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Basak SS, Adak A. Physicochemical methods for disinfection of contaminated surfaces - a way to control infectious diseases. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2024; 22:53-64. [PMID: 38887763 PMCID: PMC11180059 DOI: 10.1007/s40201-024-00893-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/21/2024] [Indexed: 06/20/2024]
Abstract
This paper represents the reviews of recent advancements in different physicochemical methods for disinfecting contaminated surfaces, which are considered to be responsible for transmitting different bacterial, viral, and fungal infectious diseases. Surface disinfection can be achieved by applying chemicals, UV-based processes, ionization radiation (gamma-ray, X-ray and electron beam), application of self-disinfecting surfaces, no-touch room disinfection methods, and robotic disinfection methods for built-in settings. Application of different chemicals, such as alcohols, hydrogen peroxide, peracetic acid, quaternary ammonium salts, phenol, and iodine solution, are common and economical. However, the process is time-consuming and less efficient. The use of UVC light (wavelength: 200-280 nm, generated by low vapor mercury lamps or pulse xenon light) has gained much attention for disinfecting fomites worldwide. In recent times, the combination of UV and H2O2, based on the principle of the advanced oxidation process, has been applied for disinfecting inanimate surfaces. The process is very efficient and faster than chemical and UV processes. Heavy metals like copper, silver, zinc, and other metals can inactivate microbes and are used for surface modification to produce self-disinfecting surfaces and used in healthcare facilities. In combination with UVB (280-315 nm) and UVA (315-400 nm), titanium oxide has been utilized for disinfecting contaminated surfaces. Ionization radiation, one of the advanced methods, can be used in disinfecting medical devices and drugs. Post-COVID-19 pandemic, the no-touch and robotic disinfection methods utilizing chemicals or UVC lights have received much importance in built-in settings. Among these methods, surface disinfection by applying chemicals by fogging/vaporization and UV radiation methods has been widely reported in the literature compared to other methods. Supplementary Information The online version contains supplementary material available at 10.1007/s40201-024-00893-2.
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Affiliation(s)
- Shib Sankar Basak
- Department of Civil Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal 711103 India
| | - Asok Adak
- Department of Civil Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal 711103 India
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Rutala WA, Donskey CJ, Weber DJ. Disinfection and sterilization: New technologies. Am J Infect Control 2023; 51:A13-A21. [PMID: 37890943 DOI: 10.1016/j.ajic.2023.01.004] [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: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Adherence to professional guidelines and/or manufacturer's instructions for use regarding proper disinfection and sterilization of medical devices is crucial to preventing cross transmission of pathogens between patients. Emerging pathogens (e.g., Candida auris) and complex medical devices provide new challenges. METHODS A search for published English articles on new disinfection and sterilization technologies was conducted by Google, Google scholar and PubMed. RESULTS Several new disinfection methods or products (e.g., electrostatic spraying, new sporicides, colorized disinfectants, "no touch" room decontamination, continuous room decontamination) and sterilization technologies (e.g., new sterilization technology for endoscopes) were identified. CONCLUSIONS These technologies should reduce patient risk.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Care, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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van der Starre CM, Cremers-Pijpers SAJ, van Rossum C, Bowles EC, Tostmann A. The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation. Antimicrob Resist Infect Control 2022; 11:149. [PMID: 36471395 PMCID: PMC9724435 DOI: 10.1186/s13756-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices. METHODS The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H2O2 vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy. RESULTS In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes. CONCLUSION Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.
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Affiliation(s)
- Caroline M. van der Starre
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Suzan A. J. Cremers-Pijpers
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carsten van Rossum
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Edmée C. Bowles
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Alma Tostmann
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Amodeo D, Lucarelli V, De Palma I, Puccio A, Nante N, Cevenini G, Messina G. Efficacy of violet-blue light to inactive microbial growth. Sci Rep 2022; 12:20179. [PMID: 36424450 PMCID: PMC9691702 DOI: 10.1038/s41598-022-24563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
The increase in health care-associated infections and antibiotic resistance has led to a growing interest in the search for innovative technologies to solve these problems. In recent years, the interest of the scientific community has focused on violet-blue light at 405 nm (VBL405). This study aimed to assess the VBL405 efficiency in reducing microbial growth on surfaces and air. This descriptive study run between July and October 2020. Petri dishes were contaminated with P. aeruginosa, E. coli, S. aureus, S. typhimurium, K. pneumoniae and were placed at 2 and 3 m from a LED light source having a wavelength peak at 405 nm and an irradiance respectively of 967 and 497 µW/cm2. Simultaneously, the air in the room was sampled for 5 days with two air samplers (SAS) before and after the exposition to the VBL405 source. The highest microbial reduction was reached 2 m directly under the light source: S. typhimurium (2.93 log10), K. pneumoniae (2.30 log10), S. aureus (3.98 log10), E. coli (3.83 log10), P. aeruginosa (3.86 log10). At a distance of 3 m from the light source, the greatest reduction was observed for S. aureus (3.49 log10), and P. aeruginosa (3.80 log10). An average percent microbial reduction of about 70% was found in the sampled air after 12 h of exposure to VBL405. VBL405 has proven to contrast microbial growth on the plates. Implementing this technology in the environment to provide continuous disinfection and to control microbial presence, even in the presence of people, may be an innovative solution.
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Affiliation(s)
- Davide Amodeo
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Valentina Lucarelli
- grid.9024.f0000 0004 1757 4641Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Isa De Palma
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Puccio
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Nicola Nante
- grid.9024.f0000 0004 1757 4641Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gabriele Cevenini
- grid.9024.f0000 0004 1757 4641Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gabriele Messina
- grid.9024.f0000 0004 1757 4641Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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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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Automated room decontamination: report of a Healthcare Infection Society Working Party. J Hosp Infect 2022; 124:97-120. [DOI: 10.1016/j.jhin.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 01/24/2023]
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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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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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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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Dancer SJ, King MF. Systematic review on use, cost and clinical efficacy of automated decontamination devices. Antimicrob Resist Infect Control 2021; 10:34. [PMID: 33579386 PMCID: PMC7881692 DOI: 10.1186/s13756-021-00894-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/21/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations. OBJECTIVES This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates. METHODS A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted. RESULTS While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors. CONCLUSION There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire, G75 8RG, Scotland, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK.
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11
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Kanamori H, Rutala WA, Gergen MF, Sickbert-Bennett EE, Knelson LP, Anderson DJ, Sexton DJ, Weber DJ. Microbial Assessment of Health Care-Associated Pathogens on Various Environmental Sites in Patient Rooms After Terminal Room Disinfection. Open Forum Infect Dis 2021; 8:ofab008. [PMID: 33575427 PMCID: PMC7863860 DOI: 10.1093/ofid/ofab008] [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: 12/17/2020] [Accepted: 01/01/2021] [Indexed: 11/14/2022] Open
Abstract
We examined the microbial burden on hospital room environmental sites after standard (quaternary ammonium [Quat]) or enhanced disinfection (quat/ultraviolet light [UV-C], bleach, or bleach/UV-C). An enhanced terminal room disinfection reduced the microbial burden of epidemiologically important pathogens on high-touch surfaces in patient rooms, especially sites around the bed, better than standard room disinfection.
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Affiliation(s)
- Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maria F Gergen
- Hospital Epidemiology, University of North Carolina Health, Chapel Hill, North Carolina, USA
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Hospital Epidemiology, University of North Carolina Health, Chapel Hill, North Carolina, USA
| | - Lauren P Knelson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel J Sexton
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Hospital Epidemiology, University of North Carolina Health, Chapel Hill, North Carolina, USA
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12
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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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13
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Antimicrobial activity of a continuously active disinfectant against healthcare pathogens. Infect Control Hosp Epidemiol 2020; 40:1284-1286. [PMID: 31556367 DOI: 10.1017/ice.2019.260] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only ∼2 log10 reduction occurred with carbapenem-resistant Enterobacter spp and K. pneumoniae, and antibiotic-susceptible K. pneumoniae.
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14
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Otter J, Yezli S, Barbut F, Perl T. An overview of automated room disinfection systems: When to use them and how to choose them. DECONTAMINATION IN HOSPITALS AND HEALTHCARE 2020. [PMCID: PMC7153347 DOI: 10.1016/b978-0-08-102565-9.00015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.
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Affiliation(s)
- J.A. Otter
- NIHR Health Protection Research Unit (HPRU) in HCAIs and AMR at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, United Kingdom
| | - S. Yezli
- Global Centre for Mass Gatherings Medicine, WHO Collaborating Centre for Mass Gatherings Medicine, Ministry of Health-Public Health Directorate, Riyadh, Kingdom of Saudi Arabia
| | - F. Barbut
- National Reference Laboratory for C. difficile, Infection Control Unit, Hôpital Saint Antoine, Paris, France,INSERM S-1139, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - T.M. Perl
- Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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15
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Ellingson KD, Pogreba-Brown K, Gerba CP, Elliott SP. Impact of a Novel Antimicrobial Surface Coating on Health Care–Associated Infections and Environmental Bioburden at 2 Urban Hospitals. Clin Infect Dis 2019; 71:1807-1813. [DOI: 10.1093/cid/ciz1077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Approximately 1 in 25 people admitted to a hospital in the United States will suffer a health care–associated infection (HAI). Environmental contamination of hospital surfaces contributes to HAI transmission. We investigated the impact of an antimicrobial surface coating on HAIs and environmental bioburdens at 2 urban hospitals.
Methods
A transparent antimicrobial surface coating was applied to patient rooms and common areas in 3 units at each hospital. Longitudinal regression models were used to compare changes in hospital-onset multidrug-resistant organism bloodstream infection (MDRO-BSI) and Clostridium difficile infection (CDI) rates in the 12 months before and after application of the surface coating. Incidence rate ratios (IRRs) were compared for units receiving the surface coating application and for contemporaneous control units. Environmental samples were collected pre- and post-application to identify bacterial colony forming units (CFUs) and the percent of sites positive for select, clinically relevant pathogens.
Results
Across both hospitals, there was a 36% decline in pooled HAIs (combined MDRO-BSIs and CDIs) in units receiving the surface coating application (IRR, 0.64; 95% confidence interval [CI], .44–.91), and no decline in the control units (IRR, 1.20; 95% CI, .92–1.55). Following the surface application, the total bacterial CFUs at Hospitals A and B declined by 79% and 75%, respectively; the percentages of environmental samples positive for clinically relevant pathogens also declined significantly for both hospitals.
Conclusions
Statistically significant reductions in HAIs and environmental bioburdens occurred in the units receiving the antimicrobial surface coating, suggesting the potential for improved patient outcomes and persistent reductions in environmental contamination. Future studies should assess optimal implementation methods and long-term impacts.
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Affiliation(s)
- Katherine D Ellingson
- Department of Epidemiology and Biostatistics, The University of Arizona College of Public Health, Tucson, Arizona, USA
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, The University of Arizona College of Public Health, Tucson, Arizona, USA
| | - Charles P Gerba
- Department of Soil, Water, and Environmental Science, The University of Arizona, Tucson, Arizona, USA
| | - Sean P Elliott
- The University of Arizona College of Medicine, Tucson, Arizona, USA
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16
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Evaluation of dilute hydrogen peroxide technology for continuous room decontamination of multidrug-resistant organisms. Infect Control Hosp Epidemiol 2019; 40:1438-1439. [PMID: 31576788 DOI: 10.1017/ice.2019.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Rutala WA, Weber DJ. Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach. Am J Infect Control 2019; 47S:A96-A105. [PMID: 31146858 DOI: 10.1016/j.ajic.2019.01.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.
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Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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18
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Clemente A, Ramsden JJ, Wright A, Iza F, Morrissey JA, Li Puma G, Malik DJ. Staphylococcus aureus resists UVA at low irradiance but succumbs in the presence of TiO2 photocatalytic coatings. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 193:131-139. [PMID: 30851512 DOI: 10.1016/j.jphotobiol.2019.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 11/25/2022]
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19
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Garvey MI, Wilkinson MAC, Bradley CW, Holden KL, Holden E. Wiping out MRSA: effect of introducing a universal disinfection wipe in a large UK teaching hospital. Antimicrob Resist Infect Control 2018; 7:155. [PMID: 30574298 PMCID: PMC6299988 DOI: 10.1186/s13756-018-0445-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Contamination of the inanimate environment around patients constitutes an important reservoir of MRSA. Here we describe the effect of introducing a universal disinfection wipe in all wards on the rates of MRSA acquisitions and bacteraemias across a large UK teaching hospital. Methods A segmented Poisson regression model was used to detect any significant changes in the monthly numbers per 100,000 bed days of MRSA acquisitions and bacteraemias from April 2013 - December 2017 across QEHB. Results From April 2013 to April 2016, cleaning of ward areas and multi-use patient equipment by nursing staff consisted of a two-wipe system. Firstly, a detergent wipe was used, which was followed by a disinfection step using an alcohol wipe. In May 2016, QEHB discontinued the use of a two-wipe system for cleaning and changed to a one wipe system utilising a combined cleaning and disinfection wipe containing a quaternary ammonium compound. The segmented Poisson regression model demonstrated that the rate of MRSA acquisition/100,000 patient bed days was affected by the introduction of the new wiping regime (20.7 to 9.4 per 100,000 patient bed days; p <0.005). Discussion Using a Poisson model we demonstrated that the average hospital acquisition rate of MRSA/100,000 patient bed days reduced by 6.3% per month after the introduction of the new universal wipe. Conclusion We suggest that using a simple one wipe system for nurse cleaning is an effective strategy to reduce the spread and incidence of healthcare associated MRSA.
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Affiliation(s)
- Mark I. Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB England
- Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, England
| | - Martyn A. C. Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB England
| | - Craig W. Bradley
- Gloucestershire Hospital’s NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN England
| | - Kerry L. Holden
- Gloucestershire Hospital’s NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN England
| | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB England
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Colin M, Klingelschmitt F, Charpentier E, Josse J, Kanagaratnam L, De Champs C, Gangloff SC. Copper Alloy Touch Surfaces in Healthcare Facilities: An Effective Solution to Prevent Bacterial Spreading. MATERIALS 2018; 11:ma11122479. [PMID: 30563265 PMCID: PMC6317222 DOI: 10.3390/ma11122479] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/15/2022]
Abstract
In the healthcare environment, microorganisms' cross-transmission between inanimate surfaces and patients or healthcare workers can lead to healthcare-associated infections. A recent interest has grown to create antimicrobial copper touch surfaces, in order to counteract microbial spread in the healthcare environment. For the first time, five French long-term care facilities were at 50% fitted with copper alloys door handles and handrails. Related to the environmental bacterial contamination, 1400 samples were carried out on copper and control surfaces over three years after copper installation. In addition, some copper door handles were taken from the different facilities, and their specific activity against methicillin-resistant S. aureus (MRSA) was tested in vitro. In comparison to control surfaces, copper door handles and handrails revealed significantly lower contamination levels. This difference was observed in the five long-term care facilities and it persists through the three years of the study. High and extreme levels of bacterial contamination were less frequent on copper surfaces. Although, the antibacterial activity of copper surfaces against MRSA was lowered after three years of regular use, it was still significant as compared to inert control surfaces. Therefore, copper containing surfaces are promising actors in the non-spreading of environmental bacterial contamination in healthcare facilities.
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Affiliation(s)
- Marius Colin
- Biomatériaux et Inflammation en Site Osseux, EA 4691, SFR CAP-Santé, UFR de Pharmacie, Université de Reims Champagne Ardenne, 51100 Reims, France.
| | - Flora Klingelschmitt
- Biomatériaux et Inflammation en Site Osseux, EA 4691, SFR CAP-Santé, UFR de Pharmacie, Université de Reims Champagne Ardenne, 51100 Reims, France.
| | - Emilie Charpentier
- Biomatériaux et Inflammation en Site Osseux, EA 4691, SFR CAP-Santé, UFR de Pharmacie, Université de Reims Champagne Ardenne, 51100 Reims, France.
- Service de Microbiologie, UFR pharmacie, Université de Reims Champagne-Ardenne, 51100 Reims, France.
| | - Jérôme Josse
- Biomatériaux et Inflammation en Site Osseux, EA 4691, SFR CAP-Santé, UFR de Pharmacie, Université de Reims Champagne Ardenne, 51100 Reims, France.
| | | | - Christophe De Champs
- Inserm UMR-S 1250 P3Cell, SFR CAP-Santé, Université de Reims Champagne-Ardenne, 51100 Reims, France.
| | - Sophie C Gangloff
- Biomatériaux et Inflammation en Site Osseux, EA 4691, SFR CAP-Santé, UFR de Pharmacie, Université de Reims Champagne Ardenne, 51100 Reims, France.
- Service de Microbiologie, UFR pharmacie, Université de Reims Champagne-Ardenne, 51100 Reims, France.
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Kim MH, Lee SG, Kim KS, Heo YJ, Oh JE, Jeong SJ. Environmental disinfection with photocatalyst as an adjunctive measure to control transmission of methicillin-resistant Staphylococcus aureus: a prospective cohort study in a high-incidence setting. BMC Infect Dis 2018; 18:610. [PMID: 30509196 PMCID: PMC6276245 DOI: 10.1186/s12879-018-3555-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Environmental disinfection with continuously antimicrobial surfaces could offer superior control of surface bioburden. We sought to decide the efficacy of photocatalyst antimicrobial coating in reducing methicillin-resistant Staphylococcus aureus (MRSA) acquisition in high incidence setting. Methods We performed prospective cohort study involving patients hospitalized in medical intensive care unit. A titanium dioxide-based photocatalyst was coated on high touch surfaces and walls. Five months of pre-intervention data were compared with five months of post-intervention data. The incidence rates of multidrug-resistant organism acquisition and the rates of hospital-acquired blood stream infection, pneumonia, urinary tract infection, and Clostridium difficile–associated diseases were compared using Cox proportional hazards regression analysis. Results In total, 621 patients were included. There was significant decrease in MRSA acquisition rate after photocatalyst coating (hazard ratio, 0.37; 95% confidence interval, 0.14–0.99; p = 0.04). However, clinical identification of vancomycin-resistant Enterococcus spp. and multidrug-resistant Acinetobacter baumannii did not decrease significantly. The hazard of contracting hospital-acquired pneumonia during the intervention period compared to baseline period was 0.46 (95% confidence interval, 0.23–0.94; p = 0.03). Conclusions In conclusion, MRSA rate was significantly reduced after photocatalyst coating. We provide evidence that photocatalyst disinfection can be an adjunctive measure to control MRSA acquisition in high-incidence settings. Trial registration ISRCTN Registry (ISRCTN31972004). Registered retrospectively on November 19, 2018. Electronic supplementary material The online version of this article (10.1186/s12879-018-3555-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Hyung Kim
- Department of Internal Medicine, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Seong Gyu Lee
- Department of Laboratory Medicine, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Ki Sook Kim
- Department of Infection Control Office, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Yoon Ji Heo
- Department of Infection Control Office, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Ji Eun Oh
- Department of Nursing, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Bache S, Maclean M, Gettinby G, Anderson J, MacGregor S, Taggart I. Universal decontamination of hospital surfaces in an occupied inpatient room with a continuous 405 nm light source. J Hosp Infect 2018; 98:67-73. [DOI: 10.1016/j.jhin.2017.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
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Fitton K, Barber KR, Karamon A, Zuehlke N, Atwell S, Enright S. Long-acting water-stable organosilane agent and its sustained effect on reducing microbial load in an intensive care unit. Am J Infect Control 2017; 45:1214-1217. [PMID: 28732741 DOI: 10.1016/j.ajic.2017.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Contaminated hospital surfaces contribute significantly to the transmission of health care-associated infections. Although disinfectants reduce bioburden by up to 99%, bacterial growth can rebound within hours to precleaning levels. We tested the effectiveness of an innovative, long-acting water-stable organosilane (WSO) to achieve sustained decreases in bioburden on hard surfaces. METHODS A 5-month prospective, randomized, double-blind controlled study was performed. Eighteen intensive care unit rooms were randomly divided into placebo or treatment groups. Hard surfaces in all rooms were cleaned using the same protocol, except the placebo surfaces were cleaned with an inert saline solution and the treatment surfaces were treated with the WSO. Binomial regression with repeated measures were used to assess mean reductions in total bioburden as measured by colony forming units. RESULTS The placebo resulted in average reductions in total colony forming units of 35% to 40% (relative risk reduction [RRR], 0.65; P < .01) and the WSO group averaged reductions of colony forming units by 66% to 99% (RRR, 0.55; P < .001). Total Staphylococcus aureus increased among the placebo rooms 30% (RRR, 0.69; P < .001), whereas in treatment rooms there was a reduction of 50%-60% (RRR, 0.57; P < .01). Although both sets of rooms saw reductions in bioburden or colony forming units, application of the WSO resulted in larger reductions. There was also greater variability in reductions in the placebo arm. CONCLUSION This is the first randomized, double-blind controlled study of an innovative WSO on high-touch hard surfaces at risk for high bioburdens. Sustained reductions of bioburden with the monthly application of this unique WSO may be associated with significant reductions in the risk of health care-associated infections.
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Morris DO, Loeffler A, Davis MF, Guardabassi L, Weese JS. Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2017; 28:304-e69. [PMID: 28516494 DOI: 10.1111/vde.12444] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple drug resistance (MDR) in staphylococci, including resistance to the semi-synthetic penicillinase-resistant penicillins such as meticillin, is a problem of global proportions that presents serious challenges to the successful treatment of staphylococcal infections of companion animals. OBJECTIVES The objective of this document is to provide harmonized recommendations for the diagnosis, prevention and treatment of meticillin-resistant staphylococcal infections in dogs and cats. METHODS The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. CONCLUSIONS Adherence to guidelines for the diagnosis, laboratory reporting, judicious therapy (including restriction of use policies for certain antimicrobial drugs), personal hygiene, and environmental cleaning and disinfection may help to mitigate the progressive development and dissemination of MDR staphylococci.
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Affiliation(s)
- Daniel O Morris
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia, PA, 19104, USA
| | - Anette Loeffler
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
| | - Meghan F Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Luca Guardabassi
- Department of Biomedical Sciences, School of Veterinary Medicine, Ross University, Basseterre, St Kitts and Nevis, West Indies
| | - J Scott Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada, N1G 2W1
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Bloomfield SF, Carling PC, Exner M. A unified framework for developing effective hygiene procedures for hands, environmental surfaces and laundry in healthcare, domestic, food handling and other settings. GMS HYGIENE AND INFECTION CONTROL 2017; 12:Doc08. [PMID: 28670508 PMCID: PMC5476842 DOI: 10.3205/dgkh000293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hygiene procedures for hands, surfaces and fabrics are central to preventing spread of infection in settings including healthcare, food production, catering, agriculture, public settings, and home and everyday life. They are used in situations including hand hygiene, clinical procedures, decontamination of environmental surfaces, respiratory hygiene, food handling, laundry hygiene, toilet hygiene and so on. Although the principles are common to all, approaches currently used in different settings are inconsistent. A concern is the use of inconsistent terminology which is misleading, especially to people we need to communicate with such as the public or cleaning professionals. This paper reviews the data on current approaches, alongside new insights to developing hygiene procedures. Using this data, we propose a more scientifically-grounded framework for developing procedures that maximize protection against infection, based on consistent principles and terminology, and applicable across all settings. A key feature is use of test models which assess the state of surfaces after treatment rather than product performance alone. This allows procedures that rely on removal of microbes to be compared with those employing chemical or thermal inactivation. This makes it possible to ensure that a consistent "safety target level" is achieved regardless of the type of procedure used, and allows us deliver maximum health benefit whilst ensuring prudent usage of antimicrobial agents, detergents, water and energy.
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Affiliation(s)
- Sally F. Bloomfield
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- International Scientific Forum on Home Hygiene, Montacute, Somerset, United Kingdom
| | - Philip C. Carling
- Department of Infectious Diseases, Carney Hospital and Boston University School of Medicine, Boston, USA
| | - Martin Exner
- Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
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Garvey MI, Bradley CW, Holden KL, Oppenheim B. Outbreak of clonal complex 22 Panton-Valentine leucocidin-positive methicillin-resistant Staphylococcus aureus. J Infect Prev 2017; 18:224-230. [PMID: 29317899 DOI: 10.1177/1757177417695647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 02/05/2017] [Indexed: 11/16/2022] Open
Abstract
Aims We describe the investigation and control of a nosocomial outbreak of Sequence Type (ST) 22 MRSA containing the Panton-Valentine leucocidin (PVL) toxin in an acute multispecialty surgical ward at University Hospital Birmingham NHS Foundation Trust. Methods A patient was classed as acquiring methicillin-resistant Staphylococcus aureus (MRSA) if they had a negative admission screen and then had MRSA isolated from a subsequent screen or clinical specimen. Spa typing and pulsed field gel electrophoresis (PFGE) was undertaken to confirm MRSA acquisitions. Findings The Infection Prevention and Control Team were alerted to the possibility of an outbreak when two patients acquired MRSA while being on the same ward. In total, five patients were involved in the outbreak where four patients acquired the PVL-MRSA clone from an index patient due to inadequate infection control practice. Two patients who acquired the strain developed a bloodstream infection. Infection control measures included decolonisation of affected patients, screening of all patients on the ward, environmental sampling and enhanced cleaning. Discussion Our study highlights the potential risk of spread and pathogenicity of this clone in the healthcare setting. Spa typing and PFGE assisted with confirmation of the outbreak and implementation of infection control measures. In outbreaks, microbiological typing should be undertaken as a matter of course as without specialist typing identification of the described outbreak would have been delayed.
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Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham UK
| | - Craig W Bradley
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham UK
| | - Kerry L Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham UK
| | - Beryl Oppenheim
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham UK
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Lei H, Jones RM, Li Y. Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcus aureus. BMC Infect Dis 2017; 17:85. [PMID: 28100179 PMCID: PMC5242018 DOI: 10.1186/s12879-016-2120-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/14/2016] [Indexed: 01/20/2023] Open
Abstract
Background Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited. Methods In this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions – whole room cleaning and wipe cleaning of touched surfaces – were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention. Results Whole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings. Conclusions Daily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2120-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hao Lei
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
| | - Rachael M Jones
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
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Adams CE, Smith J, Watson V, Robertson C, Dancer SJ. Examining the association between surface bioburden and frequently touched sites in intensive care. J Hosp Infect 2016; 95:76-80. [PMID: 27912981 DOI: 10.1016/j.jhin.2016.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Critical care patients are at increased risk of infection. Near-patient surfaces act as reservoirs of microbial soil, which may contain pathogens. AIM To correlate soil levels with hand-touch frequency of near-patient sites in an intensive care unit (ICU). METHODS Five sites around each bed in a 10-bed ICU were screened for total microbial soil (cfu/cm2) and Staphylococcus aureus every month for 10 months. Selected sites were infusion pump and cardiac monitor, left and right bedrails, and bed table. Ten 1 h covert audits of hand-touch frequency of these sites were performed in order to provide an average hand-touch count, which was modelled against soil levels obtained from microbiological screening. FINDINGS Seven of 10 staphylococci were found in conjunction with gross contamination of a specific site (P=0.005) and the same proportion from three most frequently touched sites (bedrails and bed table). There was a linear association between four sites demonstrating gross microbial contamination (>12 cfu/cm2) and mean number of hand-touch counts (P=0.08). The bed table was handled most but was not the most contaminated site. We suspected that customary placement of alcohol gel containers on bed tables may have reduced microbiological yield. Removing the gel container from one table confirmed its inhibitory effect on microbial contamination after rescreening (19% vs 50% >12 cfu/cm2: P=0.007). CONCLUSION Surface bioburden at near-patient sites in ICU is associated with hand-contact frequencies by staff and visitors. This supports the need for targeted hygienic cleaning in a high-risk healthcare environment.
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Affiliation(s)
- C E Adams
- Department of Anaesthesia, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - J Smith
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - V Watson
- Department of Anaesthesia, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, Glasgow, UK; International Prevention Research Institute, Lyon, France
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
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Surface Disinfectants for Burn Units Evaluated by a New Double Method, Using Microorganisms Recently Isolated From Patients, on a Surface Germ-Carrier Model. J Burn Care Res 2016; 38:e663-e669. [PMID: 27685810 DOI: 10.1097/bcr.0000000000000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Assessment methods of surface disinfection based on international standards (Environmental Protection Agency, European Norms, etc) do not correspond to hospital reality. New evaluation methods of surfaces disinfection are proposed to choose the most suitable disinfectant to act against clinically relevant microorganisms detected on the surfaces of burn units. 1) "Immediate effect": 6 products were compared using a glass germ-carrier and 20 recently isolated microorganisms from different patients in the intensive care units. Disinfectants were applied with microfiber cloths. Log10 reductions were calculated for colony forming units produced after 15 minutes of disinfectant application. 2) "Residual effect": the glass germ-carriers were previously impregnated with one of the studied disinfectants. After a 30-minute wait period, they were then contaminated with 1 microorganism (from the 20 above-mentioned). After 15 minutes, the disinfectant was inhibited and the log10 reduction of colony forming units was assessed. The immediate effect (disinfection and microorganism dragging and transferring from the surface to the cloth) produced complete elimination of the inoculums for all products used except one (a diluted quaternary ammonium). The average residual effect found on the 20 microorganisms was moderate: 2 to 3 log10 colony forming unit reduction with chlorine dioxide or 0.5% chlorhexidine (and lower with the other products), obtaining surfaces refractory to recontamination, at least, during 30 minutes. Two tests should be performed before advising surface disinfectant: 1) direct effect and 2) residual efficacy. These characteristics should be considered when a new surface disinfectant is chosen. Chlorine dioxide has a similar or better direct effect than sodium hypochlorite and a similar residual effect than chlorhexidine.
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Rutala WA, Weber DJ. Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues. Infect Dis Clin North Am 2016; 30:609-37. [PMID: 27515140 PMCID: PMC7134755 DOI: 10.1016/j.idc.2016.04.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
When properly used, disinfection and sterilization can ensure the safe use of invasive and noninvasive medical devices. The method of disinfection and sterilization depends on the intended use of the medical device: critical items (contact sterile tissue) must be sterilized before use; semicritical items (contact mucous membranes or nonintact skin) must be high-level disinfected; and noncritical items (contact intact skin) should receive low-level disinfection. Cleaning should always precede high-level disinfection and sterilization. Current disinfection and sterilization guidelines must be strictly followed.
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Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA.
| | - David J Weber
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA
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Rutala WA, Weber DJ. Monitoring and improving the effectiveness of surface cleaning and disinfection. Am J Infect Control 2016; 44:e69-76. [PMID: 27131138 DOI: 10.1016/j.ajic.2015.10.039] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 02/08/2023]
Abstract
Disinfection of noncritical environmental surfaces and equipment is an essential component of an infection prevention program. Noncritical environmental surfaces and noncritical medical equipment surfaces may become contaminated with infectious agents and may contribute to cross-transmission by acquisition of transient hand carriage by health care personnel. Disinfection should render surfaces and equipment free of pathogens in sufficient numbers to prevent human disease (ie, hygienically clean).
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Weber DJ, Rutala WA, Anderson DJ, Chen LF, Sickbert-Bennett EE, Boyce JM. Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials. Am J Infect Control 2016; 44:e77-84. [PMID: 27131140 PMCID: PMC7132689 DOI: 10.1016/j.ajic.2015.11.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 02/08/2023]
Abstract
Over the last decade, substantial scientific evidence has accumulated that indicates contamination of environmental surfaces in hospital rooms plays an important role in the transmission of key health care-associated pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, Acinetobacter spp). For example, a patient admitted to a room previously occupied by a patient colonized or infected with one of these pathogens has a higher risk for acquiring one of these pathogens than a patient admitted to a room whose previous occupant was not colonized or infected. This risk is not surprising because multiple studies have demonstrated that surfaces in hospital rooms are poorly cleaned during terminal cleaning. To reduce surface contamination after terminal cleaning, no touch methods of room disinfection have been developed. This article will review the no touch methods, ultraviolet light devices, and hydrogen peroxide systems, with a focus on clinical trials which have used patient colonization or infection as an outcome. Multiple studies have demonstrated that ultraviolet light devices and hydrogen peroxide systems have been shown to inactivate microbes experimentally plated on carrier materials and placed in hospital rooms and to decontaminate surfaces in hospital rooms naturally contaminated with multidrug-resistant pathogens. A growing number of clinical studies have demonstrated that ultraviolet devices and hydrogen peroxide systems when used for terminal disinfection can reduce colonization or health care-associated infections in patients admitted to these hospital rooms.
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Affiliation(s)
- David J Weber
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - William A Rutala
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Luke F Chen
- Division of Infectious Diseases, Duke University Medical School, Durham, NC
| | - Emily E Sickbert-Bennett
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - John M Boyce
- Division of Infectious Diseases, Yale School of Medicine, New Haven, CT
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Beggs C, Knibbs LD, Johnson GR, Morawska L. Environmental contamination and hospital-acquired infection: factors that are easily overlooked. INDOOR AIR 2015; 25:462-74. [PMID: 25346039 DOI: 10.1111/ina.12170] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/16/2014] [Indexed: 05/20/2023]
Abstract
There is an ongoing debate about the reasons for and factors contributing to healthcare-associated infection (HAI). Different solutions have been proposed over time to control the spread of HAI, with more focus on hand hygiene than on other aspects such as preventing the aerial dissemination of bacteria. Yet, it emerges that there is a need for a more pluralistic approach to infection control; one that reflects the complexity of the systems associated with HAI and involves multidisciplinary teams including hospital doctors, infection control nurses, microbiologists, architects, and engineers with expertise in building design and facilities management. This study reviews the knowledge base on the role that environmental contamination plays in the transmission of HAI, with the aim of raising awareness regarding infection control issues that are frequently overlooked. From the discussion presented in the study, it is clear that many unknowns persist regarding aerial dissemination of bacteria, and its control via cleaning and disinfection of the clinical environment. There is a paucity of good-quality epidemiological data, making it difficult for healthcare authorities to develop evidence-based policies. Consequently, there is a strong need for carefully designed studies to determine the impact of environmental contamination on the spread of HAI.
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Affiliation(s)
- C Beggs
- Centre for Infection Control and Biophysics, University of Bradford, Bradford, UK
| | - L D Knibbs
- School of Population Health, The University of Queensland, Herston, Qld, Australia
| | - G R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - L Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Qld, Australia
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Blazejewski C, Wallet F, Rouzé A, Le Guern R, Ponthieux S, Salleron J, Nseir S. Efficiency of hydrogen peroxide in improving disinfection of ICU rooms. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:30. [PMID: 25641219 PMCID: PMC4335785 DOI: 10.1186/s13054-015-0752-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The primary objective of this study was to determine the efficiency of hydrogen peroxide (H₂O₂) techniques in disinfection of ICU rooms contaminated with multidrug-resistant organisms (MDRO) after patient discharge. Secondary objectives included comparison of the efficiency of a vaporizator (HPV, Bioquell) and an aerosolizer using H₂O₂, and peracetic acid (aHPP, Anios) in MDRO environmental disinfection, and assessment of toxicity of these techniques. METHODS This prospective cross-over study was conducted in five medical and surgical ICUs located in one University hospital, during a 12-week period. Routine terminal cleaning was followed by H₂O₂ disinfection. A total of 24 environmental bacteriological samplings were collected per room, from eight frequently touched surfaces, at three time-points: after patient discharge (T0), after terminal cleaning (T1) and after H₂O₂ disinfection (T2). RESULTS In total 182 rooms were studied, including 89 (49%) disinfected with aHPP and 93 (51%) with HPV. At T0, 15/182 (8%) rooms were contaminated with at least 1 MDRO (extended spectrum β-lactamase-producing Gram-negative bacilli 50%, imipenem resistant Acinetobacter baumannii 29%, methicillin-resistant Staphylococcus aureus 17%, and Pseudomonas aeruginosa resistant to ceftazidime or imipenem 4%). Routine terminal cleaning reduced environmental bacterial load (P <0.001) without efficiency on MDRO (15/182 (8%) rooms at T0 versus 11/182 (6%) at T1; P = 0.371). H₂O₂ technologies were efficient for environmental MDRO decontamination (6% of rooms contaminated with MDRO at T1 versus 0.5% at T2, P = 0.004). Patient characteristics were similar in aHPP and HPV groups. No significant difference was found between aHPP and HPV regarding the rate of rooms contaminated with MDRO at T2 (P = 0.313). 42% of room occupants were MDRO carriers. The highest rate of rooms contaminated with MDRO was found in rooms where patients stayed for a longer period of time, and where a patient with MDRO was hospitalized. The residual concentration of H₂O₂ appears to be higher using aHPP, compared with HPV. CONCLUSIONS H₂O₂ treatment is efficient in reducing MDRO contaminated rooms in the ICU. No significant difference was found between aHPP and HPV regarding their disinfection efficiency.
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Affiliation(s)
- Caroline Blazejewski
- Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France.
| | - Frédéric Wallet
- Microbiology Department, University Hospital of Lille, boulevard du Pr. Leclercq, 59000, Lille Cedex, France.
| | - Anahita Rouzé
- Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France.
| | - Rémi Le Guern
- Microbiology Department, University Hospital of Lille, boulevard du Pr. Leclercq, 59000, Lille Cedex, France.
| | - Sylvie Ponthieux
- Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France.
| | - Julia Salleron
- Statistics Department, University Hospital of Lille, 1 place de Verdun, 59037, Lille Cedex, France.
| | - Saad Nseir
- Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France. .,Medicine School, Univeristy of Lille, 1 place de Verdun, 59037, Lille Cedex, France.
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Decontamination of the Hospital Environment: New Technologies for Infection Control. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0037-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Holmdahl T, Lanbeck P, Wullt M, Walder MH. A Head-to-Head Comparison of Hydrogen Peroxide Vapor and Aerosol Room Decontamination Systems. Infect Control Hosp Epidemiol 2015; 32:831-6. [DOI: 10.1086/661104] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective.New technologies have emerged in recent years for the disinfection of hospital rooms and equipment that may not be disinfected adequately using conventional methods. There are several hydrogen peroxide–based area decontamination technologies on the market, but no head-to-head studies have been performed.Design.We conducted a head-to-head in vitro comparison of a hydrogen peroxide vapor (HPV) system (Bioquell) and an aerosolized hydrogen peroxide (aHP) system (Sterinis).Setting.The tests were conducted in a purpose-built 136-m3test room.Methods.One HPV generator and 2 aHP machines were used, following recommendations of the manufacturers. Three repeated tests were performed for each system. The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouchedGeobacillus stearo-thermophilusbiological indicators (BIs). The indicators were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system.Results.All BIs were inactivated for the 3 HPV tests, compared with only 10% in the first aHP test and 79% in the other 2 aHP tests. The peak hydrogen peroxide concentration was 338 ppm for HPV and 160 ppm for aHP. The total cycle time (including aeration) was 3 and 3.5 hours for the 3 HPV tests and the 3 aHP tests, respectively. Monitoring around the perimeter of the enclosure with a handheld sensor during tests of both systems did not identify leakage.Conclusion.One HPV generator was more effective than 2 aHP machines for the inactivation ofG. stearothermophilusBIs, and cycle times were faster for the HPV system.
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Disinfection, Sterilization, and Control of Hospital Waste. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7099662 DOI: 10.1016/b978-1-4557-4801-3.00301-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Stewart M, Bogusz A, Hunter J, Devanny I, Yip B, Reid D, Robertson C, Dancer SJ. Evaluating use of neutral electrolyzed water for cleaning near-patient surfaces. Infect Control Hosp Epidemiol 2014; 35:1505-10. [PMID: 25419773 DOI: 10.1086/678595] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to monitor the microbiological effect of cleaning near-patient sites over a 48-hour period with a novel disinfectant, electrolyzed water. SETTING One ward dedicated to acute care of the elderly population in a district general hospital in Scotland. METHODS Lockers, left and right cotsides, and overbed tables in 30 bed spaces were screened for aerobic colony count (ACC), methicillin-susceptible Staphylococcus aureus (MSSA), and methicillin-resistant S. aureus (MRSA) before cleaning with electrolyzed water. Sites were rescreened at varying intervals from 1 to 48 hours after cleaning. Microbial growth was quantified as colony-forming units (CFUs) per square centimeter and presence or absence of MSSA and MRSA at each site. The study was repeated 3 times at monthly intervals. RESULTS There was an early and significant reduction in average ACC (360 sampled sites) from a before-cleaning level of 4.3 to 1.65 CFU/cm(2) at 1 hour after disinfectant cleaning ( P < .0001). Average counts then increased to 3.53 CFU/cm(2) at 24 hours and 3.68 CFU/cm(2) at 48 hours. Total MSSA/MRSA (34 isolates) decreased by 71% at 4 hours after cleaning but then increased to 155% (53 isolates) of precleaning levels at 24 hours. CONCLUSIONS Cleaning with electrolyzed water reduced ACC and staphylococci on surfaces beside patients. ACC remained below precleaning levels at 48 hours, but MSSA/MRSA counts exceeded original levels at 24 hours after cleaning. Although disinfectant cleaning quickly reduces bioburden, additional investigation is required to clarify the reasons for rebound contamination of pathogens at near-patient sites.
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Affiliation(s)
- M Stewart
- Care of the Elderly Medicine, Hairmyres Hospital, National Health Service (NHS) Lanarkshire, United Kingdom
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Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014; 27:665-90. [PMID: 25278571 PMCID: PMC4187643 DOI: 10.1128/cmr.00020-14] [Citation(s) in RCA: 375] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, East Kilbride, Lanarkshire, Scotland, United Kingdom
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Maclean M, McKenzie K, Anderson J, Gettinby G, MacGregor S. 405 nm light technology for the inactivation of pathogens and its potential role for environmental disinfection and infection control. J Hosp Infect 2014; 88:1-11. [DOI: 10.1016/j.jhin.2014.06.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/17/2014] [Indexed: 01/22/2023]
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Quoi de neuf dans les techniques de désinfection des chambres de réanimation ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0884-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution and contact time of the agent. ‘No-touch’ automated room disinfection (NTD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapour (H2O2 vapour), aerosolised hydrogen peroxide (aHP) and ultraviolet (UV) radiation. These systems have important differences in their active agent, delivery mechanism, efficacy, process time and ease of use. The choice of NTD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation and cost constraints.
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Abstract
Evidence is accumulating for the role of cleaning in controlling hospital infections. Hospital pathogens such as meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), norovirus, multi-resistant Gram-negative bacilli and Clostridium difficile persist in the healthcare environment for considerable lengths of time. Cleaning with both detergent and disinfectant-based regimens help control these pathogens in both routine and outbreak situations. The most important transmission risk comes from organisms on frequently handled items because hand contact with a contaminated site could deliver a pathogen to a patient. Cleaning practices should be tailored to clinical risk, near-patient areas and hand-touch-sites and scientifically evaluated for all surfaces and equipment in today’s hospitals.
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Plipat N, Spicknall IH, Koopman JS, Eisenberg JNS. The dynamics of methicillin-resistant Staphylococcus aureus exposure in a hospital model and the potential for environmental intervention. BMC Infect Dis 2013; 13:595. [PMID: 24341774 PMCID: PMC3878576 DOI: 10.1186/1471-2334-13-595] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 12/11/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections. An important control strategy is hand hygiene; however, non-compliance has been a major problem in healthcare settings. Furthermore, modeling studies have suggested that the law of diminishing return applies to hand hygiene. Other additional control strategies such as environmental cleaning may be warranted, given that MRSA-positive individuals constantly shed contaminated desquamated skin particles to the environment. METHODS We constructed and analyzed a deterministic environmental compartmental model of MRSA fate, transport, and exposure between two hypothetical hospital rooms: one with a colonized patient, shedding MRSA; another with an uncolonized patient, susceptible to exposure. Healthcare workers (HCWs), acting solely as vectors, spread MRSA from one patient room to the other. RESULTS Although porous surfaces became highly contaminated, their low transfer efficiency limited the exposure dose to HCWs and the uncolonized patient. Conversely, the high transfer efficiency of nonporous surfaces allows greater MRSA transfer when touched. In the colonized patient's room, HCW exposure occurred more predominantly through the indirect (patient to surfaces to HCW) mode compared to the direct (patient to HCW) mode. In contrast, in the uncolonized patient's room, patient exposure was more predominant in the direct (HCW to patient) mode compared to the indirect (HCW to surfaces to patient) mode. Surface wiping decreased MRSA exposure to the uncolonized patient more than daily surface decontamination. This was because wiping allowed higher cleaning frequency and cleaned more total surface area per day. CONCLUSIONS Environmental cleaning should be considered as an integral component of MRSA infection control in hospitals. Given the previously under-appreciated role of surface contamination in MRSA transmission, this intervention mode can contribute to an effective multiple barrier approach in concert with hand hygiene.
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Affiliation(s)
- Nottasorn Plipat
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian H Spicknall
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James S Koopman
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph NS Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Varghese S, ElFakhri SO, Sheel DW, Sheel P, Bolton FJE, Foster HA. Antimicrobial activity of novel nanostructured Cu-SiO2 coatings prepared by chemical vapour deposition against hospital related pathogens. AMB Express 2013; 3:53. [PMID: 24007899 PMCID: PMC3846808 DOI: 10.1186/2191-0855-3-53] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/28/2013] [Indexed: 02/07/2023] Open
Abstract
There is increasing recognition that the healthcare environment acts as an important reservoir for transmission of healthcare acquired infections (HCAI). One method of reducing environmental contamination would be use of antimicrobial materials. The antimicrobial activity of thin silica-copper films prepared by chemical vapour deposition was evaluated against standard strains of bacteria used for disinfectant testing and bacteria of current interest in HCAI. The structure of the coatings was determined using Scanning Electron Microscopy and their hardness and adhesion to the substrate determined. Antimicrobial activity was tested using a method based on BS ISO 22196:2007. The coatings had a pale green-brown colour and had a similar hardness to steel. SEM showed nano-structured aggregates of Cu within a silica matrix. A log10 reduction in viability of >5 could be obtained within 4 h for the disinfectant test strains and within 6 h for producing Acinetobacter baumannii, Klebsiella pneumoniae and Stenotrophomonas maltophilia. Activity against the other hospital isolates was slower but still gave log10 reduction factors of >5 for extended spectrum β-lactamase producing Escherichia coli and >3 for vancomycin resistant Enterococcus faecium, methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa within 24 h. The results demonstrate the importance of testing antimicrobial materials destined for healthcare use against isolates of current interest in hospitals as well as standard test strains. The coatings used here can also be applied to substrates such as metals and ceramics and have potential applications where reduction of microbial environmental contamination is desirable.
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Maclean M, Booth MG, Anderson JG, MacGregor SJ, Woolsey GA, Coia JE, Hamilton K, Gettinby G. Continuous decontamination of an intensive care isolation room during patient occupancy using 405 nm light technology. J Infect Prev 2013. [DOI: 10.1177/1757177413483646] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Environmental contamination within intensive care units (ICU) is recognised as a source of patient infection, and improved cleaning and disinfection methods are continually being sought. Visible light of 405 nm has been shown to have bactericidal properties, and this communication reports on the use of a ceiling-mounted 405 nm light system for continuous environmental disinfection of contact surfaces and air in an occupied ICU isolation room. Levels of bacterial contamination on a range of contact surfaces around the room were assessed before, during and after use of the system. For each study, the lighting units were operated continuously during daylight hours. Results demonstrate that the spatial distribution of bacterial contamination was reduced almost uniformly across all sampled contact surfaces during use of the 405 nm light system. Pooled data showed that significant reductions in overall bacterial contamination around the room were achieved, with bacterial counts reduced by up to 67% ( p=0.0001) over and above that achieved with standard cleaning and infection control procedures alone. Use of 405 nm light significantly reduced environmental contamination across almost all sampled contact surfaces within the ICU isolation room. This has particular benefit in ICU where equipment and other ‘hand-touch’ sites make routine cleaning difficult, thus helping maintain a cleaner environment, and contributing to reducing cross-infection from environmental sources.
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Affiliation(s)
- M Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), University of Strathclyde, Glasgow
| | - MG Booth
- Glasgow Royal Infirmary, Castle Street, Glasgow
| | - JG Anderson
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), University of Strathclyde, Glasgow
| | - SJ MacGregor
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), University of Strathclyde, Glasgow
| | - GA Woolsey
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), University of Strathclyde, Glasgow
| | - JE Coia
- Glasgow Royal Infirmary, Castle Street, Glasgow
| | - K Hamilton
- Glasgow Royal Infirmary, Castle Street, Glasgow
| | - G Gettinby
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow
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49
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Varghese S, Elfakhri S, Sheel D, Sheel P, Bolton F, Foster H. Novel antibacterial silver-silica surface coatings prepared by chemical vapour deposition for infection control. J Appl Microbiol 2013; 115:1107-16. [DOI: 10.1111/jam.12308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 12/13/2022]
Affiliation(s)
- S. Varghese
- Centre for Parasitology and Disease Research; School of Environment and Life Sciences; University of Salford; Salford UK
| | - S. Elfakhri
- Centre for Parasitology and Disease Research; School of Environment and Life Sciences; University of Salford; Salford UK
| | - D.W. Sheel
- Materials and Physics Research Centre; University of Salford; Salford UK
- CVD Technologies Ltd.; Manchester UK
| | - P. Sheel
- CVD Technologies Ltd.; Manchester UK
| | | | - H.A. Foster
- Centre for Parasitology and Disease Research; School of Environment and Life Sciences; University of Salford; Salford UK
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Gandra S, Ellison RT. Modern trends in infection control practices in intensive care units. J Intensive Care Med 2013; 29:311-26. [PMID: 23753240 DOI: 10.1177/0885066613485215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard T Ellison
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
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