, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey.
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Vande Leest L, Kawczynski R, Esser Lipp F, Barrientos R. Identifying potential areas of infectivity on high-touch locations in the OR. AORN J 2013; 96:507-12. [PMID: 23107031 DOI: 10.1016/j.aorn.2012.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 08/19/2011] [Accepted: 07/20/2012] [Indexed: 11/25/2022]
Abstract
Personnel at an ambulatory surgery center in Franklin, Wisconsin, used the nationwide emphasis on minimizing health care-associated infections as the impetus to set up an investigation to determine the effectiveness of cleaning procedures for the OR and stationary OR equipment. During the course of one week, we examined areas that we considered to be high touch (ie, with the greatest frequency of multiple hand contacts) for effective cleaning and decontamination in one OR by using a commercial cleaning verification system commonly used in the food service industry and standard culture methods. As a result of this project, we determined that the cleaning and disinfection at our facility was effective. In the process, we gained insight into the dynamics of the cleaning procedure under actual conditions. This project reports a simple method of maintaining or improving cleaning protocols in a cost-effective manner.
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