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Chen Z, Yang Y, Li G, Huang Y, Luo Y, Le S. Effective elimination of bacteria on hard surfaces by the combined use of bacteriophages and chemical disinfectants. Microbiol Spectr 2024; 12:e0379723. [PMID: 38483478 PMCID: PMC10986474 DOI: 10.1128/spectrum.03797-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024] Open
Abstract
Hospital-acquired infections (HAIs) represent one of the significant causes of morbidity and mortality worldwide, and controlling pathogens in the hospital environment is of great importance. Currently, the standard disinfection method in the hospital environment is chemical disinfection. However, disinfectants are usually not used strictly according to the label, making them less effective in disinfection. Therefore, there is an emergent need to find a better approach that can be used in hospitals to control pathogenic bacteria in the clinical environment. Bacteriophages (phages) are effective in killing bacteria and have been applied in the treatment of bacterial infections but have not received enough attention regarding the control of contamination in the clinical environment. In this study, we found that various phages remain active in the presence of chemical disinfectants. Moreover, the combined use of specific phages and chemical disinfectants is more effective in removing bacterial biofilms and eliminating bacteria on hard surfaces. Thus, this proof-of-concept study indicates that adding phages directly to chemical disinfectants might be an effective and economical approach to enhance clinical environment disinfection. IMPORTANCE In this study, we investigated whether the combination of bacteriophages and chemical disinfectants can enhance the efficacy of reducing bacterial contamination on hard surfaces in the clinical setting. We found that specific phages are active in chemical disinfectants and that the combined use of phages and chemical disinfectants was highly effective in reducing bacterial presence on hard surfaces. As a proof-of-concept, we demonstrated that adding specific phages directly to chemical disinfectants is an effective and cost-efficient strategy for clinical environment disinfection.
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Affiliation(s)
- Zongyue Chen
- School of Nursing, Army Medical University, Chongqing, China
| | - Yuhui Yang
- School of Nursing, Army Medical University, Chongqing, China
| | - Gaoming Li
- Disease Surveillance Division, Center for Disease Control and Prevention of Central Theater Command, Shijingshan, Beijing, China
| | - Youying Huang
- Biomedical Analysis Center, College of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, Army Medical University, Chongqing, China
| | - Shuai Le
- Department of Microbiology, College of Basic Medical Sciences, Key Laboratory of Microbial Engineering Under the Educational Committee in Chongqing, Army Medical University, Chongqing, China
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2
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Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc13. [PMID: 38655122 PMCID: PMC11035912 DOI: 10.3205/dgkh000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) addresses not only hospitals, but also outpatient health care facilities and compiles current evidence. The following criteria are the basis for the indications for cleaning and disinfection: Infectious bioburden and tenacity of potential pathogens on surfaces and their transmission routes, influence of disinfecting surface cleaning on the rate of nosocomial infections, interruption of cross infections due to multidrug-resistant organisms, and outbreak control by disinfecting cleaning within bundles. The criteria for the selection of disinfectants are determined by the requirements for effectiveness, the efficacy spectrum, the compatibility for humans and the environment, as well as the risk potential for the development of tolerance and resistance. Detailed instructions on the organization and implementation of cleaning and disinfection measures, including structural and equipment requirements, serve as the basis for their implementation. Since the agents for surface disinfection and disinfecting surface cleaning have been classified as biocides in Europe since 2013, the regulatory consequences are explained. As possible addition to surface disinfection, probiotic cleaning, is pointed out. In an informative appendix (only in German), the pathogen characteristics for their acquisition of surfaces, such as tenacity, infectious dose and biofilm formation, and the toxicological and ecotoxicological characteristics of microbicidal agents as the basis for their selection are explained, and methods for the evaluation of the resulting quality of cleaning or disinfecting surface cleaning are presented.
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McKinley LL, Goedken CC, Balkenende EC, Hockett Sherlock SM, Knobloch MJ, Bartel R, Perencevich EN, Reisinger HS, Safdar N. Using a human-factors engineering approach to evaluate environmental cleaning in Veterans' Affairs acute and long-term care facilities: A qualitative analysis. Infect Control Hosp Epidemiol 2024; 45:351-359. [PMID: 37873620 DOI: 10.1017/ice.2023.226] [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: 10/25/2023]
Abstract
BACKGROUND Environmental cleaning is important in the interruption of pathogen transmission. Although prevention initiatives have targeted environmental cleaning, practice variations exist and compliance is low. Evaluation of human factors influencing variations in cleaning practices can be valuable in developing interventions to standardized practices. We conducted a work-system analysis using a human-factors engineering (HFE) framework to identify barriers and facilitators to environmental cleaning practices in acute and long-term care settings within the Veterans' Affairs health system. METHODS We conducted a qualitative study with key stakeholders at 3 VA facilities. We analyzed transcripts for thematic content and mapped themes to the HFE framework. RESULTS Staffing consistency was felt to improve cleaning practices and teamwork. We found that many environmental management service (EMS) staff were veterans who were motivated to serve fellow veterans, especially to prevent infections. However, hiring veterans comes with regulatory hurdles that affect staffing. Sites reported some form of monitoring their cleaning process, but there was variation in method and frequency. The EMS workload was affected by whether rooms were occupied by patients or were semiprivate rooms; both were reportedly more difficult to clean. Room design and surface finishes were identified as important to cleaning efficiency. CONCLUSION HFE work analysis identified barriers and facilitators to environmental cleaning. These findings highlight intervention entry points that may facilitate standardized work practices. There is a need to develop task-specific procedures such as cleaning occupied beds and semiprivate rooms. Future research should evaluate interventions that address these determinants of environmental cleaning.
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Affiliation(s)
- Linda L McKinley
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
| | - Cassie C Goedken
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
| | - Erin C Balkenende
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Stacey M Hockett Sherlock
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mary Jo Knobloch
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Rosie Bartel
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Heather S Reisinger
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, Iowa City, Iowa
| | - Nasia Safdar
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
- University of Wisconsin-Madison, Madison, Wisconsin
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Youté OD, Domngang Noche C, Tamatcho Kweyang BP, Kougang EG, Fotsing Kwetche PR. Surface decontamination effectiveness at the "Université des Montagnes" Teaching Hospital: Monitoring in the biomedical analysis laboratory. Heliyon 2024; 10:e25647. [PMID: 38370175 PMCID: PMC10874729 DOI: 10.1016/j.heliyon.2024.e25647] [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: 07/29/2023] [Revised: 11/29/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
Background Many infections in healthcare facilities are associated with the microbiological quality of the work environment, generally due to poor sanitation. Aim In order to evaluate the effectiveness of a decontamination protocol (cleaning + disinfection) applied at the "Université des Montagnes" Teaching Hospital, the present study assessed the variation of bacterial loads on surfaces subsequent to decontamination. Susceptibility of bacteria to disinfectants was also evaluated in the same frame. Methodology This work was conducted with an adjusted bacterial detection/enumeration and susceptibility test protocols and standard bacterial identification protocols. Sampling on surfaces was performed by wet swabbing before cleaning, between cleaning and disinfection and after disinfection. Results Major findings revealed the predominance of Staphylococcus (75.5%) on target surfaces. High bacterial loads recorded on these surfaces before decontamination became undetectable after cleaning with the detergent "Pax lemon". The majority of isolates (98%) were susceptible to the disinfectants tested, (Surfanios® 0.25% and sodium hypochlorite 0.12%). Conclusion Overall, these findings indicated process effectiveness on the subjected bacterial populations and suggest the use of either Surfanios® (0.25%) or sodium hypochlorite (0.12%) for work surfaces hygiene, justifying the use of these products in this department for surface decontamination. Also, cleaning with the detergent "Pax lemon" and disinfection with sodium hypochlorite may be sufficient for the types of surfaces subjected in the present research.
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Affiliation(s)
- O'Neal Dorsel Youté
- Laboratory of Microbiology, Université des Montagnes Teaching Hospital, Bangangté-Cameroon
- School of Biomedical Sciences, Higher Institute of Health Sciences, Université des Montagnes, Bangangté-Cameroon
| | - Christelle Domngang Noche
- Laboratory of Microbiology, Université des Montagnes Teaching Hospital, Bangangté-Cameroon
- School of Biomedical Sciences, Higher Institute of Health Sciences, Université des Montagnes, Bangangté-Cameroon
- School of Human Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangté-Cameroon
| | | | - Esther Guladys Kougang
- Laboratory of Microbiology, Université des Montagnes Teaching Hospital, Bangangté-Cameroon
- School of Biomedical Sciences, Higher Institute of Health Sciences, Université des Montagnes, Bangangté-Cameroon
| | - Pierre René Fotsing Kwetche
- Laboratory of Microbiology, Université des Montagnes Teaching Hospital, Bangangté-Cameroon
- School of Biomedical Sciences, Higher Institute of Health Sciences, Université des Montagnes, Bangangté-Cameroon
- School of Human Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangté-Cameroon
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Marano RBM, Merezhko D, Resnick KA, Moran-Gilad J, Oster Y. Evaluation of a novel surface-coating formulation with time-extended antimicrobial activity for healthcare environment disinfection. Antimicrob Resist Infect Control 2023; 12:133. [PMID: 37996872 PMCID: PMC10666328 DOI: 10.1186/s13756-023-01341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The importance of environmental contamination in the transmission of pathogens among hospitalized patients is universally recognized, and disinfection of surfaces is a widely accepted modality for reducing healthcare-associated infections. Nevertheless, hospital disinfection is still suboptimal. In this study, we evaluated the sustained effects of the novel formulation OxiLast™ which extends the antimicrobial effects of chlorine-based disinfectants. METHODS In an experimental lab phase, PVC surfaces were coated with OxiLast™ and then inoculated with representative Gram-positive and Gram-negative pathogenic bacteria. Cells were recovered at different contact times (5, 15, 30 min) to assess the reduction in bacterial counts compared to uncoated surfaces and also subject to various challenges to assess robustness. A similar methodology was then applied in an unoccupied hospital room to evaluate the sustained effect of OxiLast™ on high-touch surfaces. RESULTS OxiLast™ demonstrated notable activity against the range of bacterial strains tested with ≥ 4 log10 reduction in bacterial counts observed for up to seven days following one surface application, for various strains and contact times. Similar results were observed following challenges such as simulated abrasion of coated surfaces, organic contamination or successive inoculations. The results were confirmed in a simulated patient care environment. CONCLUSIONS The addition of OxiLast™ to common chlorine-based disinfectants has shown a substantial and sustained reduction in bacterial pathogen counts for up to 7 days following one application. The consistent results in the laboratory and hospital are promising and should be tested in a real-life clinical scenario.
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Affiliation(s)
- Roberto Bruno Maria Marano
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Diana Merezhko
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Anat Resnick
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Yonatan Oster
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Bangani O, English R, Dramowski A. Intensive care unit nurses' knowledge, attitudes and practices of COVID-19 infection prevention and control. S Afr J Infect Dis 2023; 38:478. [PMID: 37435115 PMCID: PMC10318607 DOI: 10.4102/sajid.v38i1.478] [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: 08/29/2022] [Accepted: 02/13/2023] [Indexed: 07/13/2023] Open
Abstract
Background Intensive care units (ICUs) had to rapidly adapt infection prevention and control (IPC) practices during the coronavirus disease 2019 (COVID-19) pandemic. Objectives To determine ICU nurses' COVID-19 IPC-related knowledge, attitudes, practices, and perceptions. Method A mixed-methods study was conducted at the Groote Schuur Hospital ICU, Cape Town, South Africa (20 April 2021 and 30 May 2021). Participants completed anonymous, self-administered, knowledge, attitudes and practices (KAP) questionnaires. Individual interviews were conducted regarding nurses' lived experiences and perceptions of COVID-19 IPC in critical care. Results In total, 116 ICU nurses participated (93.5% response rate) including 57 professional nurses (49%), 34 enrolled nurses (29%) and 25 enrolled nursing assistants (22%); young females (31-49 years) predominating (n = 99; 85.3%). Nurses' overall COVID-19 IPC knowledge scores were moderately good (78%); professional nurses had greater knowledge of COVID-19 transmission (p < 0.001). Intensive care unit nurses' attitude scores towards COVID-19 IPC were low (55%), influenced by limited IPC training, insufficient time to implement IPC and shortages of personal protective equipment (PPE). Respondents' scores for self-reported COVID-19 IPC practices were moderate (65%); highest compliance rates were for hand hygiene after touching patient surroundings (68%). Only 47% ICU nurses underwent N95 respirator fit-testing despite working in a COVID-19 ICU. Conclusion Regular COVID-19 IPC training is needed to equip ICU nurses with the knowledge and skills to prevent healthcare-associated COVID-19 transmission. Enhanced IPC training and consistent PPE availability may support more favourable attitudes and better IPC practices. Comprehensive IPC and occupational health support should be offered to ensure ICU nurses' wellbeing during pandemics. Contribution Enhanced IPC training and consistent PPE availability may support better attitudes and IPC practices.
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Affiliation(s)
- Onga Bangani
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - René English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Leistner R, Kohlmorgen B, Brodzinski A, Schwab F, Lemke E, Zakonsky G, Gastmeier P. Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning. EClinicalMedicine 2023; 59:101958. [PMID: 37089619 PMCID: PMC10113752 DOI: 10.1016/j.eclinm.2023.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Background The impact of environmental hygiene on the occurrence of hospital-acquired infections (HAIs) remains a subject of debate. We determined the effect of three different surface-cleaning strategies on the incidence of HAIs. Methods Between June 2017 and August 2018 we conducted a pragmatic, cluster-randomized controlled crossover trial at 18 non-ICU wards in the university hospital of Berlin, Germany. Surfaces in patient rooms on the study wards were routinely cleaned using one of three agents: Soap-based (reference), disinfectant and probiotic. Each strategy was used on each ward for four consecutive months (4m-4m-4m). There was a one-month wash-in period at the beginning of the study and after each change in strategy. The order of strategies used was randomized for each ward. Primary outcome was the incidence of HAIs. The trial was registered with the German Clinical Trials Register, DRKS00012675. Findings 13,896 admitted patients met the inclusion criteria, including 4708 in the soap-based (reference) arm, 4535 in the disinfectant arm and 4653 in the probiotic arm. In the reference group, the incidence density of HAIs was 2.31 per 1000 exposure days. The incidence density was similar in the disinfectant arm 2.21 cases per 1000 exposure days (IRR 0.95; 95% CI 0.69-1.31; p = 0.953) and the probiotic arm 2.21 cases per 1000 exposure days (IRR 0.96; 95% CI 0.69-1.32; p = 0.955). Interpretation In non-ICU wards, routine surface disinfection proved not superior to soap-based or probiotic cleaning in terms of HAI prevention. Thus, probiotic cleaning could be an interesting alternative, especially in terms of environmental protection. Funding Federal Ministry of Education and Research of Germany (03Z0818C). Bill and Melinda Gates Foundation (INV-004308).
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Affiliation(s)
- Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Medical Department, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Corresponding author. Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Britta Kohlmorgen
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Annika Brodzinski
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elke Lemke
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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8
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McKinley L, Goedken CC, Balkenende E, Clore G, Hockett SS, Bartel R, Bradley S, Judd J, Lyons G, Rock C, Rubin M, Shaughnessy C, Reisinger HS, Perencevich E, Safdar N. Evaluation of daily environmental cleaning and disinfection practices in veterans affairs acute and long-term care facilities: A mixed methods study. Am J Infect Control 2023; 51:205-213. [PMID: 35644297 DOI: 10.1016/j.ajic.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To describe daily environmental cleaning and disinfection practices and their associations with cleaning rates while exploring contextual factors experienced by healthcare workers involved in the cleaning process. METHODS A convergent mixed methods approach using quantitative observations (ie, direct observation of environmental service staff performing environmental cleaning using a standardized observation form) and qualitative interviews (ie, semistructured interviews of key healthcare workers) across 3 Veterans Affairs acute and long-term care facilities. RESULTS Between December 2018 and May 2019 a total of sixty-two room observations (N = 3602 surfaces) were conducted. The average observed surface cleaning rate during daily cleaning in patient rooms was 33.6% for all environmental surfaces and 60.0% for high-touch surfaces (HTS). Higher cleaning rates were observed with bathroom surfaces (Odds Ratio OR = 3.23), HTSs (OR = 1.57), and reusable medical equipment (RME) (OR = 1.40). Lower cleaning rates were observed when cleaning semiprivate rooms (OR = 0.71) and rooms in AC (OR = 0.56). In analysis stratified by patient presence (ie, present, or absent) in the room during cleaning, patient absence was associated with higher cleaning rates for HTSs (OR = 1.71). In addition, the odds that bathroom surfaces being cleaned more frequently than bedroom surfaces decreased (OR = 1.97) as well as the odds that private rooms being cleaned more frequently than semi-private rooms also decreased (OR = 0.26; 0.07-0.93). Between January and June 2019 eighteen qualitative interviews were conducted and found key themes (ie, patient presence and semiprivate rooms) as potential barriers to cleaning; this supports findings from the quantitative analysis. CONCLUSION Overall observed rates of daily cleaning of environmental surfaces in both acute and long-term care was low. Standardized environmental cleaning practices to address known barriers, specifically cleaning practices when patients are present in rooms and semi-private rooms are needed to achieve improvements in cleaning rates.
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Affiliation(s)
| | - C C Goedken
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA
| | - E Balkenende
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - G Clore
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - Sherlock S Hockett
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - R Bartel
- Patient-Centered Outcomes Research Institute (PCORI), Washington DC
| | - S Bradley
- Ann Arbor VA, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - J Judd
- Salt Lake City VA, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Goedken Lyons
- Ann Arbor VA, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - C Rock
- Johns Hopkins University, Baltimore, MD
| | - M Rubin
- Salt Lake City VA, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | | | - H S Reisinger
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - E Perencevich
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - N Safdar
- Madison VA, Madison, WI; University of Wisconsin - Madison, Madison, WI
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Shi ZY, Huang PH, Chen YC, Huang HM, Chen YF, Chen IC, Sheen YJ, Shen CH, Hon JS, Huang CY. Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach. Healthcare (Basel) 2022; 10:2291. [PMID: 36421615 PMCID: PMC9690239 DOI: 10.3390/healthcare10112291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 02/22/2024] Open
Abstract
SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to sustain improvements in surgical quality. The surgical procedures, clinical data, and surgical site infections were collected among 42,233 hospitalized surgical patients from 1 January 2019 to 31 December 2020. Following strengthening leadership and empowering a multidisciplinary SSI prevention team, DMAIC (Define, Measure, Analyze, Improve, and Control) was used as the performance improvement model. An evidence-based prevention bundle for reduction of SSI was adopted as performance measures. Environmental monitoring and antimicrobial stewardship programs were strengthened to prevent the transmission of multi-drug resistant microorganisms. Process change was integrated into a clinical pathway information system. Improvement cycles by corrective actions for the risk events of SSIs were implemented to ensure sustaining improvements. We have reached the targets of the prevention bundle elements in the post-intervention period in 2020. The carbapenem resistance rates of Enterobacteriaceae and P. aeruginosa were lower than 10%. A significant 22.2% decline in SSI rates has been achieved, from 0.9% for the pre-intervention period in 2019 to 0.7% for the post-intervention period in 2020 (p = 0.004). Application of the Six Sigma DMAIC approach could significantly reduce the SSI rates. It also could help hospital administrators and quality management personnel to create a culture of patient safety.
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Affiliation(s)
- Zhi-Yuan Shi
- Infection Control Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407224, Taiwan
| | - Pei-Hsuan Huang
- Infection Control Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Ying-Chun Chen
- Infection Control Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Hui-Mei Huang
- Nursing Department, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yuh-Feng Chen
- Infection Control Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - I-Chen Chen
- Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yi-Jing Sheen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Ching-Hui Shen
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Jau-Shin Hon
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407224, Taiwan
| | - Chin-Yin Huang
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407224, Taiwan
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10
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Bakri MM. Molecular characterization and prevalence of Bacillus species isolated from Saudi hospitals. J Taibah Univ Med Sci 2022; 18:444-454. [PMID: 36818182 PMCID: PMC9932558 DOI: 10.1016/j.jtumed.2022.10.016] [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: 06/12/2022] [Revised: 09/17/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study highlighted the dissemination of Bacillus species (including drug-resistant species) in public hospital environments and calls for the design of optimal strategies to curb their spread. This a critical consideration for all health care systems such as caring for the increasing number of immune-compromised patient. Methods A total of 528 swab samples were collected from the environments of different Saudi hospitals. Swab samples were collected by swabbing approximately 5 cm2 of different surfaces at each site using pre-moisturized cotton swabs with 1 mL of neutralizing buffer. The swabs were transported in cool boxes with ice packs within 2 h of collection. Isolation and identification were performed according to conventional bacteriological, semi-automated and molecular characterization methods. Antibiogram typing was carried against different groups of antimicrobial agents. Results The most prevalent of the isolated Bacillus species were Bacillus cereus (46.6%) followed by Bacillus subtilis (38.1%); the least prevalent was Bacillus pumilus (1.1%). Most Bacillus isolates (25.6%) were isolated from the Department of Internal Medicine followed by the Emergency Department (18.8%), while the operating rooms had the lowest prevalence (4.5%). Antimicrobial susceptibility testing revealed high levels of resistance in Bacillus isolates to β-lactams and tetracycline. Overall, 21.6% of isolates showed multi-drug resistance to three or more antibiotics (21.6%). Antibiogram typing of the 176 isolates revealed 45 antibiotypes; the most common was antibiotype 31, which included 32 isolates (18.2%); this particular antibiotype was resistant to both penicillin and cefoxitin. Conclusions Analyses identified the high dissemination of Bacillus species in several hospital environments with high resistance to β-lactams and tetracycline antibiotics. Molecular analysis also revealed the existence of genetic diversity among the Bacillus isolates investigated. Thus, monitoring the hospital environment is an important tool in the prevention of hospital-associated infection by Bacillus species.
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11
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Pasqua S, Monaco F, Cardinale F, Bonelli S, Conaldi PG, D’Apolito D. Growth Performance and Recovery of Nosocomial Aspergillus spp. in Blood Culture Bottles. Microorganisms 2022; 10:microorganisms10102026. [PMID: 36296302 PMCID: PMC9608713 DOI: 10.3390/microorganisms10102026] [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: 09/01/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
Abstract
Theoretically, Aspergillus spp. grow in culture media, but frequently, blood cultures of patients with invasive Aspergillosis are negative, even if until now, the reasons are not clear. This aspect underlines the lack of a good strategy for the cultivation and isolation of Aspergillus spp. In order to develop a complete analytical method to detect Aspergillus in clinical and pharmaceutical samples, we investigated the growth performance of two blood culture systems versus the pharmacopeia standard method. At <72 h, all test systems showed comparable sensitivity, about 1−2 conidia. However, the subculture analysis showed a suboptimal recovery for the methods, despite the positive growth and the visualization of the “Aspergillus balls” in the culture media. To investigate this issue, we studied three different subculture approaches: (i) the use of a sterile subculture unit, (ii) the use of a sterile subculture unit and the collection of a larger aliquot (100 µL), following vigorous agitation of the vials, and (iii) to decapsulate the bottle, withdrawing and centrifuging the sample, and aliquot the pellet onto SDA plates. Our results showed that only the third procedure recovered Aspergillus from all positive culture bottles. This work confirmed that our strategy is a valid and faster method to culture and isolate Aspergillus spp. from blood culture bottles.
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Affiliation(s)
- Salvatore Pasqua
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesco Monaco
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesca Cardinale
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Simone Bonelli
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Edificio 16, 90128 Palermo, Italy
- Proteomics Group of Fondazione Ri.MED, Department of Research IRCCS ISMETT, Via Ernesto Tricomi 5, 90145 Palermo, Italy
| | - Pier Giulio Conaldi
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Danilo D’Apolito
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
- Correspondence: mailto: or ; Tel.: +39-091-2192472
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12
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Fallon M, Kennedy S, Daniels S, Humphreys H. Technologies to decontaminate bacterial biofilm on hospital surfaces: a potential new role for cold plasma? J Med Microbiol 2022; 71. [PMID: 36201343 DOI: 10.1099/jmm.0.001582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
Healthcare-associated infections (HCAIs) are a major challenge and the near patient surface is important in harbouring causes such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile. Current approaches to decontamination are sub-optimal and many studies have demonstrated that microbial causes of HCAIs may persist with onward transmission. This may be due to the capacity of these microbes to survive in biofilms on surfaces. New technologies to enhance hospital decontamination may have a role in addressing this challenge. We have reviewed current technologies such as UV light and hydrogen peroxide and also assessed the potential use of cold atmospheric pressure plasma (CAPP) in surface decontamination. The antimicrobial mechanisms of CAPP are not fully understood but the production of reactive oxygen and other species is believed to be important. CAPP systems have been shown to partially or completely remove a variety of biofilms including those caused by Candida albicans, and multi-drug-resistant bacteria such as MRSA. There are some studies that suggest promise for CAPP in the challenge of surface decontamination in the healthcare setting. However, further work is required to define better the mechanism of action. We need to know what surfaces are most amenable to treatment, how microbial components and the maturity of biofilms may affect successful treatment, and how would CAPP be used in the clinical setting.
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Affiliation(s)
- Muireann Fallon
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Sarah Kennedy
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Stephen Daniels
- National Centre for Plasma Science and Technology, Dublin City University, Dublin, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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13
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Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1074-1115. [PMID: 36173419 PMCID: PMC9521013 DOI: 10.1007/s00103-022-03576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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14
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Saadi S, Allem R, Sebaihia M, Merouane A, Bakkali M. Bacterial contamination of neglected hospital surfaces and equipment in an Algerian hospital: an important source of potential infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1373-1381. [PMID: 33648396 DOI: 10.1080/09603123.2021.1885631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
Hospital surfaces are heavily contaminated with bacteria, which are a potential source of nosocomial infections. This study was undertaken to identify bacterial communities isolated from neglected hospital surfaces after cleaning routine in a Algerian public hospital. Screening of bacterial contamination in patient bed (PB), reception land-line phones (TF), door handles (DH) and medical equipment (ME) during five months generated 108 inocula. Isolates obtained were identified based on biochemical characteristics and confirmed by analysis of 16S rRNA sequences. Statistical analysis was performed to reveal possible relationship between bacterial diversity and swabbed surfaces. Our findings showed a high prevalence of bacteria in various hospital surfaces, reaching (65.25%), where a highest contaminated surface was the PB (47.22%) and a lowest contaminated was TF (5.55%). Gram negative bacteria were the dominant group (62.03%) mainly represented by Entrobacteriaceae (42.59%), whereas Staphylococcus aureus belonging to Gram positive was the main expanded pathogen with (15.74%).
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Affiliation(s)
- Somia Saadi
- Laboratory of Molecular Biology, Genomics and Bioinformatics, Department of Biology, Faculty of Natural and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Rachida Allem
- Laboratory of Natural Bioresources, Faculty of Nature and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Mohammed Sebaihia
- Laboratory of Molecular Biology, Genomics and Bioinformatics, Department of Biology, Faculty of Natural and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Abdelaziz Merouane
- Laboratory of Natural Bioresources, Faculty of Nature and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Mohammed Bakkali
- Departamento de Genetica, Facultad de Ciencias, Universidad de Granada Fuentenueva S/N, 18071, Granada, Spain
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15
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An Enzyme-Based Interdigitated Electrode-Type Biosensor for Detecting Low Concentrations of H2O2 Vapor/Aerosol. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10060202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This work introduces a novel method for the detection of H2O2 vapor/aerosol of low concentrations, which is mainly applied in the sterilization of equipment in medical industry. Interdigitated electrode (IDE) structures have been fabricated by means of microfabrication techniques. A differential setup of IDEs was prepared, containing an active sensor element (active IDE) and a passive sensor element (passive IDE), where the former was immobilized with an enzymatic membrane of horseradish peroxidase that is selective towards H2O2. Changes in the IDEs’ capacitance values (active sensor element versus passive sensor element) under H2O2 vapor/aerosol atmosphere proved the detection in the concentration range up to 630 ppm with a fast response time (<60 s). The influence of relative humidity was also tested with regard to the sensor signal, showing no cross-sensitivity. The repeatability assessment of the IDE biosensors confirmed their stable capacitive signal in eight subsequent cycles of exposure to H2O2 vapor/aerosol. Room-temperature detection of H2O2 vapor/aerosol with such miniaturized biosensors will allow a future three-dimensional, flexible mapping of aseptic chambers and help to evaluate sterilization assurance in medical industry.
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Das A, Garg R, Kumar ES, Singh D, Ojha B, Kharchandy HL, Pathak BK, Srikrishnan P, Singh R, Joshua I, Nandekar S, J. V, Reghu R, Pedapanga N, Banerjee T, Yadav KK. Implementation of infection prevention and control practices in an upcoming COVID-19 hospital in India: An opportunity not missed. PLoS One 2022; 17:e0268071. [PMID: 35604919 PMCID: PMC9126379 DOI: 10.1371/journal.pone.0268071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Infection prevention and control (IPC) program is obligatory for delivering quality services in any healthcare setup. Lack of administrative support and resource-constraints (under-staffing, inadequate funds) were primary barriers to successful implementation of IPC practices in majority of the hospitals in the developing countries. The Coronavirus Disease 2019 (COVID-19) brought a unique opportunity to improve the IPC program in these hospitals. A PDSA (Plan—Do—Study- Act) model was adopted for this study in a tertiary care hospital which was converted into a dedicated COVID-19 treatment facility in Varanasi, India. The initial focus was to identify the deficiencies in existing IPC practices and perceive the opportunities for improvement. Repeated IPC training (induction and reinforce) was conducted for the healthcare personnel (HCP) and practices were monitored by direct observation and closed-circuit television. Cleaning audits were performed by visual inspection, review of the checklists and qualitative assessment of the viewpoints of the HCP was carried out by the feedbacks received at the end of the training sessions. A total of 2552 HCP and 548 medical students were trained in IPC through multiple offline/onsite sessions over a period of 15 months during the ongoing pandemic. Although the overall compliance to surface disinfection and cleaning increased from 50% to >80% with repeated training, compliance decreased whenever newly recruited HCP were posted. Fear psychosis in the pandemic was the greatest facilitator for adopting the IPC practices. Continuous wearing of personal protective equipment for long duration, dissatisfaction with the duty rosters as well as continuous posting in high-risk areas were the major obstacles to the implementation of IPC norms. Recognising the role of an infection control team, repeated training, monitoring and improvisation of the existing resources are keys for successful implementation of IPC practices in hospitals during the COVID-19 pandemic.
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Affiliation(s)
- Arghya Das
- Department of Microbiology, Institute of Medical Sciences, BHU, Varanasi, India
| | - Rahul Garg
- Department of Microbiology, Institute of Medical Sciences, BHU, Varanasi, India
| | - E. Sampath Kumar
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Dharanidhar Singh
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Bisweswar Ojha
- Department of Pharmacology, Institute of Medical Sciences, BHU, Varanasi, India
| | | | | | - Pushkar Srikrishnan
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Ravindra Singh
- Trauma Centre, Institute of Medical Sciences, BHU, Varanasi, India
| | - Immanuel Joshua
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Sanket Nandekar
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Vinothini J.
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Reenu Reghu
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Nikitha Pedapanga
- Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, BHU, Varanasi, India
- * E-mail:
| | - Kamal Kumar Yadav
- Department of Microbiology, Institute of Medical Sciences, BHU, Varanasi, India
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Centeleghe I, Norville P, Hughes L, Maillard JY. Dual species dry surface biofilms; Bacillus species impact on Staphylococcus aureus survival and surface disinfection. J Appl Microbiol 2022; 133:1130-1140. [PMID: 35543339 PMCID: PMC9543557 DOI: 10.1111/jam.15619] [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: 01/24/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022]
Abstract
Aims Dry surface biofilms (DSB) survive on environmental surfaces throughout hospitals, able to resist cleaning and disinfection interventions. This study aimed to produce a dual species DSB and explore the ability of commercially available wipe products to eliminate pathogens within a dual species DSB and prevent their transfer. Methods and Results Staphylococcus aureus was grown with two different species of Bacillus on stainless steel discs, over 12 days using sequential hydration and dehydration phases. A modified version of ASTM 2967–15 was used to test six wipe products including one water control with the Fitaflex Wiperator. Staphylococcus aureus growth was inhibited when combined with Bacillus subtilis. Recovery of S. aureus on agar from a dual DSB was not always consistent. Our results did not provide evidence that Bacillus licheniformis protected S. aureus from wipe action. There was no significant difference of S. aureus elimination by antimicrobial wipes between single and dual species DSB. B. licheniformis was easily transferred by the wipe itself and to new surfaces both in a single and dual species DSB, whilst several wipe products inhibited the transfer of S. aureus from wipe. However, S. aureus direct transfer to new surfaces was not inhibited post‐wiping. Conclusions Although we observed that the dual DSB did not confer protection of S. aureus, we demonstrated that environmental species can persist on surfaces after disinfection treatment. Industries should test DSB against future products and hospitals should consider carefully the products they choose. Significance and Impact of the Study To our knowledge, this is the first study reporting on the production of a dual species DSB. Multispecies DSB have been identified throughout the world on hospital surfaces, but many studies focus on single species biofilms. This study has shown that DSB behave differently to hydrated biofilms.
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Affiliation(s)
- Isabella Centeleghe
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales
| | - Phillip Norville
- GAMA Healthcare Ltd., Hemel Hempstead, Hertfordshire, United Kingdom
| | - Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales
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18
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McMillan S. Preventing healthcare-associated infections by decontaminating the clinical environment. Nurs Stand 2022; 37:e11935. [PMID: 35477994 DOI: 10.7748/ns.2022.e11935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/09/2022]
Abstract
Healthcare-associated infections (HAIs) continue to cause patient harm and at increasing rates. Factors contributing to this increase include suboptimal hand hygiene, antimicrobial resistance, and inadequate decontamination of the patient environment and shared patient equipment. To reduce the risk of HAIs and enhance patient safety, it is important that nurses and other healthcare professionals adhere to infection prevention and control guidance, including decontamination procedures. It is also important to identify and address the barriers that can affect adherence to this guidance. This article discusses effective decontamination of the patient environment and non-critical shared patient equipment, the barriers to adhering to guidance and strategies for improving decontamination procedures.
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Affiliation(s)
- Sacha McMillan
- Christchurch Hospital Campus, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
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19
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Gülsoy Z, Karagozoglu S. The efficiency of cleaning in intensive care units: A systematic review. ENFERMERIA INTENSIVA 2022; 33:92-106. [PMID: 35690456 DOI: 10.1016/j.enfie.2021.02.002] [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: 05/12/2020] [Accepted: 02/22/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This review aims to analyze the studies on cleaning practices and the efficiency of the cleaning carried out in environments that have a great risk of resistant microorganism infection, such as intensive care units. METHODS In this study, a retrospective literature review was undertaken of the relevant publications between the years 2005 and 2020, using the keywords "Cross Infection, Infection Control, Multidrug-Resistant Bacteria, Intensive Care, Room Cleaning, Environmental Cleaning, Hospital-Associated Infection"; using the international databases Pubmed, CINAHL and EBSCO and domestic database ULAKBIM on search engines. Titles and abstracts of all relevant articles found on electronic searches were reviewed by the researchers independently. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline and Patient, Intervention, Comparison, Outcomes, Study design model were used in analysing the studies. RESULTS The selected studies were reviewed in four main categories: Materials used in cleaning, the period between taking environmental samples, cleaning methods, and the efficiency of cleaning. Among the studies included herein, eight were randomized controlled trials, three were retrospective intervention studies, two were case-control studies and one was a retrospective cohort study. CONCLUSIONS Today, the assessment of cleaning in environments can be evaluated by different methods, but there are advantages and disadvantages of these methods. Therefore, in the relevant literature, it is suggested that cleaning must be evaluated by several methods, not only one. Also, training the staff that carries out the cleaning and rewarding correct behavior by giving feedback are important approaches to increase the efficiency of cleaning. It is suggested that cleaning must be carried out every day, regularly with effective methods and equipment; frequency of cleaning during epidemics must be increased, institutions must prepare cleaning manuals according to evidence-based guidelines that are recognized at an international level.
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Affiliation(s)
- Z Gülsoy
- Cumhuriyet University Research and Practice Hospital, Department of Anesthesia Intensive Care Unit, Sivas, Turkey.
| | - S Karagozoglu
- Cumhuriyet University Faculty of Health Science, Division of Nursing, Department of Fundamentals of Nursing, Sivas, Turkey
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20
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Engaging veterans in identifying key elements of environmental cleaning and disinfection for preventing healthcare-associated infections: A qualitative study. Am J Infect Control 2022; 50:148-154. [PMID: 35101177 DOI: 10.1016/j.ajic.2021.10.012] [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: 09/17/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Environmental cleaning and disinfection are important for preventing healthcare-associated infections (HAIs) via contaminated surfaces. Hospital cleanliness plays a large role in patient perception and satisfaction regarding their healthcare. However, patient perceptions of environmental cleaning procedures remain unclear. The objective of the study was to engage patients in achieving patient-centered care and examine patient perspectives on environmental cleaning work systems in healthcare. METHODS A qualitative descriptive study was conducted using semi-structured interviews with hospitalized patients at a Midwestern Veterans Administration Hospital. Interviews were audio recorded, transcribed, then coded to identify recurring themes. RESULTS Fifteen patient interview were conducted. Patients reported expecting a clean hospital room. Some patients expressed feeling "in the way" during cleaning, possibly rushing cleaning procedures. Patients expressed confidence in Environmental Management Service (EMS) staff's skilled work and noted "soft skills" as desirable attributes, including camaraderie which can develop between Veteran patients and Veteran staff during room cleaning. CONCLUSIONS Patients identified environmental cleaning as a priority for HAI patient-centered infection prevention practices. Cleaning occupied rooms may be an important entry point for intervention to address actual or perceived disruption to patients or build upon Veteran peer relationships. Cleaning procedures may become more patient-centric if cleaning procedures were explained and based on patient preferences.
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21
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Golladay GJ, Leslie KA, Zuelzer WA, Cassano AD, Plauny JJ, Daniels FE, Bearman G, Kates SL. Rationale and process for N95 respirator sanitation and reuse in the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2022; 43:40-44. [PMID: 33526158 PMCID: PMC8712955 DOI: 10.1017/ice.2021.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The novel severe acute respiratory coronavirus virus 2 (SARS-CoV-2) was first reported in Wuhan, China, in December 2019 and is notable for being highly contagious and potentially lethal; and SARS-CoV-2 is mainly spread by droplet transmission. The US healthcare system's response to the COVID-19 pandemic has been challenged by a shortage of personal protective equipment (PPE), especially N95 respirators. Restricted use, reuse, and sanitation of PPE have been widely adopted to provide protection for frontline healthcare workers caring for often critically ill and highly contagious patients. Here, we describe our validated process for N95 respirator sanitation. DESIGN Process development, validation, and implementation. SETTING Level 1, urban, academic, medical center. METHODS A multidisciplinary team developed a novel evidence-based process for N95 respirator reprocessing and sanitation using ultraviolet (UV) light. Dose measurement, structural integrity, moisture content, particle filtration, fit testing, and environmental testing were performed for both quality control and validation of the process. RESULTS The process achieved UV light dosing for sanitation while maintaining the functional and structural integrity of the N95 respirators, with a daily potential throughput capacity of ∼12,000 masks. This process has supported our health system to provide respiratory PPE to all frontline team members. CONCLUSIONS This novel method of N95 respirator sanitation can safely enable reuse of the N95 respirators essential for healthcare workers caring for patients with COVID-19. Our high-throughput process can extend local supplies of this critical PPE until the national supply is replenished.
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Affiliation(s)
- Gregory J. Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kevin A. Leslie
- VCU Ventures, Virginia Commonwealth University, Richmond, Virginia
| | - Wilhelm A. Zuelzer
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Anthony D. Cassano
- Division of Thoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | | | - Frank E. Daniels
- High-Level Disinfection Unit, VCU Health System, Richmond, Virginia
| | - Gonzalo Bearman
- Division of Infectious Disease, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Stephen L. Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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22
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Singh V, Narula H, Supehia S, Sharma M, Gupta PK, Sharma A, Rao S. Impact of Video Modules-Based Training on Knowledge, Attitude, and Practices of Cleaning and Disinfection Among Housekeeping Staff at a Tertiary Care Center During the COVID-19 Pandemic. Cureus 2021; 13:e19125. [PMID: 34868766 PMCID: PMC8627668 DOI: 10.7759/cureus.19125] [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] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Aim To assess the knowledge, attitude, and practice toward cleaning and disinfection among housekeeping (HK) staff amid the coronavirus disease 2019 (COVID-19) pandemic. Methods A quasi-experimental was undertaken among HK staff at a tertiary care hospital. A 30-item structured questionnaire was used in the study, which consisted of questions pertaining to knowledge (11), attitude (8), and practice (11) toward cleaning and disinfection. Result One-hundred-two participants were included by convenient sampling, with mean age = 30-37 years. There was an improvement in pre-test and post-test knowledge (6.21 to 9.7) and practice score (9.97 to post-test 10.52). However, the attitude score did not show a significant change in the post-test score (p=0.964), showing that they were having a positive attitude toward the practices before training too. Conclusion Improvement in the post-test score shows that periodic targeted training sessions on cleaning and disinfection among housekeeping staff help improve their knowledge, attitude, and practices toward infection prevention and control (IPC) during the COVID-19 pandemic, thus minimizing the spread of the virus in a hospital environment, reducing their apprehension, and preparing them to work in such pandemic situations.
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Affiliation(s)
- Vanya Singh
- Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Himanshu Narula
- Microbiology, Rifleman Jaswant Singh Rawat (RJSH) COVID Hospital, All India Institute of Medical Sciences, Rishikesh, IND
| | - Sakshi Supehia
- Public Health, All India Institute of Medical Sciences, Rishikesh, IND
| | - Maneesh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, IND
| | - Puneet K Gupta
- Microbiology, All India Institute of Medical Sciences, Bilaspur, IND
| | - Anita Sharma
- Hospital Infection Control, All India Institute of Medical Sciences, Rishikesh, IND
| | - Shalinee Rao
- Pathology, All India Institute of Medical Sciences, Rishikesh, IND
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Chiu CJ, Tien YC, Feng KT, Tseng PH. Intelligent Visual Acuity Estimation System With Hand Motion Recognition. IEEE TRANSACTIONS ON CYBERNETICS 2021; 51:6226-6239. [PMID: 32092028 DOI: 10.1109/tcyb.2020.2969520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Visual acuity (VA) measurement is utilized to test a subject's acuteness of vision. Conventional VA measurement requires a physician's assistance to ask a subject to speak out or wave a hand in response to the direction of an optotype. To avoid this repetitive testing procedure, different types of automatic VA tests have been developed in recent years by adopting contact-based responses, such as pushing buttons or keyboards on a device. However, contact-based testing is not as intuitive as speaking or waving hands, and it may distract the subjects from concentrating on the VA test. Moreover, problems related to hygiene may arise if all the subjects operate on the same testing device. To overcome these problems, we propose an intelligent VA estimation (iVAE) system for automatic VA measurements that assists the subject to respond in an intuitive, noncontact manner. VA estimation algorithms using maximum likelihood (VAML) are developed to automatically estimate the subject's vision by compromising between a prespecified logistic function and a machine-learning technique. The neural-network model adapts human learning behavior to consider the accuracy of recognizing the optotype as well as the reaction time of the subject. Furthermore, a velocity-based hand motion recognition algorithm is adopted to classify hand motion data, collected by a sensing device, into one of the four optotype directions. Realistic experiments show that the proposed iVAE system outperforms the conventional line-by-line testing method as it is approximately ten times faster in testing trials while achieving a logarithm of the minimum angle of resolution error of less than 0.2. We believe that our proposed system provides a method for accurate and fast noncontact automatic VA testing.
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Brought to Light: How Ultraviolet Disinfection Can Prevent the Nosocomial Transmission of COVID-19 and Other Infectious Diseases. Appl Microbiol 2021. [DOI: 10.3390/applmicrobiol1030035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has brought to light the role of environmental hygiene in controlling disease transmission. Healthcare facilities are hot spots for infectious pathogens where physical distancing and personal protective equipment (PPE) are not always sufficient to prevent disease transmission. Healthcare facilities need to consider adjunct strategies to prevent transmission of infectious pathogens. In combination with current infection control procedures, many healthcare facilities are incorporating ultraviolet (UV) disinfection into their routines. This review considers how pathogens are transmitted in healthcare facilities, the mechanism of UV microbial inactivation and the documented activity of UV against clinical pathogens. Emphasis is placed on the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as well as multidrug resistant organisms (MDROs) that are commonly transmitted in healthcare facilities. The potential benefits and limitations of UV technologies are discussed to help inform healthcare workers, including clinical studies where UV technology is used in healthcare facilities.
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Castelli A, Norville P, Kiernan M, Maillard JY, Evans SL. Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS Acute Care Organisations. J Hosp Infect 2021; 120:65-72. [PMID: 34767870 DOI: 10.1016/j.jhin.2021.10.021] [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: 08/17/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decontamination of non-critical objects shared by patients is key in reducing HAIs, but it is a complex process that needs precise guidance from UK NHS Acute Care Organisations (ACOs). AIM To review the indications given by NHS ACOs' policies regarding the decontamination of shared non-critical devices. METHODS Detailed lists of decontamination protocols for shared non-critical objects were retrieved from cleaning, disinfection, and decontamination policies of 35 NHS ACOs. Three parameters were considered for each object: decontamination method, decontamination frequency and person responsible for decontamination. FINDINGS 1279 decontamination protocols regarding 283 different shared non-critical objects were retrieved. 689 (54%) did not indicate the person responsible for decontamination, while only 425 (33%), were complete, giving indications for all three parameters analysed. Only 2.5% (32/1279) decontamination protocols were complete and identical in two policies. In policies where cleaning represented the major decontamination method, chemical disinfection was rarely mentioned and vice versa. A general agreement among policies can be found for four main decontamination methods (detergent and water, detergent wipes, disinfectant wipes, use of disposable items), two decontamination frequencies (between events, daily) and two responsible person designations (nurses, domestic staff). CONCLUSIONS Decontamination protocol policies for shared non-critical objects had some similarities but did not concur on how each individual object should be decontaminated. The lack of clear indications regarding the person responsible for the decontamination process put at risk the ability of policies to serve as guidance.
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Affiliation(s)
- Andrea Castelli
- School of Engineering, Cardiff University, Cardiff, Wales, UK; School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK
| | - Phillip Norville
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK
| | - Martin Kiernan
- Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK; School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; Richard Wells Research Centre, University of West London, Brentford, UK
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Sam L Evans
- School of Engineering, Cardiff University, Cardiff, Wales, UK.
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D’Accolti M, Soffritti I, Bonfante F, Ricciardi W, Mazzacane S, Caselli E. Potential of an Eco-Sustainable Probiotic-Cleaning Formulation in Reducing Infectivity of Enveloped Viruses. Viruses 2021; 13:2227. [PMID: 34835033 PMCID: PMC8617880 DOI: 10.3390/v13112227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has deeply influenced sanitization procedures, and high-level disinfection has been massively used to prevent SARS-CoV-2 spread, with potential negative impact on the environment and on the threat of antimicrobial resistance (AMR). Aiming to overcome these concerns, yet preserving the effectiveness of sanitization against enveloped viruses, we assessed the antiviral properties of the Probiotic Cleaning Hygiene System (PCHS), an eco-sustainable probiotic-based detergent previously proven to stably abate pathogen contamination and AMR. PCHS (diluted 1:10, 1:50 and 1:100) was tested in comparison to common disinfectants (70% ethanol and 0.5% sodium hypochlorite), in suspension and carrier tests, according with the European UNI EN 14476:2019 and UNI EN 16777:2019 standards. Human alpha- and beta-coronaviruses hCoV-229E and SARS-CoV-2, human herpesvirus type 1, human and animal influenza viruses, and vaccinia virus were included in the study. The results showed that PCHS was able to inactivate 99.99% of all tested viruses within 1-2 h of contact, both in suspension and on surface. Notably, while control disinfectants became inactive within 2 h after application, the PCHS antiviral action persisted up to 24 h post-application, suggesting that its use may effectively allow a continuous prevention of virus spread via contaminated environment, without worsening environmental pollution and AMR concern.
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Affiliation(s)
- Maria D’Accolti
- Section of Microbiology, Department of Chemical, Pharmaceutical and Agricultural Sciences, LTTA, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (M.D.); (I.S.)
- CIAS Research Center, University of Ferrara, Via Saragat 13, 44122 Ferrara, Italy;
| | - Irene Soffritti
- Section of Microbiology, Department of Chemical, Pharmaceutical and Agricultural Sciences, LTTA, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (M.D.); (I.S.)
- CIAS Research Center, University of Ferrara, Via Saragat 13, 44122 Ferrara, Italy;
| | - Francesco Bonfante
- Istituto Zooprofilattico Sperimentale delle Venezie, IZSVe, Viale dell’Università 10, 35020 Legnaro, Italy;
| | - Walter Ricciardi
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Roma, Italy;
| | - Sante Mazzacane
- CIAS Research Center, University of Ferrara, Via Saragat 13, 44122 Ferrara, Italy;
| | - Elisabetta Caselli
- Section of Microbiology, Department of Chemical, Pharmaceutical and Agricultural Sciences, LTTA, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (M.D.); (I.S.)
- CIAS Research Center, University of Ferrara, Via Saragat 13, 44122 Ferrara, Italy;
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Christenson EC, Cronk R, Atkinson H, Bhatt A, Berdiel E, Cawley M, Cho G, Coleman CK, Harrington C, Heilferty K, Fejfar D, Grant EJ, Grigg K, Joshi T, Mohan S, Pelak G, Shu Y, Bartram J. Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11100. [PMID: 34769620 PMCID: PMC8582915 DOI: 10.3390/ijerph182111100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/23/2023]
Abstract
Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.
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Affiliation(s)
- Elizabeth C. Christenson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
- ICF, Durham, NC 27713, USA
| | - Helen Atkinson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Aayush Bhatt
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Emilio Berdiel
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Michelle Cawley
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Grace Cho
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Collin Knox Coleman
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Cailee Harrington
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Kylie Heilferty
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Don Fejfar
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Emily J. Grant
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Karen Grigg
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Tanmay Joshi
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Suniti Mohan
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Grace Pelak
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Yuhong Shu
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
- School of Civil Engineering, University of Leeds, Leeds LS2 9DY, UK
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28
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Mbhele ZN, Shobo CO, Amoako DG, Zishiri OT, Bester LA. Occurrence, Antibiotic Resistance, Virulence Factors, and Genetic Diversity of Bacillus spp. from Public Hospital Environments in South Africa. Microb Drug Resist 2021; 27:1692-1704. [PMID: 34546077 DOI: 10.1089/mdr.2020.0543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This study aimed to assess the molecular dissemination of Bacillus species in public hospitals in South Africa. The study conducted over 3 months during 2017 involved representative samples obtained from three wards (general ward, intensive care unit, and pediatric unit) from four public hospitals denoted as A (Central), B (Tertiary), C (Regional), and D (District). Swabs collected from 11 distinct hospital surfaces were screened using selective media, biochemical testing, and molecular methods. Overall, 17% (135/777) isolates were identified with a prevalence of 24% (32/135) for central, 33% (45/135) for tertiary, 27% (36/135) for regional, and 16% (22/135) for district hospital. Bacillus species were further confirmed to belong to Bacillus cereus (129/135; 96%) and Bacillus subtilis (6/135; 4%). Prevalence was similar across the wards, averaging 33.3% (45/135). The highest prevalence of Bacillus isolates was found on the drip stands (11.8%), sink (11.8%), ward phone (11.5%), and nurses' tables (10.3%). Minimum inhibitory concentration analyses revealed high resistance to β-lactams, fluoroquinolones, and tetracyclines. The most common resistance genes detected were ermB (56%) and tetM (5%). Enterotoxin virulence genes hblA (77%) and hblD (88%) associated with the diarrheal syndrome were most detected; however, no ces genes (cereulide toxin) for emetic syndrome was found. The enterobacterial repetitive intergenic consensus PCR revealed considerable diversity at the different levels of health care, although the clonal spread of strains between the sites/wards within each specific hospital was revealed. The study highlighted the dissemination of drug-resistant Bacillus spp. in public hospital environments and calls for the design of optimal strategies to curb their spread.
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Affiliation(s)
- Zamile N Mbhele
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Christiana O Shobo
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Daniel G Amoako
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal Durban, Durban, South Africa.,Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Oliver T Zishiri
- Discipline of Genetics, School of Life Sciences, College of Agriculture Engineering and Science University of KwaZulu-Natal Durban, Durban, South Africa
| | - Linda A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal Durban, Durban, South Africa
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29
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Bacteriophage treatment before chemical disinfection can enhance removal of plastic surface-associated Pseudomonas aeruginosa. Appl Environ Microbiol 2021; 87:e0098021. [PMID: 34347517 PMCID: PMC8478462 DOI: 10.1128/aem.00980-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Opportunistic pathogens can linger on surfaces in hospital and building plumbing environments, leading to infections in at-risk populations. Further, biofilm-associated bacteria are protected from removal and inactivation protocols, such as disinfection. Bacteriophages show promise as tools to treat antibiotic resistant infections. As such, phages may also be useful in environmental applications to prevent newly acquired infections. In the current study, the potential of synergies between bacteriophage and chemical disinfection of the opportunistic pathogen Pseudomonas aeruginosa was assessed under various conditions. Specifically, surface-associated P. aeruginosa was treated with various concentrations of phages (P1 or JG004), chemical disinfectant (sodium hypochlorite or benzalkonium chloride), or combined sequential treatments under three distinct attachment models (spot inoculations, dry biofilms, and wet biofilms). Phages were very effective at removing bacteria in spot inoculation (>3.2 log10 removal) and wet biofilms (up to 2.6 log10 removal), while phages prevented regrowth of dry biofilms in the application time. In addition, phage treatment followed by chemical disinfection inactivated more P. aeruginosa under wet biofilm conditions better than either treatment alone. This effect was hindered when chemical disinfection was applied first, followed by phage treatment, suggesting additive benefits of combination treatments are lost when phage is applied last. Further, we confirm prior evidence of greater phage tolerance to benzalkonium chloride relative to sodium hypochlorite, informing choices for combination phage-disinfectant approaches. Overall, this paper further supports the potential of using combination phage and chemical disinfectant treatments to improve inactivation of surface-associated P. aeruginosa. Importance Phages are already utilized in the healthcare industry to treat antibiotic resistant infections, such as on implant-associated biofilms and in compassionate care cases. Phage treatment could also be a promising new tool to control pathogens in the built environment, preventing infections from occurring. This study shows that phage can be combined effectively with chemical disinfectants to improve removal of wet biofilms and bacteria spotted onto surfaces while preventing regrowth in dry biofilms. This has the potential to improve pathogen containment within the built environment and drinking water infrastructure to prevent infections of opportunistic pathogens.
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McElheny KD, Little D, Taylor D, Manzi JE. Communicable Illness Mitigation Strategies for Traveling Elite Sporting Organizations. Sports Health 2021; 14:532-537. [PMID: 34292110 DOI: 10.1177/19417381211032226] [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] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Transmission of communicable diseases observed in sporting organizations is often preventable. Early detection, isolation, and treatment can significantly diminish time lost. Until recently, there has been a paucity of standardized guidelines outlining feasible, preventable measures to protect both athletes and staff from contagious illnesses. Therefore, the purpose of this narrative was to highlight optimal prevention practices for transmission mitigation, with a particular focus on hygiene activity and travel considerations in professional sporting organizations. EVIDENCE ACQUISITION Current recommendations from the Centers for Disease Control and Prevention and peer-reviewed journals. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Communicable illness prevention strategies begin at the level of sufficient personal hygiene practices. Common area surface cleaning recommendations, including shared equipment sanitization between usage as well as designated equipment use to specific athletes, should be considered to minimize cross-contamination, in particular, for liked-position players. Intelligent design for shared areas can include redistributing the layout of communal spaces, most feasibly, spreading locker designation a minimum distance of 6 ft from one another. Travel considerations can include placing most susceptible passengers closest to window seating, boarding last and exiting first. Team physicians should have knowledge of essential personnel medical histories in an effort to risk stratify staff members and players in the setting of communicable disease. CONCLUSION Providing a framework for illness management and prevention is important when considering the effects on player health, missed time, performance, and overall cost. Containment of commonly observed communicable illnesses can be optimized with sufficient personal hygiene practices, common area surface cleaning recommendations, intelligent design for shared areas, travel and hotel considerations, as well as appropriate screening tools and isolation techniques. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
- Kathryn D McElheny
- Hospital for Special Surgery, New York, New York.,New York Mets Baseball Club, Queens, New York
| | - Dean Little
- New York Mets Baseball Club, Queens, New York
| | - David Taylor
- United States Olympic and Paralympics Committee, Colorado Springs, Colorado.,Golden State Warriors Basketball Club, San Francisco, California
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Ventilation-Associated Particulate Matter Is a Potential Reservoir of Multidrug-Resistant Organisms in Health Facilities. Life (Basel) 2021; 11:life11070639. [PMID: 34209235 PMCID: PMC8307074 DOI: 10.3390/life11070639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 02/03/2023] Open
Abstract
Most healthcare-associated infections (HCAIs) develop due to the colonisation of patients and healthcare workers by multidrug-resistant organisms (MDRO). Here, we investigated whether the particulate matter from the ventilation systems (Vent-PM) of health facilities can harbour MDRO and other microbes, thereby acting as a potential reservoir of HCAIs. Dust samples collected in the ventilation grilles and adjacent air ducts underwent a detailed analysis of physicochemical properties and biodiversity. All Vent-PM samples included ultrafine PM capable of reaching the alveoli. Strikingly, >70% of Vent-PM samples were contaminated, mostly by viruses (>15%) or multidrug-resistant and biofilm-producing bacterial strains (60% and 48% of all bacteria-contaminated specimens, respectively). Total viable count at 1 m from the ventilation grilles was significantly increased after opening doors and windows, indicating an association between air flow and bacterial contamination. Both chemical and microbial compositions of Vent-PM considerably differed across surgical vs. non-surgical and intensive vs. elective care units and between health facilities located in coal and chemical districts. Reduced diversity among MDRO and increased prevalence ratio in multidrug-resistant to the total Enterococcus spp. in Vent-PM testified to the evolving antibiotic resistance. In conclusion, we suggest Vent-PM as a previously underestimated reservoir of HCAI-causing pathogens in the hospital environment.
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32
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Malinga NZZ, Shobo CO, Molechan C, Amoako DG, Zishiri OT, Bester LA. Molecular Surveillance and Dissemination of Klebsiella pneumoniae on Frequently Encountered Surfaces in South African Public Hospitals. Microb Drug Resist 2021; 28:306-316. [PMID: 34170205 DOI: 10.1089/mdr.2020.0546] [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] [Indexed: 12/31/2022] Open
Abstract
Bacteria that cause life-threatening illnesses in humans are also capable of contaminating hospital surfaces, thus pose as a potential source of infection. This study aimed to investigate the prevalence, genetic diversity, virulence, and antibiotic resistance profile of Klebsiella pneumoniae in South Africa. In a nonoutbreak setting involving four public hospitals, 777 samples were collected in three different wards from 11 different sites. Phenotypic and genotypic methods were used for isolation and identification. The Kirby-Bauer disk-diffusion method was used to examine antibiotic resistance followed by the combination disk method to characterize extended-spectrum β-lactamases (ESBLs). Antibiotic resistance and virulence genes were screened using PCR and clonality was investigated using enterobacterial repetitive intergenic consensus (ERIC)-PCR. Seventy-five (10%) K. pneumoniae isolates were recovered. These isolates were obtained from all four hospitals and all three wards involved. However, only six frequently touched surfaces were contaminated. Thirty (40%) isolates were characterized as ESBLs showing high resistance to antibiotics and mostly harboring the blaCTX-M group one gene. Virulence genes were highly prevalent among all the isolates. ERIC-PCR showed that the isolates recovered from different sites within the same hospital were genetically similar. The study highlighted that K. pneumoniae can contaminate various surfaces and this persistence allows for the dissemination of bacteria within the hospital environment. The information from this study can assist hospitals to evaluate and improve current infection prevention and control interventions in place.
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Affiliation(s)
- Nongcebo Z Z Malinga
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christiana O Shobo
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Chantal Molechan
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel G Amoako
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Oliver T Zishiri
- Discipline of Genetics, School of Life Sciences, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Linda A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Gülsoy Z, Karagozoglu S. The efficiency of cleaning in intensive care units: A systematic review. ENFERMERIA INTENSIVA 2021; 33:S1130-2399(21)00056-0. [PMID: 34083131 DOI: 10.1016/j.enfi.2021.02.002] [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: 05/12/2020] [Revised: 12/19/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This review aims to analyze the studies on cleaning practices and the efficiency of the cleaning carried out in environments that have a great risk of resistant microorganism infection, such as intensive care units. METHODS In this study, a retrospective literature review was undertaken of the relevant publications between the years 2005 and 2020, using the keywords "Cross Infection, Infection Control, Multidrug-Resistant Bacteria, Intensive Care, Room Cleaning, Environmental Cleaning, Hospital-Associated Infection"; using the international databases Pubmed, CINAHL and EBSCO and domestic database ULAKBIM on search engines. Titles and abstracts of all relevant articles found on electronic searches were reviewed by the researchers independently. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline and Patient, Intervention, Comparison, Outcomes, Study design model were used in analysing the studies. RESULTS The selected studies were reviewed in four main categories: Materials used in cleaning, the period between taking environmental samples, cleaning methods, and the efficiency of cleaning. Among the studies included herein, eight were randomized controlled trials, three were retrospective intervention studies, two were case-control studies and one was a retrospective cohort study. CONCLUSIONS Today, the assessment of cleaning in environments can be evaluated by different methods, but there are advantages and disadvantages of these methods. Therefore, in the relevant literature, it is suggested that cleaning must be evaluated by several methods, not only one. Also, training the staff that carries out the cleaning and rewarding correct behavior by giving feedback are important approaches to increase the efficiency of cleaning. It is suggested that cleaning must be carried out every day, regularly with effective methods and equipment; frequency of cleaning during epidemics must be increased, institutions must prepare cleaning manuals according to evidence-based guidelines that are recognized at an international level.
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Affiliation(s)
- Z Gülsoy
- Cumhuriyet University Research and Practice Hospital, Department of Anesthesia Intensive Care Unit, Sivas, Turkey.
| | - S Karagozoglu
- Cumhuriyet University Faculty of Health Science, Division of Nursing, Department of Fundamentals of Nursing, Sivas, Turkey
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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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Assadian O, Harbarth S, Vos M, Knobloch JK, Asensio A, Widmer AF. Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. J Hosp Infect 2021; 113:104-114. [PMID: 33744383 DOI: 10.1016/j.jhin.2021.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Healthcare-associated infections (HAIs) are the most common adverse outcomes due to delivery of medical care. HAIs increase morbidity and mortality, prolong hospital stay, and are associated with additional healthcare costs. Contaminated surfaces, particularly those that are touched frequently, act as reservoirs for pathogens and contribute towards pathogen transmission. Therefore, healthcare hygiene requires a comprehensive approach whereby different strategies may be implemented together, next to targeted, risk-based approaches, in order to reduce the risk of HAIs for patients. This approach includes hand hygiene in conjunction with environmental cleaning and disinfection of surfaces and clinical equipment. This review focuses on routine environmental cleaning and disinfection including areas with a moderate risk of contamination, such as general wards. As scientific evidence has not yet resulted in universally accepted guidelines nor led to universally accepted practical recommendations pertaining to surface cleaning and disinfection, this review provides expert guidance for healthcare workers in their daily practice. It also covers outbreak situations and suggests practical guidance for clinically relevant pathogens. Key elements of environmental cleaning and disinfection, including a fundamental clinical risk assessment, choice of appropriate disinfectants and cleaning equipment, definitions for standardized cleaning processes and the relevance of structured training, are reviewed in detail with a focus on practical topics and implementation.
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Affiliation(s)
- O Assadian
- Regional Hospital Wiener Neustadt, Wiener Neustadt, Austria; Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - S Harbarth
- Infection Control Programme and Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Asensio
- Preventive Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - A F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Raji MA, Suaifan G, Shibl A, Weber K, Cialla-May D, Popp J, Al-Kattan K, Zourob M. Aptasensor for the detection of Methicillin resistant Staphylococcus aureus on contaminated surfaces. Biosens Bioelectron 2021; 176:112910. [PMID: 33395571 DOI: 10.1016/j.bios.2020.112910] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022]
Abstract
There is mounting evidence that contaminated hospital environment plays a crucial role in the transmission of nosocomial pathogens such as MRSA. The institution of infection control protocols is predicated on the early laboratory detection of the pathogen from relevant samples. Processing of environmental samples for the presence of bacterial contaminants in the clinical environment is poorly standardized when compared with analysis of clinical samples. The various laboratory methods available for processing environmental samples are difficult to standardized and most require a long turnaround time before results are available. In this study, we present a report of the performance of a novel pathogen aptasensor swab designed to qualitatively and quantitatively detect MRSA, on contaminated non-absorbable surfaces. The visual detection limit of the MRSA aptasensor swab was less than 100 CFU/ml and theoretically using a standard curve, was 2 CFU/ml. A relatively short turnaround time of 5 min was established for the assay while the linear range of quantitation was 102-105 CFU/ml. Engineered aptasensor targets MRSA selectively and binds to none of the other tested bacterial pathogen, on a multi-contaminated surface. This novel detection tool was easy to use and relatively cheap to produce.
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Affiliation(s)
- Muhabat Adeola Raji
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia
| | - Ghadeer Suaifan
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, The University of Jordan, Amman-Jordan, P.O. Box 11942, Amman, Jordan
| | - Atef Shibl
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia
| | - Karina Weber
- InfectoGnostics Research Campus Jena, Center for Applied Research, Friedrich-Schiller-University, Philosophenweg7, Jena, 07743, Germany; Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany; Leibniz Institute of Photonic Technology, Member of the Leibniz Research Alliance, Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Dana Cialla-May
- InfectoGnostics Research Campus Jena, Center for Applied Research, Friedrich-Schiller-University, Philosophenweg7, Jena, 07743, Germany; Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany; Leibniz Institute of Photonic Technology, Member of the Leibniz Research Alliance, Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Jürgen Popp
- InfectoGnostics Research Campus Jena, Center for Applied Research, Friedrich-Schiller-University, Philosophenweg7, Jena, 07743, Germany; Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany; Leibniz Institute of Photonic Technology, Member of the Leibniz Research Alliance, Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Khaled Al-Kattan
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia
| | - Mohammed Zourob
- Department of Chemistry, College of Science, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia; King Faisal Specialist Hospital and Research Center, Zahrawi Street, Al Maather, Riyadh, 12713, Saudi Arabia.
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Aranke M, Moheimani R, Phuphanich M, Kaye AD, Ngo AL, Viswanath O, Herman J. Disinfectants In Interventional Practices. Curr Pain Headache Rep 2021; 25:21. [PMID: 33693989 PMCID: PMC7946573 DOI: 10.1007/s11916-021-00938-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This review aims to provide relevant, aggregate information about a variety of disinfectants and antiseptics, along with potential utility and limitations. While not exhaustive, this review's goal is to add to the body of literature available on this topic and give interventional providers and practitioners an additional resource to consider when performing procedures. RECENT FINDINGS In the current SARS-CoV2 epidemiological environment, infection control and costs associated with healthcare-associated infections (HAIs) are of paramount importance. Even before the onset of SARS-CoV2, HAIs affected nearly 2million patients a year in the USA and resulted in nearly 90,000 deaths, all of which resulted in a cost to hospitals ranging from US$28 billion to 45 billion. The onset SARS-CoV2, though not spread by an airborne route, has heightened infection control protocols in hospitals and, as such, cast a renewed focus on disinfectants and their utility across different settings and organisms. The aim of this review is to provide a comprehensive overview of disinfectants used in the inpatient setting.
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Affiliation(s)
- Mayank Aranke
- Department of Anesthesiology, University of Texas Health Science Center, Houston, TX, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roya Moheimani
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Melissa Phuphanich
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Anh L Ngo
- Harvard Medical School, Boston, MA, USA
- Pain Specialty Group, Newington, NH, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Valley Pain Consultants, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Jared Herman
- Department of Anesthesiology, Mount Sinai Medical Center, Alton Road Miami Beach, FL, 4300, USA.
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Is a reduction in viability enough to determine biofilm susceptibility to a biocide? Infect Control Hosp Epidemiol 2021; 42:1486-1492. [PMID: 33650476 DOI: 10.1017/ice.2021.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The abundance and prevalence of dry-surface biofilms (DSBs) in hospitals constitute an emerging problem, yet studies rarely report the cleaning and disinfection efficacy against DSBs. Here, the combined impact of treatments on viability, transferability, and recovery of bacteria from DSBs has been investigated for the first time. METHODS Staphylococcus aureus DSBs were produced in alternating 48-hour wet-dry cycles for 12 days on AISI 430 stainless steel discs. The efficacy of 11 commercially available disinfectants, 4 detergents, and 2 contactless interventions were tested using a modified standardized product test. Reduction in viability, direct transferability, cross transmission (via glove intermediate), and DSB recovery after treatment were measured. RESULTS Of 11 disinfectants, 9 were effective in killing and removing bacteria from S. aureus DSBs with >4 log10 reduction. Only 2 disinfectants, sodium dichloroisocyanurate 1,000 ppm and peracetic acid 3,500 ppm, were able to lower both direct and cross transmission of bacteria (<2 compression contacts positive for bacterial growth). Of 11 disinfectants, 8 could not prevent DSB recovery for >2 days. Treatments not involving mechanical action (vaporized hydrogen peroxide and cold atmospheric plasma) were ineffective, producing <1 log10 reduction in viability, DSB regrowth within 1 day, and 100% transferability of DSB after treatment. CONCLUSIONS Reduction in bacterial viability alone does not determine product performance against biofilm and might give a false sense of security to consumers, manufacturers and regulators. The ability to prevent bacterial transfer and biofilm recovery after treatment requires a better understanding of the effectiveness of biocidal products.
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Impact of a Whole-Room Atomizing Disinfection System on Healthcare Surface Contamination, Pathogen Transfer, and Labor Efficiency. Crit Care Explor 2021; 3:e0340. [PMID: 33623925 PMCID: PMC7892299 DOI: 10.1097/cce.0000000000000340] [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] [Indexed: 12/05/2022] Open
Abstract
Supplemental Digital Content is available in the text. Healthcare surfaces contribute to nosocomial disease transmission. Studies show that despite standard guidelines and practices for cleaning and disinfection, secondary infection spread among healthcare workers and patients is common in ICUs. Manual terminal cleaning practices in healthcare are subject to highly variable results due to differences in training, compliance, and other inherent complexities. Standard cleaning practices combined with no-touch disinfecting technologies, however, may significantly lower nosocomial infection rates. The objective of this study was to evaluate the efficacy of a whole-room, no-touch disinfection intervention to reduce the concentration and cross-contamination of surface bacteria when used in tandem with manual cleaning protocols.
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Update on Interfacial Charge Transfer (IFTC) Processes on Films Inactivating Viruses/Bacteria under Visible Light: Mechanistic Considerations and Critical Issues. Catalysts 2021. [DOI: 10.3390/catal11020201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review presents an update describing binary and ternary semiconductors involving interfacial charge transfer (IFCT) in composites made up by TiO2, CuO, Ag2O and Fe2O3 used in microbial disinfection (bacteria and viruses). The disinfection mechanism, kinetics and generation of reactive oxygen species (ROS) in solution under solar/visible light are discussed. The surface properties of the photocatalysts and their active catalytic sites are described in detail. Pathogenic biofilm inactivation by photocatalytic thin films is addressed since biofilms are the most dangerous agents of spreading pathogens into the environment.
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc36. [PMID: 33520601 PMCID: PMC7818848 DOI: 10.3205/dgkh000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI – Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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Daily Disinfection of the Hospital Room and Non-critical Items: Barriers and Practical Approaches. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00743-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Cresswell K, Sheikh A. Can Disinfection Robots Reduce the Risk of Transmission of SARS-CoV-2 in Health Care and Educational Settings? J Med Internet Res 2020; 22:e20896. [PMID: 32903196 PMCID: PMC7511221 DOI: 10.2196/20896] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
We explore the opportunities and challenges surrounding the use of disinfection robots to reduce the risk of SARS-CoV-2 transmission in health care and educational settings. Although there is some potential for deploying robots to help with manual cleaning, the evidence base is mixed, and we highlight that there needs to be work to establish and enhance the effectiveness of these robots in inactivating the virus.
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Affiliation(s)
- Kathrin Cresswell
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
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Rodriguez JA, Hooper G. Adenosine Triphosphate-Bioluminescence Technology as an Adjunct Tool to Validate Cleanliness of Surgical Instruments. AORN J 2020; 110:596-604. [PMID: 31774154 DOI: 10.1002/aorn.12864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Perioperative and sterile processing department personnel commonly use visual inspection to validate surgical instrument cleanliness. This validation process does not detect microbes (eg, bacteria, viruses) and the resultant inadequately decontaminated instruments can put patients at risk for developing surgical site infections. Sterile processing department personnel should use a rapid, straightforward method to validate surgical instrument cleanliness objectively. During a quality improvement project at a military treatment facility, staff members found that adenosine triphosphate (ATP)-based technology was a viable and affordable solution for detecting bioburden and validating cleaning practices. The project design compared manually and mechanically cleaned cannulated instruments (59 of each) and identified 16 contaminated instruments, 14 of which had been manually cleaned. The contamination rate after mechanical cleaning was significantly lower (P = .0022) compared with manual cleaning. As a result of this quality improvement project, this facility fully implemented the technology to validate instrument cleaning.
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Rawlinson S, Asadi F, Saraqi H, Childs B, Ciric L, Cloutman-Green E. Does size matter? The impact of a small but targeted cleaning training intervention within a paediatric ward. Infect Prev Pract 2020; 2:100083. [PMID: 34368722 PMCID: PMC8336042 DOI: 10.1016/j.infpip.2020.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cleaning is a critical tool for infection prevention and control, and is a key intervention for preventing healthcare associated infections (HCAIs) and controlling intermediate transmission routes between patient and environment. This study sought to identify potential areas of weakness in clinical surface cleaning, and assess the effectiveness of a staff group specific training intervention. Observations One-hundred hours of audit observations in a paediatric cardiac intensive care unit (CICU) assessed surface cleaning technique of healthcare staff within bedspaces. Cleaning was assessed with a 5-component bundle, with each cleaning opportunity scored out of five. Training Intervention Fifty hours of audit observations before and after a training intervention tested the efficacy of a staff group specific education intervention. The intervention was developed and implemented for 69% of nurses and 100% of cleaners. Results One hundred and eighteen cleaning opportunities were observed before training, and scored an average of 2.4. One hundred and twenty-one cleaning opportunities were observed after training and scored an average 3.0. On average, before training, each cleaning opportunity by nurses and cleaners fulfilled 2.4 and 2.5, respectively, of the 5 bundle components. Following training, this improved to 3.3 and 2.9 respectively. There was a statistically significant improvement in bundle scores for nurses (P=.004) and cleaners (P=.0003). Conclusions Surface wipe methods were inconsistent between all staff groups. The education based intervention resulted in a small improvement in most of the cleaning components. This study has identified how a small but targeted cleaning training intervention can have a significant (P= <.0001) impact on cleaning bundle compliance for both nurses and cleaners.
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Affiliation(s)
- Stacey Rawlinson
- Department of Civil, Environmental and Geomatic Engineering, University College London, Chadwick Building, London, UK
| | - Faiza Asadi
- Great Ormond Street Hospital NHS Foundation Trust, Camellia Botnar Laboratories, Department of Microbiology, London, UK
| | - Helen Saraqi
- Great Ormond Street Hospital NHS Foundation Trust, Camellia Botnar Laboratories, Department of Microbiology, London, UK
| | - Barbara Childs
- Great Ormond Street Hospital NHS Foundation Trust, Cardiac Intensive Care Unit, London, UK
| | - Lena Ciric
- Department of Civil, Environmental and Geomatic Engineering, University College London, Chadwick Building, London, UK
| | - Elaine Cloutman-Green
- Department of Civil, Environmental and Geomatic Engineering, University College London, Chadwick Building, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, Camellia Botnar Laboratories, Department of Microbiology, London, UK
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Surface sampling within a pediatric ward-how multiple factors affect cleaning efficacy. Am J Infect Control 2020; 48:740-745. [PMID: 31818511 DOI: 10.1016/j.ajic.2019.10.023] [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: 09/05/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND The objectives of this study were to assess the number of organisms present on different surfaces within a clinical environment before and after cleaning took place, and to identify the impact of cleaning. The study involved extensive 2-week microbiological environmental monitoring of an entire ward before and after cleaning; the ward was located within a pediatric hematology-oncology ward comprised of a day unit and outpatient ward. METHODS Tryptone soya agar contact plates were used to take a total of 1,160 surface samples before and after cleaning from 55 predetermined sites. Samples were taken from representative surfaces throughout the ward representing a variety of materials, surface heights, functions, and distances from patients, as well as both high-touch and infrequently touched surfaces. RESULTS After surface cleaning was undertaken within the ward, there was a significant difference between the amount of colony-forming units (CFUs) recovered before and after cleaning (P < .0001). Cleaning produced an average CFU reduction of 68% throughout the ward environment. The corridor was the most contaminated area within the ward. There were differences in the CFUs among the various areas within the ward, which were cleaned with varying efficiency. The surface material, who interacted with the surface, levels of initial contamination, perceived risk, and perceived cleanability were all found to have a varying impact on the cleaning effectiveness. CONCLUSIONS To the authors' current knowledge, this is the only study to assess cleaning within a pediatric ward by taking samples directly before and after cleaning. The standard of cleaning undertaken within the ward is open for discussion, and these data highlight the need for an improved cleaning intervention and can provide insight into the multitude of factors that must be considered when designing an effective training protocol.
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Fu Y, Yang Q, Xu M, Kong H, Chen H, Fu Y, Yao Y, Zhou H, Zhou J. Secondary Bacterial Infections in Critical Ill Patients With Coronavirus Disease 2019. Open Forum Infect Dis 2020; 7:ofaa220. [PMID: 32613024 PMCID: PMC7313762 DOI: 10.1093/ofid/ofaa220] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
Secondary bacterial infections occurred in 13.9% (5 of 36) of critical ill patients with coronavirus disease 2019. All 5 patients had been admitted to intensive care unit and received mechanical ventilation before developing bacterial infection. Active surveillance of culture should be performed for critically ill patients. Prevention of nosocomial infection should to be taken seriously.
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Affiliation(s)
- Yiqi Fu
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Min Xu
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China
| | - Haishen Kong
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hongchao Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China
| | - Yajie Fu
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China
| | - Yake Yao
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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49
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Determining the ideal prevention strategy for multidrug-resistance organisms in resource-limited countries: a cost-effectiveness analysis study. Epidemiol Infect 2020; 148:e176. [PMID: 32430090 PMCID: PMC7439291 DOI: 10.1017/s0950268820001120] [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] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to determine the most cost-effective strategy for the prevention and control of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) in areas with limited health resources. The study was conducted in 12 ICUs of four hospitals. The total cost for the prevention of MDROs and the secondary attack rate (SAR) of MDROs for each strategy were collected retrospectively from 2046 subjects from January to December 2017. The average cost-effectiveness ratio (CER), incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve were calculated. Hand hygiene (HH) had the lowest total cost (2149.6 RMB) and SAR of MDROs (8.8%) while single-room isolation showed the highest cost (33 700.2 RMB) and contact isolation had the highest SAR of MDROs (31.8%). The average cost per unit infection prevention was 24 427.8 RMB, with the HH strategy followed by the environment disinfection strategy (CER = 21 314.67). HH had the highest iterative cost effect under willingness to pay less than 2000 RMB. Due to the low cost for repeatability and obvious effectiveness, we conclude that HH is the optimal strategy for MDROs infections in ICUs in developing countries. The cost-effectiveness of the four prevention strategies provides some reference for developing countries but multiple strategies remain to be examined.
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50
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Oliveira BADS, Bernardes LDO, Ferreira AM, Pessalacia JDR, Furlan MCR, de Sousa ÁFL, de Andrade D, Barbosa DA, Lapão LV, dos Santos Junior AG. Impact of Educational Intervention on Cleaning and Disinfection of an Emergency Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093313. [PMID: 32397527 PMCID: PMC7246614 DOI: 10.3390/ijerph17093313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the impact of an educational intervention on the surface cleaning and disinfection of an emergency room. This is an interventional, prospective, longitudinal, analytical and comparative study. Data collection consisted of three stages (Stage 1-baseline, Stage 2-intervention and immediate assessment, Stage 3-long term assessment). For the statistical analysis, we used a significance level of α = 0.05. The Wilcoxon and the Mann-Whitney test tests were applied. We performed 192 assessments in each stage totaling 576 evaluations. Considering the ATP method, the percentage of approval increased after the educational intervention, as the approval rate for ATP was 25% (Stage 1), immediately after the intervention it went to 100% of the approval (Stage 2), and in the long run, 75% of the areas have been fully approved. Stage 1 showed the existence of significant differences between the relative light units (RLU) scores on only two surfaces assessed: dressing cart (p = 0.021) and women's toilet flush handle (p = 0.014); Stage 2 presented three results with significant differences for ATP: dressing cart (p = 0.014), women's restroom door handle (p = 0.014) and women's toilet flush handle (p = 0.014); in step III, there was no significant difference for the ATP method. Therefore, conclusively, the educational intervention had a positive result in the short term for ATP; however, the same rates are not observed with the colony-forming units (CFU), due to their high sensitivity and the visual inspection method since four surfaces had defects in their structure.
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Affiliation(s)
- Bruna Andrade dos Santos Oliveira
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Lucas de Oliveira Bernardes
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Adriano Menis Ferreira
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Juliana Dias Reis Pessalacia
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Mara Cristina Ribeiro Furlan
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Álvaro Francisco Lopes de Sousa
- Network in Exposome Human and Infectious Diseases (NEHID), School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil;
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal;
- Correspondence:
| | - Denise de Andrade
- Network in Exposome Human and Infectious Diseases (NEHID), School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil;
| | | | - Luis Velez Lapão
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal;
| | - Aires Garcia dos Santos Junior
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
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