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Allerton F, Weese S. CON: Environmental microbiological surveillance does not support infection control in veterinary hospitals. JAC Antimicrob Resist 2024; 6:dlae114. [PMID: 39040535 PMCID: PMC11261388 DOI: 10.1093/jacamr/dlae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Affiliation(s)
- Fergus Allerton
- Willows Veterinary Centre & Referral Service,
Department of Internal Medicine, West Midlands, UK
| | - Scott Weese
- Deptartment of Pathobiology, Ontario Veterinary College, University of
Guelph, Guelph, Canada
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Niephaus V, Parohl N, Heiligtag S, Reuter H, Hackler R, Popp W. Can the adenosine triphosphate (ATP) bioluminescence assay be used as an indicator for hospital cleaning? - A pilot study. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc07. [PMID: 38505093 PMCID: PMC10949084 DOI: 10.3205/dgkh000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background In hospital cleaning, there is currently no standard for uniform monitoring of surface cleaning, either in Germany or internationally. One possibility for monitoring is the use of so-called objective methods for checking cleaning performance (e.g. fluorescence or adenosine triphosphate (ATP) method). Aim The aim of the study was to monitor and evaluate the implementation of the adenosine triphosphate (ATP) bioluminescence assay as a cleaning indicator in everyday hospital cleaning, in order to verify its utility and effectiveness. Methods In three phases, five frequently touched surfaces were examined with the ATP bioluminescence assay at different time points. 846 measurements were performed on the dermatology ward of a university hospital (phase 1), 1,350 measurements were performed on five different wards of the university hospital (phase 2), and 1,044 measurements were performed on five wards of another large hospital (phase 3). For this purpose, one structurally old and one structurally new ward as well as an intensive care unit (ICU), an outpatient clinic and a radiology department were selected for phases 2 and 3. Results With the ATP bioluminescence method, we were able to demonstrate a reduction in values after cleaning: before cleaning mean of ATP, 907 relative light units (RLU) (95% confidence interval [CI] 777; 1,038); after cleaning mean=286 RLU (CI=233; 495) (phase 1) and by intervention (five hours after daily cleaning mean=360 RLU (CI=303; 428); five hours after daily cleaning and two additional cleanings mean=128 RLU (CI=107; 152) (phase 3). The ATP values increased five hours after cleaning in phases 1 and 2, and eight hours after cleaning in phase 3. The structurally old wards had the highest ATP content, the ICU and the radiology department, among others, the lowest. In all phases, door handles showed both a reduction after cleaning or intervention and a subsequent increase in ATP values. Chair armrests, examination tables and door handles had high ATP values overall. Conclusion The study shows ward differences both for cleaning effects and for the soiling characteristics of surfaces during the course of the day. In addition, it demonstrates the benefit of intermediate cleaning twice a day. It is noteworthy that structurally old stations and older inventory were more heavily soiled and, in some cases, more difficult to clean. The results show that the ATP bioluminescence method is suitable for detecting cleaning effects and can be used in everyday clinical practice for simple cleaning monitoring. Furthermore, it enables the detection of risk surfaces and easy-to-clean surfaces with significant re-soiling.
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Dequeker S, van Hensbergen M, den Heijer CDJ, Dhaeze W, Raven SFH, Ewalts-Hakkoer H, Tolsma P, Willemsen I, van Drunen-Kamp KJ, van der Slikke-Verstraten K, Goossens H, Kluytmans-van den Bergh MFQ, Hoebe CJPA. Cross-border differences in the prevalence and risk factors for carriage of antimicrobial resistance in children attending daycare centers: a point prevalence study in the Netherlands and Belgium. BMC Infect Dis 2024; 24:131. [PMID: 38267878 PMCID: PMC10809597 DOI: 10.1186/s12879-024-08996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Day care centres (DCCs) are ideal settings for drug-resistant bacteria to emerge. Prevalence numbers of faecal carriage of antimicrobial resistant bacteria in these settings are rare. We aimed to determine the prevalence of faecal antimicrobial resistant bacteria carriage in children attending DCCs and to assess and identify infection risk factors within DCCs in The Netherlands and Belgium. METHODS A point-prevalence study was conducted in 28 Dutch (499 children) and 18 Belgian (448 children) DCCs. Stool samples were taken from the children's diapers and a questionnaire was filled in by their parents. Hygiene related to stool and toilet use, hygiene related to food, environmental contamination, hand hygiene and hygiene guidelines were assessed conform a standardized questionnaire by the infection prevention and control expert visiting the DCC. Multilevel logistical regression analyses were used to define which characteristics predicted the presence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE), and ciprofloxacin-resistant Enterobacterales (CipR-E). RESULTS The ESBL-E prevalence was 16% (n = 71) in Belgium and 6% (n = 30) in the Netherlands. The CipR-E prevalence was 17% (n = 78) in Belgium and 8% (n = 38) in the Netherlands. Antimicrobial use (RR: 0.30; 95% CI: 0.33-0.48) and hospital admissions (RR: 0.37; 95% CI: 0.25-0.54) were lower in the Netherlands. Children travelling to Asia were at higher risk of being an ESBL-E carrier. Children using antimicrobials were at higher risk of being a CipR-E carrier. Cleaning the changing mat after each use was found as a protective factor for CipR-E carriage. CONCLUSIONS We established a significant difference in ESBL-E and CipR-E carriage and antimicrobial use and hospital admissions between the Netherlands and Belgium among children attending DCCs. The differences between both countries should be further studied to improve the policy on anti-microbial use and hospital admissions in children.
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Affiliation(s)
- Sara Dequeker
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium.
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium.
| | - Mitch van Hensbergen
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Casper D J den Heijer
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Wouter Dhaeze
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium
| | - Stijn F H Raven
- Department of Infectious Diseases, Public Health Service region Utrecht, Zeist, The Netherlands
| | | | - Paulien Tolsma
- Public Health Service Brabant-Zuidoost, Eindhoven, The Netherlands
| | - Ina Willemsen
- Contrain Infectiepreventiecoach, Breda, The Netherlands
- Amphia Hospital, Breda, The Netherlands
| | | | | | | | | | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
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Improving infection control in a veterinary hospital: a detailed study on patterns of faecal contamination to inform changes in practice. Ir Vet J 2023; 76:4. [PMID: 36782258 PMCID: PMC9924846 DOI: 10.1186/s13620-023-00229-w] [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: 07/26/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The main purpose of this study was to investigate the cleanliness and microbial burden of a veterinary hospital to establish the extent of cross-contamination with faecal bacteria as an aid to reducing nosocomial infections. Enterococci and Escherichia coli were used as faecal indicator organisms as they can survive on inanimate surfaces for months and pose a threat to animal health. The study consisted of several elements: (i) a cross-sectional study to identify sites currently contaminated with faecal organisms that could be usefully included in a longitudinal study, (ii) a 3-week longitudinal study to identify sites from which faecal bacteria were repeatedly recovered, (iii) once-off monitoring of hand hygiene, (iv) a review of all hospitalised cases with confirmed E. coli or enterococcal infection during the 8-week study period to investigate possible hospital-acquired (HAI) infection and relationship with environmental contamination. Environmental surface and hand hygiene were assessed using 3M™ Clean-Trace™ ATP test, 3M™ Petrifilm™ plates and bacteriological culture of Enterococcus species and E. coli. Cross contamination was assessed using results of antimicrobial susceptibility testing. RESULTS In the cross-sectional study, 26 of 113 (24.5%) of sites sampled exceeded the accepted microbial threshold (2.5 CFU/cm2) and Enterococcus species were isolated from 31 (27.4%) and E. coli from 9 (7.9%) of 113 samples. Organic residue and microbial levels were high in the dog kennels even after cleaning and faecal organisms were also recovered from sites such as the dispensary, a student computer and staff common room. Four of 51 (7.8%) hand samples were contaminated with faecal bacteria. Nine sites were monitored on three occasions in the longitudinal study and a total of 23 Escherichia coli and 6 Enterococcus species were recovered. Seven of the nine sites were positive for faecal organisms on more than one occasion. There was no change in cleanliness or microbial burden over 3 weeks. Twenty-one of the 73 isolates (28.8%) recovered during all parts of the study were multi-drug resistant. Enterococci and E. coli isolates with similar resistance patterns were recovered from the environment in the large and small animal hospitals and from a small number of patients during the same timeframe, suggesting possible hospital acquired infections. CONCLUSIONS Results suggested that movement between the small and large animal hospital areas may have been responsible for cross-contamination and possible hospital-acquired infections. The data show that cross-sectional and longitudinal monitoring of faecal contamination across all hospital areas can play an important role in informing review of infection control protocols in veterinary hospital settings. Changes in practices in the hospital based on results generated are outlined.
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Hewage SN, Makawita P, Gibson KE, Lee JA, Fraser AM. Relationship between ATP Bioluminescence Measurements and Microbial Assessments in Studies Conducted in Food Establishments: A Systematic Literature Review and Meta-Analysis. J Food Prot 2022; 85:1855-1864. [PMID: 36173898 DOI: 10.4315/jfp-22-187] [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: 06/15/2022] [Accepted: 09/25/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT Adherence to proper environmental cleaning practices is critical in food establishments. To validate cleanliness, cleaning practices should be routinely monitored, preferably by a rapid, reliable, and cost-effective method. The aim of this study was to determine whether a correlation exists between ATP bioluminescence measurements and selected microbial assessments in studies conducted in food establishments. A systematic literature review and meta-analysis was conducted using the principles of preferred reporting items for systematic reviews and meta-analyses. Twelve online databases and search engines were selected for the review. Peer-reviewed articles published in English between January 2000 and July 2020 were included in the search. From a total of 19 eligible studies, 3 that included Pearson correlation coefficients (r) between ATP bioluminescence measurements and microbial assessments were used for the meta-analysis calculations. Only the fixed-effect model produced a strong correlation because one value dominated the estimates: r = 0.9339 (0.9278, 0.9399). In contrast, both the random effects model, 0.2978 (0.24, 0.3471), and the mixed effects model, r = 0.3162 (-0.0387, 0.6711), indicated a weak relationship between ATP bioluminescence and microbial assessments, with no evidence of a strong correlation. The meta-analysis results indicated no sufficient evidence of a strong correlation between ATP bioluminescence measurements and microbial assessments when applied within food establishments. This lack of evidence for a strong correlation between the results of these two monitoring tools suggests that food establishments cannot depend on only one method. Yet, with immediate feedback and quantification of organic soiling, ATP bioluminescence could be an effective monitoring tool to use in food establishments. HIGHLIGHTS
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Affiliation(s)
- Supun Nabadawa Hewage
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, 223 Poole Agricultural Center, Box 340316, Clemson, South Carolina 29634-0316
| | - P Makawita
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, 223 Poole Agricultural Center, Box 340316, Clemson, South Carolina 29634-0316
| | - Kristen E Gibson
- Department of Food Science, System Division of Agriculture, University of Arkansas, 2650 North Young Avenue, Fayetteville, Arkansas 72704
| | - Jung-Ae Lee
- Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, 368 Plantation Street, Worcester, Massachusetts 01605, USA
| | - Angela M Fraser
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, 223 Poole Agricultural Center, Box 340316, Clemson, South Carolina 29634-0316
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Jennings JM, Johnson RM, Brady AC, Stuckey WP, Pollet AK, Dennis DA. Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field. Arthroplast Today 2022; 17:53-57. [PMID: 36032796 PMCID: PMC9399380 DOI: 10.1016/j.artd.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Periprosthetic joint infection may result from pathogen to patient transmission within the environment. The purpose of this study is to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean. Methods Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as “clean” (>75%), “partially clean” (26%-74%), or poorly cleaned (<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study. Results A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P < .001. Only the OR back table (75%) had a rating of clean. Partially clean areas included Mayfield table (72%), overhead lights (70.1%), infusion pump (61.1%), clock reset button (58.3%), table remote control (50%), tourniquet machine (50%), and the OR table (33.3%). Poorly cleaned surfaces included anesthesia medication cart (21.8%), door handles (20.8%), phone (16.7%), electrocautery unit (16.7%), foot pedal (16.7%), anesthesia cart (16.2%), nurses’ station (14.1%), and supply cabinet doors (6%). Conclusions Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed.
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Affiliation(s)
- Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Corresponding author. Colorado Joint Replacement, 2535 S. Downing St Suite 100, Denver, CO 80210, USA. Tel.: +1 720 524 1367.
| | | | | | | | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Cannon JL, Park GW, Anderson B, Leone C, Chao M, Vinjé J, Fraser AM. Hygienic monitoring in long-term care facilities using ATP, crAssphage, and human noroviruses to direct environmental surface cleaning. Am J Infect Control 2022; 50:289-294. [PMID: 35184878 PMCID: PMC8903150 DOI: 10.1016/j.ajic.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Norovirus and C. difficile are associated with diarrheal illnesses and deaths in long-term care (LTC) facilities and can be transmitted by contaminated environmental surfaces. Hygienic monitoring tools such as adenosine triphosphate (ATP) bioluminescence and indicators of fecal contamination can help to identify LTC facility surfaces with cleaning deficiencies. METHODS High-touch surfaces in 11 LTC facilities were swabbed and tested for contamination by norovirus, a fecal indicator virus, crAssphage, and ATP which detects organic debris. High levels of contamination were defined as log ATP relative light unit values or crAssphage log genomic copy values in the 75th percentile of values obtained from each facility. RESULTS Over 90% of surfaces tested positive for crAssphage or gave failing ATP scores. Norovirus contamination was not detected. Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high levels of crAssphage. Patient bed handrails and tables and chairs in patient lounges had high levels of both ATP and crAssphage. CONCLUSIONS Surfaces with high levels of ATP and crAssphage were identified. Quantifying levels of contamination longitudinally and before and after cleaning might enhance infection prevention and control procedures for reducing diarrheal illnesses in LTC facilities.
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Affiliation(s)
- Jennifer L. Cannon
- National Foundation for the Centers for Disease Control and Prevention Inc., 600 Peachtree St. NE #1000, Atlanta, GA, 30308, USA,Center for Food Safety, University of Georgia, 1109 Experiment St, Griffin, GA, 30223, USA,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA,Correspondence: Jennifer Cannon, 1600 Clifton Rd. NE, H18-7, Atlanta, GA, 30333, USA,
| | - Geun Woo Park
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Benjamin Anderson
- Center for Food Safety, University of Georgia, 1109 Experiment St, Griffin, GA, 30223, USA
| | - Cortney Leone
- Food, Nutrition, and Packaging Sciences Department, Clemson University, 206 Poole Agricultural Center, Clemson, SC, 29334, USA
| | - Morgan Chao
- Food, Nutrition, and Packaging Sciences Department, Clemson University, 206 Poole Agricultural Center, Clemson, SC, 29334, USA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Angela M. Fraser
- Food, Nutrition, and Packaging Sciences Department, Clemson University, 206 Poole Agricultural Center, Clemson, SC, 29334, USA
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Verelst M, Willemsen I, Weterings V, De Waegemaeker P, Leroux-Roels I, Nieuwkoop E, Saegeman V, van Alphen L, van Kleef-van Koeveringe S, Kluytmans-van den Bergh M, Kluytmans J, Schuermans A. Implementation of the Infection Risk Scan (IRIS) in nine hospitals in the Belgian-Dutch border region (i-4-1-Health project). Antimicrob Resist Infect Control 2022; 11:43. [PMID: 35227333 PMCID: PMC8887653 DOI: 10.1186/s13756-022-01083-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background A tool, the Infection Risk Scan has been developed to measure the quality of infection control and antimicrobial use. This tool measures various patient-, ward- and care-related variables in a standardized way. We describe the implementation of this tool in nine hospitals in the Dutch/Belgian border area and the obtained results.
Methods The IRIS consists of a set of objective and reproducible measurements: patient comorbidities, (appropriate) use of indwelling medical devices, (appropriate) use of antimicrobial therapy, rectal carriage of Extended-spectrum beta-lactamase producing Enterobacterales and their clonal relatedness, environmental contamination, hand hygiene performance, personal hygiene of health care workers and presence of infection prevention preconditions. The Infection Risk Scan was implemented by an expert team. In each setting, local infection control practitioners were trained to achieve a standardized implementation of the tool and an unambiguous assessment of data. Results The IRIS was implemented in 34 wards in six Dutch and three Belgian hospitals. The tool provided ward specific results and revealed differences between wards and countries. There were significant differences in the prevalence of ESBL-E carriage between countries (Belgium: 15% versus The Netherlands: 9.6%), environmental contamination (median adenosine triphosphate (ATP) level Belgium: 431 versus median ATP level The Netherlands: 793) and calculated hand hygiene actions based on alcohol based handrub consumption (Belgium: 12.5/day versus The Netherlands: 6.3/day) were found. Conclusion The Infection risk Scan was successfully implemented in multiple hospitals in a large cross-border project and provided data that made the quality of infection control and antimicrobial use more transparent. The observed differences provide potential targets for improvement of the quality of care.
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Affiliation(s)
- Martine Verelst
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium.
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Veronica Weterings
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | | | | | - Ellen Nieuwkoop
- Department of Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Veroniek Saegeman
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium
| | - Lieke van Alphen
- Departement of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Marjolein Kluytmans-van den Bergh
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Annette Schuermans
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium
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McGinn C, Scott R, Ryan C, Donnelly N, Cullinan MF, Beckett M. Rapid disinfection of radiology treatment rooms using an autonomous ultraviolet germicidal irradiation robot. Am J Infect Control 2022; 50:947-953. [PMID: 35065149 DOI: 10.1016/j.ajic.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising adjunct to manual cleaning, however, their potential to shorten cleaning times remains unexplored. METHODS A <10-minute disinfection procedure was developed using a robotic UVGI platform. The efficacy and time to perform the UVGI procedure in a CT scan treatment room was compared with current protocols involving manual disinfection using biocides. For each intervention, environmental samples were taken at 12 locations in the room before and after disinfection on seven distinct occasions. RESULTS The mean UVC dose at each sample location was found to be 13.01 ± 4.36 mJ/cm2, which exceeded published UVC thresholds for achieving log reductions of many common pathogens. Significant reductions in microbial burden were measured after both UVGI (P≤.001) and manual cleaning (P≤.05) conditions, with the UVGI procedure revealing the largest effect size (r = 0.603). DISCUSSION These results support the hypothesis that automated deployments of UVGI technology can lead to germicidal performance that is comparable with, and potentially better than, current manual cleaning practices. CONCLUSIONS Our findings provide early evidence that the incorporation of automated UVGI procedures into cleaning workflow could reduce turnaround times in radiology, and potentially other hospital settings.
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Whiteley GS, Glasbey TO, Fahey PP. Using a simplified ATP algorithm to improve data reliability and improve cleanliness standards for surface and medical device hygiene. Infect Dis Health 2021; 27:3-9. [PMID: 34391730 DOI: 10.1016/j.idh.2021.07.001] [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: 05/20/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND An algorithm has been improved to mitigate variability in cleanliness measurements of various surfaces using rapid Adenosine Triphosphate (ATP) testing. A cleaning intervention step (CIS) verifies the cleanability of those surfaces. METHODS ATP testing was performed on surfaces which were pre-approved as "clean" and ready for re-use. Adjacent (duplicate) ATP sampling was undertaken on 421 environmental surfaces, medical devices and other implements. The CIS was conducted on 270 surfaces using an aseptic technique and disposable cleaning wipes. RESULTS The two initial ATP results were plotted against each other with a 100 RLU threshold grading the results as clean (2x < 100RLU), dirty (2x > 100RLU) or equivocal (1x < 100RLU and 1x > 100RLU). Of the surfaces sampled, 68.5 % were clean (288/421), 13.5 % were dirty (57/421) and 18 % were equivocal (76/421). The duplicate testing demonstrated a false negative rate of 10 % (44/421) where the first swab was <100 RLU and the second swab >100 RLU. For the equivocal group, the gap between the two swabs was >100 RLU for 7.5 % of surfaces (33/421). The CIS was conducted on 270 of the surfaces tested and showed that cleaning could be improved (P=<0.001) on 88.5 % of surfaces (239/270). CONCLUSION The simplified ATP testing algorithm provides real-time discrimination between surface cleanliness levels and improved certainty over surface hygiene. The duplicate swab sampling approach mitigates uncontrolled variability in the results and the CIS provides a nuanced understanding of the measurable cleanliness of any surface.
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Affiliation(s)
- Greg S Whiteley
- School of Medicine, Western Sydney University, Australia; Whiteley Corporation, Western Sydney University, Australia.
| | - Trevor O Glasbey
- Whiteley Corporation, Western Sydney University, Australia; Macquarie University, Western Sydney University, Australia
| | - Paul P Fahey
- School of Health Sciences, Western Sydney University, Australia
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11
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Masia MD, Dettori M, Deriu GM, Bellu S, Arcadu L, Azara A, Piana A, Palmieri A, Arghittu A, Castiglia P. ATP Bioluminescence for Assessing the Efficacy of the Manual Cleaning Procedure during the Reprocessing of Reusable Surgical Instruments. Healthcare (Basel) 2021; 9:352. [PMID: 33808731 PMCID: PMC8003443 DOI: 10.3390/healthcare9030352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Achieving sterilization by adopting proper practices is essential to ensure that surgical instruments do not transmit microorganisms to patients. As the effectiveness of sterilization mandates effective cleaning, it is necessary to verify the success of cleaning procedures. In this study, we used the adenosine triphosphate (ATP) bioluminescence method for assessing the efficacy of the manual cleaning procedure during the reprocessing of reusable surgical instruments. The ATP bioluminescence assay was performed on 140 surgical instruments of 12 different types, both before being cleaned (baseline) and after each of the cleaning procedures (i.e., decontamination, manual washing, drying, and visual inspection). For each instrument, two swabs were used as follows: one to sample the entire surface (test point 1) and the other to sample the most difficult part of the surface to clean (test point 2). Overall, for each type of instrument, there was a decrease in contamination ranging from 99.6 to >99.9% (log reduction from 2.40 to 3.76). Thus, in order to standardize the assessment of cleanliness, it may be useful to introduce the bioluminescence method into the daily routine or, at least, at regular time intervals as a complementary check combined with visual inspection. This would allow real-time verification of the achievement of an adequate level of cleanliness.
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Affiliation(s)
- Maria Dolores Masia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Marco Dettori
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Grazia Maria Deriu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.B.); (A.A.)
| | - Sabina Bellu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.B.); (A.A.)
| | - Lisa Arcadu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Antonio Azara
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Alessandra Palmieri
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Antonella Arghittu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.B.); (A.A.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Paolo Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
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12
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McGinn C, Scott R, Donnelly N, Roberts KL, Bogue M, Kiernan C, Beckett M. Exploring the Applicability of Robot-Assisted UV Disinfection in Radiology. Front Robot AI 2021; 7:590306. [PMID: 33501347 PMCID: PMC7815819 DOI: 10.3389/frobt.2020.590306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/12/2020] [Indexed: 01/21/2023] Open
Abstract
The importance of infection control procedures in hospital radiology departments has become increasingly apparent in recent months as the impact of COVID-19 has spread across the world. Existing disinfectant procedures that rely on the manual application of chemical-based disinfectants are time consuming, resource intensive and prone to high degrees of human error. Alternative non-touch disinfection methods, such as Ultraviolet Germicidal Irradiation (UVGI), have the potential to overcome many of the limitations of existing approaches while significantly improving workflow and equipment utilization. The aim of this research was to investigate the germicidal effectiveness and the practical feasibility of using a robotic UVGI device for disinfecting surfaces in a radiology setting. We present the design of a robotic UVGI platform that can be deployed alongside human workers and can operate autonomously within cramped rooms, thereby addressing two important requirements necessary for integrating the technology within radiology settings. In one hospital, we conducted experiments in a CT and X-ray room. In a second hospital, we investigated the germicidal performance of the robot when deployed to disinfect a CT room in <15 minutes, a period which is estimated to be 2-4 times faster than current practice for disinfecting rooms after infectious (or potentially infectious) patients. Findings from both test sites show that UVGI successfully inactivated all of measurable microbial load on 22 out of 24 surfaces. On the remaining two surfaces, UVGI reduced the microbial load by 84 and 95%, respectively. The study also exposes some of the challenges of manually disinfecting radiology suites, revealing high concentrations of microbial load in hard-to-reach places. Our findings provide compelling evidence that UVGI can effectively inactivate microbes on commonly touched surfaces in radiology suites, even if they were only exposed to relatively short bursts of irradiation. Despite the short irradiation period, we demonstrated the ability to inactivate microbes with more complex cell structures and requiring higher UV inactivation energies than SARS-CoV-2, thus indicating high likelihood of effectiveness against coronavirus.
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Affiliation(s)
- Conor McGinn
- School of Engineering, Trinity College Dublin, Dublin, Ireland
- Akara Robotics, Dublin, Ireland
| | - Robert Scott
- School of Engineering, Trinity College Dublin, Dublin, Ireland
| | | | - Kim L. Roberts
- Department of Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Marina Bogue
- Department of Microbiology, Trinity College Dublin, Dublin, Ireland
| | | | - Michael Beckett
- Department of Microbiology, Trinity College Dublin, Dublin, Ireland
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13
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Heinemann C, Leubner CD, Hayer JJ, Steinhoff-Wagner J. Hygiene management in newborn individually housed dairy calves focusing on housing and feeding practices. J Anim Sci 2021; 99:skaa391. [PMID: 33279999 PMCID: PMC7799592 DOI: 10.1093/jas/skaa391] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
In calf rearing, the first weeks of life are critical and associated with the highest mortality due to enteric and respiratory diseases. A well-implemented hygiene management can help to protect calves' health preventively by reducing the load of pathogenic bacteria and interrupting infection chains. The aim of this study was to identify deficiencies in hygiene management of individually housed dairy calves by surveying current practice and examining feeding and housing equipment with different hygiene indicators. On 11 farms, different locations in 2 pens or hutches for individual calf rearing prepared for restocking and 2 feeding buckets per farm, including the inner and outer surfaces of artificial teats, were visually scored for cleanliness and sampled with swabs (housing equipment: n = 167; feeding equipment: n = 120). The sanitation of floors was tested with sock samples (n = 41). A total of 328 samples were analyzed for adenosine triphosphate (ATP) and protein residues, aerobic total viable count (TVC), total coliform count (TCC), Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing bacteria (ESBL), and Salmonella spp. After evaluation of these results, the farmers were informed about the findings and trained on improvement in hygiene management personally. The sampling was repeated after 1 year to detect possible changes in hygiene management. The highest bacterial loads (TVC, TCC, and E. coli) were observed in feeding equipment, especially the inner teat of milk feeding buckets. Environmental samples, primarily the sidewalls and back walls of tested pens and hutches, exhibited the lowest bacterial counts and ATP and protein residues. All samples were negative for MRSA and Salmonella spp. In 10.5% of all samples, ESBL was detected, and in 6.8%, ESBL E. coli was detected, predominately in sock samples, followed by feeding equipment samples. Training in hygiene management showed only limited effects. In conclusion, there is still great potential to improve the implementation of hygiene measures in individual calf housing. In particular, more attention should be paid to the cleaning of feeding buckets and artificial teats, as this is a simple means of interrupting the possible spread of pathogens among calves.
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Affiliation(s)
| | | | - Jason J Hayer
- Institute of Animal Science, University of Bonn, Bonn, Germany
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14
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Mildenhall KB, Rankin SA. Implications of Adenylate Metabolism in Hygiene Assessment: A Review. J Food Prot 2020; 83:1619-1631. [PMID: 32338738 DOI: 10.4315/jfp-20-087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/24/2020] [Indexed: 11/11/2022]
Abstract
The assessment of a hygienic state or cleanliness of contact surfaces has significant implications for food and medical industries seeking to monitor sanitation and exert improved control over a host of operations affecting human health. Methods used to make such assessments commonly involve visual inspections, standard microbial plating practices, and the application of ATP-based assays. Visual methods for inspection of hygienic states are inherently subjective and limited in efficacy by the accuracy of human senses, the degree of task-specific work experience, and various sources of human bias. Standard microbial swabbing and plating techniques are limited in that they require hours or even days of incubation to generate results, with such steps as enrichment and colony outgrowth resulting in delays that are often incompatible with manufacturing or usage schedules. Rapid in conduct and considered more objective in operation than visual or tactile inspection techniques, swabbing surfaces using ATP-based assessments are relied on as routine, even standard, methods of hygienic assessment alone or in complement with microbial and visual inspection methods. Still, current ATP methods remain indirect methods of total hygiene assessment and have limitations that must be understood and considered if such methods are to be applied judiciously, especially under increasingly strict demands for the verification of hygiene state. Here, we present current methods of ATP-based bioluminescence assays and describe the limitations of such methods when applied to general food manufacturing or health care facilities.
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Affiliation(s)
- Kristen B Mildenhall
- Department of Food Science, University of Wisconsin-Madison, Madison, Wisconsin 53528, USA (ORCID: https://orcid.org/0000-0001-6784-6770 [S.A.R.])
| | - Scott A Rankin
- Department of Food Science, University of Wisconsin-Madison, Madison, Wisconsin 53528, USA (ORCID: https://orcid.org/0000-0001-6784-6770 [S.A.R.])
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15
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Cicciarella Modica D, Maurici M, D’Alò GL, Mozzetti C, Messina A, Distefano A, Pica F, De Filippis P. Taking Screenshots of the Invisible: A Study on Bacterial Contamination of Mobile Phones from University Students of Healthcare Professions in Rome, Italy. Microorganisms 2020; 8:microorganisms8071075. [PMID: 32707676 PMCID: PMC7409191 DOI: 10.3390/microorganisms8071075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/07/2023] Open
Abstract
Mobile phones (MPs) are commonly used both in the personal and professional life. We assessed microbiological contamination of MPs from 108 students in healthcare professions (HPs), in relation to their demographic characteristics and MPs handling habits, collected by means of a questionnaire. Cultural and biochemical tests were performed, and statistical analyses were carried out. Staphylococci were present in 85% of MPs, Enterococci in 37%, Coliforms in 6.5%; E. coli was never detected. Staphylococcus epidermidis was the most frequently isolated staphylococcal species (72% of MPs), followed by S. capitis (14%), S. saprophyticus, S. warneri, S. xylosus (6%), and by S. aureus (4%). Heterotrophic Plate Counts (HPC) at 37 °C, ranged from 0 to 1.2 × 104 CFU/dm2 (mean = 362 CFU/dm2). In univariate analysis, the male gender only was significantly associated with higher HPCs and enterococcal contamination. Multiple linear regression models explained only 17% and 16% of the HPC 37 °C and staphylococcal load variability, respectively. Developing specific guidelines for a hygienic use of MPs in clinical settings, for preventing cross-infection risks, is advisable, as well as introducing specific training programs to HP students. MPs decontamination procedures could also be implemented in the community.
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Affiliation(s)
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (C.M.); (A.M.); (A.D.); (P.D.F.)
- Correspondence: (M.M.); (G.L.D.); Tel.: +39-327-8218-514 (G.L.D.)
| | - Gian Loreto D’Alò
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (C.M.); (A.M.); (A.D.); (P.D.F.)
- Department of Epidemiology, Lazio Regional Health Service, 00154 Rome, Italy
- Correspondence: (M.M.); (G.L.D.); Tel.: +39-327-8218-514 (G.L.D.)
| | - Cinzia Mozzetti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (C.M.); (A.M.); (A.D.); (P.D.F.)
| | - Alessandra Messina
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (C.M.); (A.M.); (A.D.); (P.D.F.)
| | - Alessandra Distefano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (C.M.); (A.M.); (A.D.); (P.D.F.)
| | - Francesca Pica
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Patrizia De Filippis
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (C.M.); (A.M.); (A.D.); (P.D.F.)
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16
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Ogunsola FT, Mehtar S. Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review. Antimicrob Resist Infect Control 2020; 9:81. [PMID: 32517810 PMCID: PMC7285732 DOI: 10.1186/s13756-020-00747-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/01/2020] [Indexed: 01/18/2023] Open
Abstract
Background Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries. The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions. Method This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs. Results From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding. Conclusion Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.
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Affiliation(s)
- Folasade T Ogunsola
- College of Medicine, University of Lagos, Ishaga, Lagos, PMB 12003, Nigeria. .,Infection Control Africa Network, Cape Town, South Africa.
| | - Shaheen Mehtar
- Infection Control Africa Network, Cape Town, South Africa.,Stellenbosch University Cape Town, Cape Town, South Africa
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17
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van Arkel A, Willemsen I, Kilsdonk-Bode L, Vlamings-Wagenaars S, van Oudheusden A, Waegemaeker PD, Leroux-Roels I, Verelst M, Maas E, van Oosten A, Willemse P, van Asselen E, Klomp-Berens E, Franssen K, Van Cauwenberg E, Kluytmans J. ATP measurement as an objective method to measure environmental contamination in 9 hospitals in the Dutch/Belgian border area. Antimicrob Resist Infect Control 2020; 9:77. [PMID: 32466792 PMCID: PMC7254657 DOI: 10.1186/s13756-020-00730-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background The objective of this study was to determine the level of environmental contamination in hospitals in the Dutch/Belgian border area, using ATP measurements. Design A cross-sectional observational survey. Methods Standardized ATP measurements were conducted in 9 hospitals on 32 hospital wards. Thirty pre-defined surfaces per hospital ward were measured with the 3 M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU > 1000 was considered as “not clean.” Differences in RLU values were compared between countries, hospitals, fomite groups and medical specialties. Results A total of 960 ATP measurements were performed, ranging from 60 up to 120 per hospital. The median RLU-value was 568 (range: 3–277,586) and 37.7% of the measurements were rated as not clean (RLU > 1000). There were significant differences between countries, hospitals and fomite groups. Conclusion ATP measurements can be used as a more objective approach to determine the level of environmental contamination in hospitals. Significant differences in ATP levels were found between hospitals and between countries. Also, substantial differences were found between different fomite groups. These findings offer potential targets for improvement of cleanliness in healthcare facilities.
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Affiliation(s)
- Andreas van Arkel
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands. .,Laboratory for Microbiology and Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | | | | | - Anne van Oudheusden
- Department of Infection Control, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Isabel Leroux-Roels
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium.,Laboratory for Microbiology, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, University hospital Ghent, Ghent, Belgium
| | - Martine Verelst
- Department of Infection Control, University Hospitals Leuven, Leuven, Belgium
| | - Evelien Maas
- Department of Infection Control, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Anita van Oosten
- Department of Infection Control, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Patricia Willemse
- Department of Infection Control, Elkerliek Hospital, Helmond, The Netherlands
| | - Esther van Asselen
- Department of Infection Control, Elkerliek Hospital, Helmond, The Netherlands
| | - Ella Klomp-Berens
- Department of Infection Control, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Karen Franssen
- Department of Infection Control, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Laboratory for Microbiology and Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.,Microvida Laboratory for Microbiology, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
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18
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Heinemann C, Meyer I, Bögel FT, Schmid SM, Hayer JJ, Steinhoff-Wagner J. Individual training for farmers based on results from protein and ATP rapid tests and microbiological conventional cultural methods improves hygiene in pig fattening pens. J Anim Sci 2020; 98:5687032. [PMID: 31875908 DOI: 10.1093/jas/skz389] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/21/2019] [Indexed: 11/13/2022] Open
Abstract
Optimal hygiene management is an essential part of maintaining a high standard of health in conventional pig production systems and for the successful interruption of infection chains. Currently, efficiency assessments on cleaning and disinfection are only performed by visual inspection or are neglected completely. The aim of this study was to evaluate the available methods for on farm monitoring of hygiene, identify critical points in pig pens and use the data obtained for training purposes. In addition to visual inspection by assessing the cleanliness, microbiological swab samples, i.e., aerobic total viable count (TVC), total coliform count, methicillin-resistant Staphylococcus aureus (MRSA), and extended-spectrum β-lactamases-producing bacteria (ESBL), swab samples for ATP as well as protein residues and agar contact plates combined with 3 different culture media, were applied and ranked according to their suitability for livestock farming. Samples were collected on at least 15 critical points from one representative pen on 6 pig fattening farms with various hygiene management practices after cleaning and disinfection. After the first sampling, farmers were trained with their individual results, and sampling was repeated 6 mo after training. Nipple drinkers, feeding tubes (external and inner surface), and troughs (external and inner surface) showed the greatest bacterial loads (TVC: 4.5-6.7 log10 cfu cm-2) and values for ATP and protein residues; therefore, these surfaces could be identified as the most important critical points. Spearman rank correlations (P < 0.01) were found between the different assessment methods, especially for the TVC and ATP (r = 0.82, P < 0.001). For rapid assessment on farms, ATP tests represented an accurate and cost-efficient alternative to microbiological techniques. Training improved cleaning performance as indicated by a lower rating for visual inspection, TVC, ATP, MRSA, and ESBL in the second assessment. The monitoring of cleaning efficiency in pig pens followed by training of the staff constitutes a valuable strategy to limit the spread of infectious diseases and antibiotic-resistant bacteria. Special attention should be paid to the sufficient hygiene of drinkers and feeders.
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Affiliation(s)
- Céline Heinemann
- Institute of Animal Science, Preventive Health Management, University of Bonn, Bonn, Germany
| | - Isabell Meyer
- Institute of Animal Science, Physiology and Hygiene Unit, University of Bonn, Bonn, Germany
| | - Franziska T Bögel
- Institute of Animal Science, Preventive Health Management, University of Bonn, Bonn, Germany
| | - Simone M Schmid
- Institute of Animal Science, Preventive Health Management, University of Bonn, Bonn, Germany
| | - Jason J Hayer
- Institute of Animal Science, Preventive Health Management, University of Bonn, Bonn, Germany
| | - Julia Steinhoff-Wagner
- Institute of Animal Science, Preventive Health Management, University of Bonn, Bonn, Germany
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19
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Holleck JL, Campbell S, Alrawili H, Frank C, Merchant N, Rodwin B, Perez MF, Gupta S, Federman DG, Chang JJ, Vientos W, Dembry L. Stethoscope hygiene: Using cultures and real-time feedback with bioluminescence-based adenosine triphosphate technology to change behavior. Am J Infect Control 2020; 48:380-385. [PMID: 31761292 DOI: 10.1016/j.ajic.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stethoscope hygiene is rarely done despite guideline recommendations. We wanted to determine whether demonstrating what is growing on the stethoscopes of providers via culture or bioluminescence technology alters perceptions and improves compliance. METHODS Providers were given the opportunity to (1) culture their stethoscopes before and after disinfection with alcohol pads, alcohol-based hand rub, or hydrogen peroxide disinfectant wipes and (2) swab stethoscopes for bioluminescence-based adenosine triphosphate testing before and after disinfection. Outcomes were observed for hand and stethoscope hygiene rates and before and after intervention survey responses. The bacteria that were isolated, colony-forming units (CFU), and bioluminescence scores were tracked. RESULTS A total of 1,245 observed hand hygiene opportunities showed that compliance improved from 72.5%-82.3% (P < .001). In addition, 590 observed patient-provider encounters revealed no significant change in stethoscope hygiene rates of 10% initially and 5% afterward (P = .08), although self-reported rates trended from 56%- 67% postintervention (P = .06). Perceptions regarding stethoscope hygiene importance improved (8.5/10 to 9.3/10; P = .04). Disinfection with alcohol pads, alcohol-based hand rub, and hydrogen peroxide disinfectant wipes were equivalent in CFU reduction (P = .21). CONCLUSIONS Showing providers what is growing on their stethoscopes via cultures and bioluminescence technology before and after disinfection improved "buy in" regarding stethoscope hygiene importance. Both methods were rated as having an equal impact, however, objective observations failed to show improvement.
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Affiliation(s)
- Jürgen L Holleck
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT.
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Department of Pathology and Laboratory Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | | | - Cynthia Frank
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Naseema Merchant
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Benjamin Rodwin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Mario F Perez
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Storrs, CT
| | - Shaili Gupta
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Daniel G Federman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - John J Chang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Wilson Vientos
- Department of Pathology and Laboratory Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT; Quinnipiac University, Hamden, CT
| | - Louise Dembry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
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20
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Willemsen I, Jefferson J, Mermel L, Kluytmans J. Comparison of infection control practices in a Dutch and US hospital using the infection risk scan (IRIS) method. Am J Infect Control 2020; 48:391-397. [PMID: 31703820 DOI: 10.1016/j.ajic.2019.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The infection risk scan (IRIS) is a tool to measure the quality of infection control (IC) and antimicrobial use in a standardized way. We describe the feasilibility of the IRIS in a Dutch hospital (the Netherlands, NL) and a hospital in the United States (US). METHODS Cross-sectional measurements were performed. Variables included a hand hygiene indicator, environmental contamination, IC preconditions, personal hygiene of health care workers, use of indwelling medical devices, and use of antimicrobials. RESULTS IRIS was performed in 2 wards in a US hospital and 4 wards in a Dutch hospital. Unjustified use of medical devices: none in the US hospital, 2.2% in the Dutch hospital; inappropriate use of antibiotics: 11.7% (US), 19% (NL); items considered not clean: 10% (US); 36% (NL); shortcomings preconditions: 6 of 20 (US), 6 of 40 (NL); health care workers with rings, watches, or long sleeves: 34 of 43 (US), none in the NL hospital; and hand hygiene actions per patient/day: 41 (US) and 10 (NL). US data judged against the Dutch guidelines and vice versa revealed remarkable differences. CONCLUSIONS We showed the feasibility of using the IRIS in a US hospital. The method provided insight in IC local performance. This method could be the first step to standardize the measurement of the quality of IC and antimicrobial use. However, if the IRIS is used for benchmarking between hospitals in different regions, this should be done in the context of regional guidelines and policies.
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21
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Mitchell BG, McGhie A, Whiteley G, Farrington A, Hall L, Halton K, White NM. Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial. Infect Dis Health 2020; 25:168-174. [PMID: 32234296 DOI: 10.1016/j.idh.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Environmental cleaning is an important approach to reducing healthcare-associated infection. The aim of this short research paper is to describe changes in the efficacy of post-discharge cleaning by examining the amount of bio-burden on frequent touch points (FTPs) in patient areas, using a validated Adenosine Triphosphate (ATP) bioluminescence sampling method. In so doing, we present findings from a secondary outcome of a recent trial, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study. METHODS The REACH study used a prospective, stepped-wedge randomised cluster design. Cross sectional ATP sampling was conducted at three of the 11 participating hospitals. At each hospital, during the control and intervention phase of the study, six Frequent Touch Points (FTPs) were sampled: toilet flush, bathroom tap, inside bathroom door handle, patient call button, over bed tray table, and bed rails. RESULTS Across the three hospitals, 519 surfaces in 49 rooms (control phase) and 2856 surfaces in 251 rooms (intervention phase) were sampled. Bedroom FTP cleaning improved across all three hospitals. The cleaning of bathroom FTPs was generally high from the outset and remained consistent throughout the whole study period. Average cleaning outcomes for bathroom FTPs were consistently high during the control period however outcomes varied between individual FTP. Changes in cleaning performance over time reflected variation in intervention effectiveness at the hospital level. CONCLUSION Findings confirm improvement in cleaning in the FTPs in bedrooms, demonstrating improvements in discharge cleaning aligned with the improvements seen when using fluorescent marking technology as a marker of performance.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, 2258, Australia.
| | - Alexandra McGhie
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Greg Whiteley
- Whiteley Corporation, North Sydney, NSW, 2060, Australia; Western Sydney University, School of Medicine, Liverpool, NSW, 2010, Australia
| | - Alison Farrington
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia; School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Herston, Qld, 4006, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Nicole M White
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia; School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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Ucak Ozkaya G, Durak MZ, Akyar I, Karatuna O. Antimicrobial Susceptibility Test for the Determination of Resistant and Susceptible S. aureus and Enterococcus spp. Using a Multi-Channel Surface Plasmon Resonance Device. Diagnostics (Basel) 2019; 9:E191. [PMID: 31731591 PMCID: PMC6963824 DOI: 10.3390/diagnostics9040191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to investigate the development of a surface plasmon resonance (SPR) sensor platform equipped with multiple channels for the simultaneous determination of methicillin-resistant S. aureus (MRSA), methicillin-susceptible S. aureus (MSSA) and vancomycin-resistant Enterococcus (VRE), and vancomycin-susceptible Enterococcus (VSE). Drug resistance of S. aureus strains against cefoxitin and Enterococcus strains against vancomycin were investigated both using the minimum inhibitory concentration method (MIC) assay and the SPR system equipped with single and multiple channels. The MIC values of MRSA and MSSA ranged from 32 µg/mL to >128 µg/mL and from 1 µg/mL to 4 µg/mL, respectively. The MIC values of VRE and VSE were between 64 to >128 µg/mL and 2-4 µg/mL, respectively. With the multiple-channel system, the angle shifts of MRSA, MSSA, VRE and VSE were found to be -0.030° and -0.260°, -0.010° and -0.090° respectively. The antibiotic-resistant and susceptible strains were distinguished within 3 h for S. aureus strains and within 6 h for Enterococcus strains.
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Affiliation(s)
- Gulsum Ucak Ozkaya
- Department of Food Engineering, Faculty of Chemical and Metallurgical Engineering, Yildiz Technical University, Istanbul 34210, Turkey
- Department of Food Engineering, Faculty of Engineering and Architecture, Bitlis Eren University, Bitlis 13000, Turkey
| | - Muhammed Zeki Durak
- Department of Food Engineering, Faculty of Chemical and Metallurgical Engineering, Yildiz Technical University, Istanbul 34210, Turkey
| | - Isin Akyar
- Department of Medical Microbiology, School of Medicine, Acibadem University, Istanbul 34752, Turkey; (I.A.); (O.K.)
| | - Onur Karatuna
- Department of Medical Microbiology, School of Medicine, Acibadem University, Istanbul 34752, Turkey; (I.A.); (O.K.)
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Xu H, Liang J, Wang Y, Wang B, Zhang T, Liu X, Gong L. Evaluation of different detector types in measurement of ATP bioluminescence compared to colony counting method for measuring bacterial burden of hospital surfaces. PLoS One 2019; 14:e0221665. [PMID: 31490948 PMCID: PMC6730931 DOI: 10.1371/journal.pone.0221665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
Abstract
The ATP bioluminescence method has been increasingly employed as a rapid, on-site detection method in nosocomial infections control. In this study, we used a paired design of monitoring methods, the colony counting method (C) and the ATP bioluminescence method, to evaluate environmental surfaces after disinfection. The ATP bioluminescence method included three detector types (B, P, and N). Every surface after disinfection was performed by combining two types of monitoring methods or detectors. There was no statistically significant difference in theATP content per surface siteamong samples from intensive care units (ICUs)and internal medicine wards using B (p = 0.435) and P (p = 0.260). According to the Spearman’s rank correlation coefficients, with the exception of the correlation between the ATP content values detected by B and P, the correlation between the values generated by the remaining methods/detectors was weak or lacking, whereasthe differences between the detectors were statistically significant. Therefore, there are differences between the ATP bioluminescence method and the colony counting method, also between different detectors.
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Affiliation(s)
- Huiqiong Xu
- Department of Disinfection and Pest Control, Wuhan Centers for Disease Prevention and Control, Wuhan, Hubei, China
| | - Jiansheng Liang
- Department of Disinfection and Pest Control, Wuhan Centers for Disease Prevention and Control, Wuhan, Hubei, China
- * E-mail:
| | - Yimei Wang
- Department of Disinfection and Pest Control, Wuhan Centers for Disease Prevention and Control, Wuhan, Hubei, China
| | - Bin Wang
- Department of Disinfection and Pest Control, Wuhan Centers for Disease Prevention and Control, Wuhan, Hubei, China
| | - Tianbao Zhang
- Department of Infectious Disease Prevention, Hubei Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Xiaoli Liu
- Department of Disinfection and Pest Control, Wuhan Centers for Disease Prevention and Control, Wuhan, Hubei, China
| | - Lin Gong
- Department of Disinfection and Pest Control, Wuhan Centers for Disease Prevention and Control, Wuhan, Hubei, China
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Furlan MCR, Ferreira AM, Rigotti MA, Guerra OG, Frota OP, Sousa AFLD, Andrade DD. Correlação entre métodos de monitoramento de limpeza e desinfecção de superfícies ambulatoriais. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Avaliar a correlação entre cultura microbiológica, teste de ATP por bioluminescência e inspeção visual na monitorização da eficiência da limpeza e da desinfecção de superfícies de uma unidade ambulatorial e determinar o valor de corte de ATP-bioluminescência capaz de indicar superfície limpa em relação à avaliação microbiológica. Métodos Estudo exploratório, longitudinal e correlacional. Foram realizadas 720 avaliações em cinco superfícies antes e após a limpeza e a desinfecção. Nos resultados, foram realizadas análises de duas proporções, a correlação de Spearman e a curva ROC. Resultados Ocorreram proporções semelhantes (p≥0,05) entre as taxas de reprovação apenas entre ATP-bioluminescência e contagem de colônias aeróbias (CCA) quando somadas as avaliações de todas as superfícies antes e depois da limpeza e da desinfecção. Houve correlação significativa entre os métodos de quantificação de ATP e a contagem microbiana para o balcão da recepção e a maca. A análise ROC indicou que a quantificação de ATP apresentou resultado significativo na comparação com a CCA (p=0,044). Conclusão Embora discreta, houve correlação significativa entre os métodos de quantificação de ATP e contagem microbiana para duas superfícies. Sugere-se que superfícies que apresentam valores ≤49 unidades relativas de luz estão limpas.
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Kwan SE, Peccia J, Simonds J, Haverinen-Shaughnessy U, Shaughnessy RJ. Comparing bacterial, fungal, and human cell concentrations with rapid adenosine triphosphate measurements for indicating microbial surface contamination. Am J Infect Control 2019; 47:671-676. [PMID: 30584018 DOI: 10.1016/j.ajic.2018.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The goal of this study was to test for associations between adenosine triphosphate (ATP) content and microbial concentrations on desk surfaces in school classrooms. METHODS ATP bioluminescence and quantitative polymerase chain reaction (qPCR) techniques were employed to measure total bacterial, fungal, and human cell concentrations on 66 high-traffic desks spread across 9 schools: 3 in Connecticut (CT) and 6 in Oklahoma (OK). In CT, 6 samples were taken from each desk, 1 precleaning and 5 postcleaning (after 30 minutes, 1 day, 3 days, 7 days, and 21 days). In OK, samples were taken immediately before and after cleaning each desk. RESULTS Based on simple linear regression analyses, ATP values were good predictors of microbial concentrations (r = 0.8, P = .003) in both CT school postcleaning samples and OK pre- and postcleaning samples (r = 0.7, P = .00002). However, biomass reductions measured after cleaning were 1.5-2 times greater when measured by ATP than by qPCR (P = .007). CONCLUSIONS Overall, ATP bioluminescence measurements correlate with qPCR-based surface measurements on school desks but may overestimate the physical removal of bacteria and fungi due to cleaning.
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Affiliation(s)
- Sarah E Kwan
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
| | - Jordan Peccia
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
| | - Jonathan Simonds
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
| | | | - Richard J Shaughnessy
- Indoor Air Program, Department of Chemical Engineering, University of Tulsa, Tulsa, OK.
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Furlan MCR, Ferreira AM, da Silva Barcelos L, Rigotti MA, de Sousa AFL, Dos Santos Junior AG, de Andrade D, de Almeida MTG, da Silva Barreto M. Evaluation of disinfection of surfaces at an outpatient unit before and after an intervention program. BMC Infect Dis 2019; 19:355. [PMID: 31035961 PMCID: PMC6489196 DOI: 10.1186/s12879-019-3977-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cleaning and disinfection processes must be improved so that there is a reduction in environmental contamination of frequent-contact surfaces. The objective of this study was to evaluate cleaning and disinfection of surfaces at a specialized healthcare unit after an intervention program. METHODS Exploratory, longitudinal, and correlational study carried out in a medium-complexity clinic. Two hundred and forty samples from five surfaces were collected during three phases: diagnosis; implementation of an intervention program; and evaluation of immediate and long-term effects. In total, 720 evaluations were made, performed through three monitoring methods: visual inspection; adenosine triphosphate bioluminescence assay (ATP); and aerobic colony count (ACC). The Wilcoxon, Mann-Whitney, and Fisher's Exact tests were run to analyze data statistically. RESULTS Cleaning and disinfection of surfaces were not being performed properly in most cases. Failure rates of surfaces reached 37.5 and 100% when the ATP and ACC procedures were used, respectively. However, after an intervention program, an improvement occurred. Success rates increased by 43.96% (ATP) and 12.46% (ACC) in phase I, by 70.6% (ATP) and 82.3% (ACC) immediately after interventions, and by 76.52% (ATP) and 85.76% (ACC) two months after the changes, showing that the program was effective. CONCLUSION The present study reveals that implementing intervention actions with a cleaning and healthcare team brings benefits to prevent the spread of pathogenic agents through frequently touched hospital surfaces.
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Affiliation(s)
| | | | | | | | - Alvaro Francisco Lopes de Sousa
- Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil. .,Global Health and Tropical Medicine, Instituto de Higiene e MedicinaTropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal. .,Campus Universitário - Bairro Monte Alegre, Avenida dos Bandeirantes, 3900, Ribeirão Preto, CEP: 14040-902, SP, Brasil.
| | | | - Denise de Andrade
- Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Fysun O, Kern H, Wilke B, Langowski H. Formation of dairy fouling deposits on food contact surfaces. INT J DAIRY TECHNOL 2019. [DOI: 10.1111/1471-0307.12580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Olga Fysun
- TUM School of Life Sciences Weihenstephan Technical University of Munich Freising Germany
- Robert Bosch Packaging Technology GmbH Waiblingen Germany
| | - Heike Kern
- Robert Bosch Packaging Technology GmbH Waiblingen Germany
- Institute of Food Science and Biotechnology University of Hohenheim Stuttgart Germany
| | - Bernd Wilke
- Robert Bosch Packaging Technology GmbH Waiblingen Germany
| | - Horst‐Christian Langowski
- TUM School of Life Sciences Weihenstephan Technical University of Munich Freising Germany
- Fraunhofer Institute for Process Engineering and Packaging IVV Freising Germany
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Aalirezaie A, Akkaya M, Barnes CL, Bengoa F, Bozkurt M, Cichos KH, Ghanem E, Darouiche RO, Dzerins A, Gursoy S, Illiger S, Karam JA, Klaber I, Komnos G, Lohmann C, Merida E, Mitt P, Nelson C, Paner N, Perez-Atanasio JM, Reed M, Sangster M, Schweitzer D, Simsek ME, Smith BM, Stocks G, Studers P, Talevski D, Teuber J, Travers C, Vince K, Wolf M, Yamada K, Vince K. General Assembly, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S105-S115. [PMID: 30348570 DOI: 10.1016/j.arth.2018.09.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Sanna T, Dallolio L, Raggi A, Mazzetti M, Lorusso G, Zanni A, Farruggia P, Leoni E. ATP bioluminescence assay for evaluating cleaning practices in operating theatres: applicability and limitations. BMC Infect Dis 2018; 18:583. [PMID: 30453892 PMCID: PMC6245901 DOI: 10.1186/s12879-018-3505-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Environmental cleaning practice plays an important role in reducing microbial contamination in hospital surfaces and contributes to prevent Healthcare Associated Infections. Adenosine Triphosphate (ATP) bioluminescence assay is a commonly used method for assessing environmental cleanliness on healthcare surfaces. This study tested the feasibility of using ATP-bioluminescence assay for evaluating the efficiency of cleaning procedures in the operating theatre settings, comparing the ATP-bioluminescence test with the traditional culture method. Methods The surfaces of 10 operating rooms of two public hospitals (140 samples in total) were examined “at rest”, in two moments of the same daily session: before the first scheduled operation (Pre), and before the second, after a clean environment was re-established (Post). Surface contamination was assessed using the cultural method to detect Total Viable Counts (TVC36°C) and ATP-bioluminescence assay (RLU). Results The examined surfaces presented very low TVCs (geometric means: 1.8 CFU/plate; IC95%: 1.6–2.0), always compliant with the relative reference standards. No statistical correlation was found between ATP values and TVCs. However, considering the results in terms of general evaluation of hygienic quality of surfaces, the two methods were consistent in identifying the most contaminated areas (Hospital A > Hospital B; Pre > Post; most contaminated surfaces: scialytic lamp). Furthermore, the ATP mean values showed a progressive increase from surfaces with TVC = 0 to surfaces with TVC > 15 CFU/plate. Conclusions Although not an alternative to cultural methods, the ATP-bioluminescence-assay can be a useful tool to measure the efficiency of cleaning procedures also in environments with very low microbial counts. Each health facility should identify appropriate reference values, depending on the devices used and on the basis of the analysis of the data collected through spatial and temporal sampling series. By providing a rapid feedback, the ATP-assay helps to increase the awareness of operators and allows immediate action to be taken in critical situations.
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Affiliation(s)
- Tiziana Sanna
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy.
| | - Alessandra Raggi
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
| | - Magda Mazzetti
- Unit of Hygiene, Control of Healthcare Associated Infections, Bologna Local Health Authority, "Bellaria" Hospital, via Altura 3, 40139, Bologna, Italy
| | - Giovanni Lorusso
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
| | - Angela Zanni
- Unit of Hygiene and Quality of Residencial Services, Bologna Local Health Authority, "Bellaria" Hospital, via Altura 3, 40139, Bologna, Italy
| | - Patrizia Farruggia
- Unit of Hygiene and Quality of Residencial Services, Bologna Local Health Authority, "Bellaria" Hospital, via Altura 3, 40139, Bologna, Italy
| | - Erica Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
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Najafi Saleh H, Kavosi A, Pakdel M, Yousefi M, Baghal Asghari F, Mohammadi AA. Assessment health status of ICU medical equipment levels at Neyshabur hospitals using ICNA and ACC indices. MethodsX 2018; 5:1364-1372. [PMID: 30425934 PMCID: PMC6222287 DOI: 10.1016/j.mex.2018.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/06/2018] [Indexed: 01/16/2023] Open
Abstract
This study was conducted to evaluate the health status of medical equipment's in Neyshabur hospital's intensive care units (ICU) before and after daily cleaning in order to compare the efficiency of the observational and microbial methods in evaluating hygienic conditions and cleaning of the environmental surfaces at the hospitals in Neyshabur. The study was performed in a ten-week period, twice a week before and after daily cleaning according to the ICNA observational method and the ACC microbial method were performed on the selected sites. (before and after daily cleaning in order to compare ICNA observational method and the ACC microbial method which performed on the selected sites). Result showed in total, 826 ICNA checklists were completed in this research for the 13 studied spots, 27.12% of the spots were contaminated before cleaning procedures, which dropped to 7.75% after cleaning. Data of the samples using the ACC index revealed that 74.82 were contaminated and 7.75% were clean. Bottle suction with 8.2% and Electroshock with 1% were the most and the least contaminated spots, respectively. As the results proved, the microorganism of Staphylococcus epidermises is the most grown organism in the intensive care unit. This study suggests that visual assessment is not enough to ensure quality of the process and it is necessary to document the level of cleanliness by quantitative methods. Also preparing the integrated instructions and guidelines of cleaning and disinfection and its continuous monitoring with standard methods would be effective in reducing the microbial contamination.
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Affiliation(s)
- Hossein Najafi Saleh
- Department of Environmental Health Engineering School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Ali Kavosi
- Nursing Research Center, Faculty Member, Golestan University of Medical Sciences, Gorgan, Iran
| | - Manizhe Pakdel
- Students Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mahmood Yousefi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Baghal Asghari
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Mohammadi
- Department of Environmental Health Engineering, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Application of a fluorescent marker with quantitative bioburden methods to assess cleanliness. Infect Control Hosp Epidemiol 2018; 39:1296-1300. [PMID: 30221609 DOI: 10.1017/ice.2018.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Improvement of environmental cleaning in hospitals has been shown to decrease in-hospital cross transmission of pathogens. Several objective methods, including aerobic colony counts (ACCs), the adenosine triphosphate (ATP) bioluminescence assay, and the fluorescent marker method have been developed to assess cleanliness. However, the standard interpretation of cleanliness using the fluorescent marker method remains uncertain. OBJECTIVE To assess the fluorescent marker method as a tool for determining the effectiveness of hospital cleaning. DESIGN A prospective survey study. SETTING An academic medical center. METHODS The same 10 high-touch surfaces were tested after each terminal cleaning using (1) the fluorescent marker method, (2) the ATP assay, and (3) the ACC method. Using the fluorescent marker method under study, surfaces were classified as totally clean, partially clean, or not clean. The ACC method was used as the standard for comparison. RESULTS According to the fluorescent marker method, of the 830 high-touch surfaces, 321 surfaces (38.7%) were totally clean (TC group), 84 surfaces (10.1%) were partially clean (PC group), and 425 surfaces (51.2%) were not clean (NC group). The TC group had significantly lower ATP and ACC values (mean ± SD, 428.7 ± 1,180.0 relative light units [RLU] and 15.6 ± 77.3 colony forming units [CFU]/100 cm2) than the PC group (1,386.8 ± 2,434.0 RLU and 34.9 ± 87.2 CFU/100 cm2) and the NC group (1,132.9 ± 2,976.1 RLU and 46.8 ± 119.2 CFU/100 cm2). CONCLUSIONS The fluorescent marker method provided a simple, reliable, and real-time assessment of environmental cleaning in hospitals. Our results indicate that only a surface determined to be totally clean using the fluorescent marker method could be considered clean.
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Casini B, Tuvo B, Totaro M, Aquino F, Baggiani A, Privitera G. Evaluation of the Cleaning Procedure Efficacy in Prevention of Nosocomial Infections in Healthcare Facilities Using Cultural Method Associated with High Sensitivity Luminometer for ATP Detection. Pathogens 2018; 7:pathogens7030071. [PMID: 30200291 PMCID: PMC6161163 DOI: 10.3390/pathogens7030071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 01/05/2023] Open
Abstract
In healthcare facilities, environmental surfaces may be a reservoir of infectious agents even though cleaning and disinfection practices play a role in the control of healthcare-associated infections. In this study, the effectiveness of cleaning/disinfection procedures has been evaluated in two hospital areas, which have different risk category classifications. According to the contract with the cleaning service, after the daily ambulatory activities, the housekeeping staff apply an alcohol-based detergent followed by a chlorine-based disinfectant (2% Antisapril, Angelini; 540 mg/L active chlorine), properly diluted and sprayed. The contract provides for the use of disposable microfiber wipes which must be replaced with new ones in each health out-patient department. Surface contamination was analyzed using cultural methods and ATP detection, performed with a high-sensitivity luminometer. The values 100 CFU/cm² and 40 RLU/cm² were considered as the threshold values for medium-risk category areas, while 250 CFU/cm² and 50 RLU/cm² were defined for the low-risk category ones. Air quality was evaluated using active and passive sampling microbiological methods and particle count (0.3 μm⁻10 μm) detection. The cleaning/disinfection procedure reduced the medium bacterial counts from 32 ± 56 CFU/cm² to 2 ± 3 CFU/cm² in the low-risk area and from 25 ± 40 CFU/cm² to 7 ± 11 CFU/cm² in the medium-risk one. Sample numbers exceeding the threshold values decreased from 3% and 13% to 1% and 5%, respectively. RLU values also showed a reduction in the samples above the thresholds from 76% to 13% in the low-risk area. From the air samples collected using the active method, we observed a reduction of 60% in wound care and 53% in an ambulatory care visit. From the air samples collected using the passive method, we highlighted a 71.4% and 50% reduction in microbial contamination in the medium-risk area and in the low-risk one, respectively. The 10 μm size particle counts decreased by 52.7% in wound care and by 63% in the ambulatory care visit. Correct surface sanitation proved crucial for the reduction of microbial contamination in healthcare settings, and plays an important role in ensuring air quality in hospital settings.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Benedetta Tuvo
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Francesco Aquino
- Department of Pubblic Health and Hygiene, Azienda USL Toscana Nord Ovest, 56124 Pontedera, Italy.
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
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Vos MC, Galetzka M, Mobach MP, Van Hagen M, Pruyn AT. Exploring cleanliness in the Dutch facilities management industry: a Delphi approach. FACILITIES 2018. [DOI: 10.1108/f-09-2017-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to identify antecedents that influence perceived cleanliness by consulting experts and end-users in the field of facilities management (facility service providers, clients of facility service providers and consultants). Business models were evaluated to understand why some antecedents are adopted by practitioners and others are not.
Design/methodology/approach
A qualitative study, with end-users (n = 7) and experts (n = 24) in the field of facilities management, was carried out to identify antecedents of perceived cleanliness. Following the Delphi approach, different research methods including interviews, group discussions and surveys were applied.
Findings
Actual cleanliness, cleaning staff behaviour and the appearance of the environment were identified as the three main antecedents of perceived cleanliness. Client organisations tend to have a stronger focus on antecedents that are not related to the cleaning process compared to facility service providers.
Practical implications
More (visible) cleaning, maintenance, toilets, scent, architecture and use of materials offer interesting starting points for practitioners to positively influence perceived cleanliness. These antecedents may also be used for the development of a standard for perceived cleanliness.
Originality/value
A basis was created for the development of an instrument that measures perceived cleanliness and includes antecedents that are typically not included in most of the current standards of actual cleanliness (e.g. NEN 2075, ISSA).
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Kenters N, Gottlieb T, Hopman J, Mehtar S, Schweizer ML, Tartari E, Huijskens EGW, Voss A. An international survey of cleaning and disinfection practices in the healthcare environment. J Hosp Infect 2018; 100:236-241. [PMID: 29772262 DOI: 10.1016/j.jhin.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. AIM To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. METHODS The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. FINDINGS A total of 110 healthcare professionals, representing 23 countries, participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. CONCLUSIONS The survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide.
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Affiliation(s)
- N Kenters
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, Australia
| | - J Hopman
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - S Mehtar
- Unit of Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa
| | - M L Schweizer
- Department of Epidemiology, College of Public Health, Department of Internal Medicine, Iowa, USA
| | - E Tartari
- Infection Control Programme and WHO Collaborating Centre of Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - E G W Huijskens
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Voss
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Department of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Santos-Junior AG, Ferreira AM, Frota OP, Rigotti MA, Barcelos LDS, Lopes de Sousa AF, de Andrade D, Guerra OG, R Furlan MC. Effectiveness of Surface Cleaning and Disinfection in a Brazilian Healthcare Facility. Open Nurs J 2018; 12:36-44. [PMID: 29643951 PMCID: PMC5876921 DOI: 10.2174/1874434601812010036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/24/2018] [Accepted: 02/22/2018] [Indexed: 11/22/2022] Open
Abstract
Background Failures in the processes of cleaning and disinfecting health service surfaces may result in the spread and transfer of pathogens that are often associated with healthcare-related infections and outbreaks. Aims To assess the effectiveness of environmental surface cleaning and disinfection in a hospital clinic. Method The study was conducted in a nursing ward with 45 beds. A total of 80 samples from five high-touch surfaces were evaluated before and after cleaning and disinfection, using the following methods: visual inspection, adenosine triphosphate bioluminescence assay, aerobic colony count, Staphylococcus aureus colony count, and evaluation of resistance to methicillin. The data analysis used nonparametric comparative and correlative tests to observe any differences in the pre- and post- cleaning and disinfection results for the surfaces assessed. Results Effective cleaning and disinfection had a significant effect on only two surfaces when measured for the presence of adenosine triphosphate, the inner bathroom door handle (p=0.007) and the toilet bowl (p=0.01). When evaluated for Staphylococcus aureus colony count, the toilet flush handle also demonstrated a significant effect (p=0.04). Conclusion The effectiveness of cleaning and disinfection of the surfaces tested was not satisfactory. An educational intervention is recommended for the cleaning and disinfection staff and the nursing team at the healthcare facility. Relevance to Clinical Practice The data in the study revealed that daily hospital cleaning and disinfection in the sampled sites are not sufficient in medical and surgical wards. Hospital cleanliness must be reevaluated from the point of view of materials, such as an adequate supply of clean cloths, in addition to establishing more precise cleanliness protocols and accurate monitoring systems.
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Affiliation(s)
| | - Adriano M Ferreira
- Course of Nursing, Federal University of Mato Grosso do Sul, Coxim, Brazil
| | - Oleci P Frota
- School of Medicine, Program of Health and Development in the Center-West Region and Master's Degree Program in Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Marcelo A Rigotti
- Course of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | - Denise de Andrade
- Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
| | - Odanir G Guerra
- Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
| | - Mara C R Furlan
- Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
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Willemsen I, Kluytmans J. The infection risk scan (IRIS): standardization and transparency in infection control and antimicrobial use. Antimicrob Resist Infect Control 2018. [PMID: 29541449 PMCID: PMC5845162 DOI: 10.1186/s13756-018-0319-z] [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] [Indexed: 11/10/2022] Open
Abstract
Background Infection control needs user-friendly standardized instruments to measure the compliance to guidelines and to implement targeted improvement actions. This abstract describes a tool to measure the quality of infection control and antimicrobial use, the Infection Risk Scan (IRIS). It has been applied in a hospital, several nursing homes and a rehabilitation clinic in the Netherlands. Method The IRIS consists of a set of objective reproducible measurements, combining patient- and healthcare related variables, such as: hand hygiene compliance, environmental contamination using ATP measurements, prevalence of resistant microorganisms by active screening, availability of infection control preconditions, personal hygiene of healthcare workers, appropriate use of indwelling medical devices and appropriate use of antimicrobials. Results are visualized in a spider plot using traffic light colors to facilitate the interpretation. Results The IRIS provided ward specific results within the hospital that were the basis for targeted improvement programs resulting in measurable improvements. Hand hygiene compliance increased from 43% to 66% (more than 1000 observations per IRIS, p < 0.000) and ATP levels were significantly reduced (p < 0.000). In the nursing homes, large differences were observed with environmental contamination as common denominator. Most remarkable were the difference in Extended Spectrum Beta-Lactamase Enterobacteriaceae (ESBL-E) prevalence (mean 11%, range 0–21%). Conclusion The bundle approach and visualization of the IRIS makes it a useful infection prevention tool providing standardization and transparency. Targeted interventions can be started based on the results of the improvement plot and repeated IRIS can show the effect of interventions. In that way, a quality control cycle with continuous improvement can be achieved.
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Affiliation(s)
- Ina Willemsen
- 1Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, The Netherlands.,Center for Infectious Disease Expertise and Research (CIDER), Tilburg, The Netherlands
| | - Jan Kluytmans
- 1Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, The Netherlands.,3Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands
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Santos Junior AGD, Ferreira AM, Rigotti MA, Santos FRD, Furlan MCR, Andrade DD. AVALIAÇÃO DA EFICIÊNCIA DA LIMPEZA E DESINFECÇÃO DE SUPERFÍCIES EM UMA UNIDADE BÁSICA DE SAÚDE. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018003720017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar o efeito de intervenções educativasna limpeza e desinfecção de superfícies em uma unidade básica de saúde. Métodos: trata-se de um estudo prospectivo, analítico com abordagem quantitativa. O estudo foi realizado em uma unidade básica de saúde, onde atuam duas equipes da Estratégia de Saúde da Família. Optou-se por avaliar a limpeza e desinfecção das superfícies: carrinho de curativo, balcão da recepção, mesa ginecológica, maca do paciente e mesa de consulta de enfermagem, utilizando-se dos métodos de monitoramento: avaliação visual, contagem de unidades formadoras de colônias e mensuração de adenosina trifosfato. Utilizaram-se, para a análise estatística, o teste de postos de Wilcoxon e o teste de Mann-Whitney, considerou-se nível de significância de 5% ou (p<0,05). Resultados: obteve-se um total de 720 avaliações realizadas ao término de todas as fases. Observou-se na fase I uma taxa de reprovação de 57,5%, 20,0% e 90,0%; após a intervenção educativa, os quantitativos de reprovação em curto prazo diminuíram para 0,0%, 2,5,0% e 50,0% (dados da fase III) e, em longo prazo, para 5,0%, 0,0% e 65% (dados da fase IV) para os métodos visual, adenosina trifosfato e cultura, respectivamente. A inspeção visual foi o método que apresentou maior frequência de superfícies reprovadas nas fases I e IV. Conclusão: houve redução da carga microbiana e valores das leituras de adenosina trifosfato; embora essa redução não tenha sido estatisticamente significativa em todas as superfícies. Constatou-se que a intervenção educativa foi eficiente.
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Environmental cleaning and disinfection of patient areas. Int J Infect Dis 2017; 67:52-57. [PMID: 29102556 DOI: 10.1016/j.ijid.2017.10.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 12/19/2022] Open
Abstract
The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.
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Ferreira AM, de Andrade D, Rigotti MA, de Almeida MTG, Guerra OG, dos Santos Junior AG. Assessment of disinfection of hospital surfaces using different monitoring methods. Rev Lat Am Enfermagem 2017; 23:466-74. [PMID: 26312634 PMCID: PMC4547070 DOI: 10.1590/0104-1169.0094.2577] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 01/15/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE: to assess the efficiency of cleaning/disinfection of surfaces of an Intensive
Care Unit. METHOD: descriptive-exploratory study with quantitative approach conducted over the
course of four weeks. Visual inspection, bioluminescence adenosine triphosphate
and microbiological indicators were used to indicate cleanliness/disinfection.
Five surfaces (bed rails, bedside tables, infusion pumps, nurses' counter, and
medical prescription table) were assessed before and after the use of rubbing
alcohol at 70% (w/v), totaling 160 samples for each method. Non-parametric tests
were used considering statistically significant differences at p<0.05. RESULTS: after the cleaning/disinfection process, 87.5, 79.4 and 87.5% of the surfaces
were considered clean using the visual inspection, bioluminescence adenosine
triphosphate and microbiological analyses, respectively. A statistically
significant decrease was observed in the disapproval rates after the cleaning
process considering the three assessment methods; the visual inspection was the
least reliable. CONCLUSION: the cleaning/disinfection method was efficient in reducing microbial load and
organic matter of surfaces, however, these findings require further study to
clarify aspects related to the efficiency of friction, its frequency, and whether
or not there is association with other inputs to achieve improved results of the
cleaning/disinfection process.
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Affiliation(s)
| | - Denise de Andrade
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
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What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay. Clin Orthop Relat Res 2017; 475:1819-1824. [PMID: 28050814 PMCID: PMC5449321 DOI: 10.1007/s11999-016-5221-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Contaminated operating room surfaces can increase the risk of orthopaedic infections, particularly after procedures in which hardware implantation and instrumentation are used. The question arises as to how surgeons can measure surface cleanliness to detect increased levels of bioburden. This study aims to highlight the utility of adenosine triphosphate (ATP) bioluminescence technology as a novel technique in detecting the degree of contamination within the sterile operating room environment. QUESTIONS/PURPOSES What orthopaedic operating room surfaces are contaminated with bioburden? METHODS When energy is required for cellular work, ATP breaks down into adenosine biphosphate (ADP) and phosphate (P) and in that process releases energy. This process is inherent to all living things and can be detected as light emission with the use of bioluminescence assays. On a given day, six different orthopaedic surgery operating rooms (two adult reconstruction, two trauma, two spine) were tested before surgery with an ATP bioluminescence assay kit. All of the cases were considered clean surgery without infection, and this included the previously performed cases in each sampled room. These rooms had been cleaned and prepped for surgery but the patients had not been physically brought into the room. A total of 13 different surfaces were sampled once in each room: the operating room (OR) preparation table (both pre- and postdraping), OR light handles, Bovie machine buttons, supply closet countertops, the inside of the Bair Hugger™ hose, Bair Hugger™ buttons, right side of the OR table headboard, tourniquet machine buttons, the Clark-socket attachment, and patient positioners used for total hip and spine positioning. The relative light units (RLUs) obtained from each sample were recorded and data were compiled and averaged for analysis. These values were compared with previously published ATP benchmark values of 250 to 500 RLUs to define cleanliness in both the hospital and restaurant industries. RESULTS All surfaces had bioburden. The ATP RLUs (mean ± SD) are reported for each surface in ascending order: the OR preparation table (postdraping; 8.3 ± 3.4), inside the sterilized pan (9.2 ± 5.5), the inside of the Bair Hugger™ hose (212.5 ± 155.7), supply closet countertops (281.7 ± 236.7), OR light handles (647.8 ± 903.7), the OR preparation table (predraping; 1054 ± 387.5), the Clark-socket attachment (1135.7 ± 705.3), patient positioners used for total hip and spine positioning (1201.7 ± 1144.9), Bovie machine buttons (1264.5 ± 638.8), Bair Hugger™ buttons (1340.8 ± 1064.1), tourniquet machine buttons (1666.5 ± 2144.9), computer keyboard (1810.8 ± 929.6), and the right side of the OR table headboard (2539 ± 5635.8). CONCLUSIONS ATP bioluminescence is a novel method to measure cleanliness within the orthopaedic OR and can help identify environmental trouble spots that can potentially lead to increased infection rates. Future studies correlating ATP bioluminescence findings with microbiology cultures could add to the clinical utility of this technology. CLINICAL RELEVANCE Surfaces such as the undersurface of the OR table headboard, Bair Hugger™ buttons, and tourniquet machine buttons should be routinely cleansed as part of an institutional protocol. Although correlation between ATP bioluminescence and clinical infection was not evaluated in this study, it is the subject of future research. Specifically, evaluating microbiology samples taken from these environmental surfaces and correlating them with increased bioburden found with ATP bioluminescence technology can help promote improved surgical cleaning practices.
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CORR Insights ®: What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay. Clin Orthop Relat Res 2017; 475:1825-1826. [PMID: 28229323 PMCID: PMC5449329 DOI: 10.1007/s11999-017-5283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 01/31/2023]
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Ho YH, Tseng CC, Wang LS, Chen YT, Ho GJ, Lin TY, Wang LY, Chen LK. Application of Bacteriophage-containing Aerosol against Nosocomial Transmission of Carbapenem-Resistant Acinetobacter baumannii in an Intensive Care Unit. PLoS One 2016; 11:e0168380. [PMID: 27992494 PMCID: PMC5161369 DOI: 10.1371/journal.pone.0168380] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) is associated with nosocomial infections worldwide. Here, we used phage as a potential agent to evaluate the efficacy of daily cleaning practices combined with a bacteriophage-containing aerosol against CRAB. METHODS A two-phase prospective intervention study was performed at a 945-bed public teaching hospital. From March to December 2013, we performed terminal cleaning using standard procedures plus an aerosol with active bacteriophage in the intensive care units to evaluate the impact on nosocomial incidence density, carbapenem-resistance rates and antimicrobial drug consumption amounts. Patients with culture proven CRAB infection were transferred to the isolation room when the phage aerosol cleaning had been completed. RESULTS A total of 264 new acquisitions of CRAB were identified in the intensive care units (191 in the pre-intervention period and 73 in the intervention period). The rates of new acquisitions of CRAB in the intensive care units decreased from 8.57 per 1000 patient-days in the pre-intervention period to 5.11 per 1000 patient-days in the intervention period (p = 0.0029). The mean percentage of resistant isolates CRAB decreased from 87.76% to 46.07% in the intensive care units (p = 0.001). All of the antimicrobials showed a significant reduction in consumption except imipenem. CONCLUSIONS The bacteriophage was successful in decreasing the rates of infection caused by CRAB across intensive care units in a large teaching hospital.
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Affiliation(s)
- Yu-Huai Ho
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chun-Chieh Tseng
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Yi-Ting Chen
- Medical Intensive Care Unit, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Guan-Jin Ho
- Department of Surgical Critical Care Unit, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Teng-Yi Lin
- Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ling-Yi Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Li-Kuang Chen
- Institute of Medical Sciences, Department of Laboratory Diagnostic, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Laboratory Medicine, Clinical Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- * E-mail:
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Whiteley G, Glasbey T, Fahey P. A suggested sampling algorithm for use with ATP testing in cleanliness measurement. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Casini B, Selvi C, Cristina ML, Totaro M, Costa AL, Valentini P, Barnini S, Baggiani A, Tagliaferri E, Privitera G. Evaluation of a modified cleaning procedure in the prevention of carbapenem-resistant Acinetobacter baumannii clonal spread in a burn intensive care unit using a high-sensitivity luminometer. J Hosp Infect 2016; 95:46-52. [PMID: 27939245 DOI: 10.1016/j.jhin.2016.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enhanced environmental cleaning practices are among the most accepted measures for controlling the spread of carbapenem-resistant Acinetobacter baumannii (CR-Ab). AIM To evaluate the impact of heightened cleaning on an ongoing CR-Ab outbreak in a burn intensive care unit (BICU) of an Italian teaching hospital, where chlorhexidine-60% isopropyl alcohol was applied as a complementary disinfectant on high-touch surfaces. METHODS Compliance with the microbial limit proposed for the BICU by AFNOR-NF-S90-351 (20 colony-forming units/100cm2) was assessed by plate count, and compared with the results obtained with intracellular adenosine triphosphate (ATP) detection. Genotyping was performed using pulsed-field gel electrophoresis. FINDINGS During the standard cleaning regimen, three out of 23 samples (13%) gave results over the AFNOR limit and five (21.7%) showed unacceptable ATP levels with 100 relative light units/100cm2 as the benchmark limit (sensibility 86.4%, specificity 92.2%). Following improvement of the cleaning procedure, only two samples out of 50 (4%) did not satisfy the microbiological criteria and seven (14%) exceeded the ATP limit. In a successive phase, eight of 30 samples collected showed unacceptable results (27%). CONCLUSIONS Adding chlorhexidine-60% isopropyl alcohol as complementary disinfectant proved to be effective for reducing environmental microbial contamination, ATP levels and CR-Ab infection/colonization in patients admitted to the BICU. Real-time monitoring by ATP assay was useful for managing the cleaning schedule and reducing hospital infections, although the calculated values must be interpreted as cleanliness indicators rather than risk indicators.
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Affiliation(s)
- B Casini
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
| | - C Selvi
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - M L Cristina
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - A L Costa
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - P Valentini
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - S Barnini
- Unit of Microbiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - E Tagliaferri
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - G Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
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Ho YH, Wang LS, Jiang HL, Chang CH, Hsieh CJ, Chang DC, Tu HY, Chiu TY, Chao HJ, Tseng CC. Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060576. [PMID: 27294944 PMCID: PMC4924033 DOI: 10.3390/ijerph13060576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022]
Abstract
Contaminated surfaces play an important role in the transmission of pathogens. We sought to establish a criterion that could indicate "cleanliness" using a sampling area-adjusted adenosine triphosphate (ATP) assay. In the first phase of the study, target surfaces were selected for swab sampling before and after daily cleaning; then, an aerobic colony count (ACC) plate assay of bacteria and antibiotic-resistant bacteria was conducted. ATP swabs were also tested, and the ATP readings were reported as relative light units (RLUs). The results of the ACC and ATP assays were adjusted according to the sampling area. During the second phase of the study, a new cleaning process employing sodium dichloroisocyanurate (NaDCC) was implemented for comparison. Using the criterion of 2.5 colony-forming units (CFU)/cm², 45% of the sampled sites were successfully cleaned during phase one of the study. During phase two, the pass rates of the surface samples (64%) were significantly improved, except under stringent (5 RLU/cm²) and lax (500 RLU) ATP criteria. Using receiver-operating characteristic curve analysis, the best cut-off point for an area-adjusted ATP level was 7.34 RLU/cm², which corresponded to culture-assay levels of <2.5 CFU/cm². An area adjustment of the ATP assay improved the degree of correlation with the ACC-assay results from weak to moderate.
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Affiliation(s)
- Yu-Huai Ho
- Division of Infection Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien 97004, Taiwan.
| | - Lih-Shinn Wang
- Division of Infection Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien 97004, Taiwan.
| | - Hui-Li Jiang
- Unit of Infection Control and Management, Buddhist Tzu Chi General Hospital, Hualien 97004, Taiwan.
| | - Chih-Hui Chang
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Chia-Jung Hsieh
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Dan-Chi Chang
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Hsin-Yu Tu
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Tan-Yun Chiu
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Huei-Jen Chao
- Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien 97004, Taiwan.
| | - Chun-Chieh Tseng
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
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Extensive dissemination of extended spectrum β-lactamase-producing Enterobacteriaceae in a Dutch nursing home. Infect Control Hosp Epidemiol 2016; 36:394-400. [PMID: 25782893 DOI: 10.1017/ice.2014.76] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Risk factors for rectal carriage of ESBL-E and transmission were investigated in an outbreak of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). DESIGN Rectal carriage of ESBL-E was determined in a cross-sectional survey by culture of perianal swabs or fecal samples. Both phenotypical and genotypical methods were used to detect the production of ESBL. Nosocomial transmission was defined as the presence of genotypically related strains in ≥2 residents within the NH. Patient characteristics and variables in infection control practices were registered to investigate risk factors for transmission. SETTING A nursing home (NH) in the southern Netherlands. PARTICIPANTS Of 189 residents, 160 residents (84.7%) were screened for ESBL-E carriage. Of these 160 residents, 33 (20.6%) were ESBL-E positive. ESBL carriage rates varied substantially between wards (range, 0-47%). Four different ESBL-E clusters were observed. A bla CTX-M1-15 positive E. coli ST131 constituted the largest cluster (n=21) and was found in multiple wards (n=7). RESULTS Our investigation revealed extensive clonal dissemination of bla CTX-M1-15-positive E. coli ST131 in a nursing home. Unexplained differences in ESBL prevalence were detected among the wards. CONCLUSIONS As NHs constitute potential sources of multidrug-resistant bacteria, it is important to gain a better understanding of the risks factors and routes of transmission of ESBL-E.
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Ling ML, Apisarnthanarak A, Thu LTA, Villanueva V, Pandjaitan C, Yusof MY. APSIC Guidelines for environmental cleaning and decontamination. Antimicrob Resist Infect Control 2015; 4:58. [PMID: 26719796 PMCID: PMC4696151 DOI: 10.1186/s13756-015-0099-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.
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Affiliation(s)
- Moi Lin Ling
- />Singapore General Hospital, Outram Road, 169608 Singapore
| | | | | | | | - Costy Pandjaitan
- />Association of Infection Prevention Control Nurse, Jakarta, Indonesia
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Rigotti MA, Ferreira AM, Nogueira MCL, Almeida MTGD, Guerra OG, Andrade DD. EVALUATION OF THREE SURFACE FRICTION TECHNIQUES FOR THE REMOVAL OF ORGANIC MATTER. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-0707201500003690014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The objective of this study was to assess the effectiveness of three surface friction techniques for the removal of organic material. A quantitative, descriptive and exploratory study was developed to evaluate the presence or not of organic material before and after the cleaning and disinfection process of surfaces of bedside tables of patients hospitalized at an Intensive Care Unit. Three friction techniques were executed in the one-way, two-way and centrifugal sense, individually, three times on each table, during alternate weeks. For each patient unit and friction technique, a single table and three sides of cloth were used, moistened with 70% (w/v) alcohol. The organic matter was detected through the presence of adenosine triphosphate by bioluminescence, using 3M(tm) Clean-Trace(tm) ATP Systems. For each technique, 13 samples were collected before and 13 after the cleaning/disinfection process, totaling 78 samples of adenosine triphosphate by bioluminescence. No statistically significant difference was found among the removal techniques of organic matter. This study demonstrated that none of the three surface friction methods was better than the other to remove organic matter. Nevertheless, further research is needed in which other cleaning/disinfection indicators and surfaces are considered.
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Usefulness of Adenosinetriphosphate Bioluminescence Assay (ATPmetry) for Monitoring the Reprocessing of Endoscopes. Infect Control Hosp Epidemiol 2015; 36:1437-43. [DOI: 10.1017/ice.2015.212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVETo assess the diagnostic value of an adenosinetriphosphate bioluminescence assay (ATPmetry) to monitor the effectiveness of the reprocessing of endoscopes compared with microbiologic sampling.DESIGNDiagnostic study.SETTINGA 2,200-bed teaching hospital performing 5,000 to 6,000 endoscopic procedures annually.INCLUSION CRITERIAAll samples from bronchial or gastrointestinal endoscopes whatever the context.METHODSSamples for microbiologic analysis and ATPmetry measurements were taken when each endoscope was inspected following reprocessing. Sampling was performed by flushing each endoscope with 300 mL Neutralizing Pharmacopeia Diluent thiosulfate rinsing solution divided equally between the endoscope channels. For each endoscope a series of 3 ATPmetry measurements were made on a vial containing the first jet from each channel and a second series on the whole sample.RESULTSOf 165 samples from endoscopes, 11 exceeded the acceptability threshold of 25 colony-forming units/endoscope. In the first jet collected, the median (interquartile range) level of ATPmetry was 30.5 (15.3–37.7) relative light units (RLU) for samples with 25 or fewer colony-forming units compared with 37.0 (34.7–39.3) RLU for samples with more than 25 colony-forming units (P=.008). For the whole sample, the median (interquartile range) level of ATPmetry was 24.8 (14.3–36.3) RLU and 36.3 (36.0–38.3) RLU (P=.006), respectively. After adjusting on the batch of cleansing solution used, no difference in ATPmetry values was found between microbiologically acceptable and unacceptable samples.CONCLUSIONATPmetry cannot be used as an alternative or complementary approach to microbiologic tests for monitoring the reprocessing of endoscopes in FranceInfect. Control Hosp. Epidemiol. 2015;36(12):1437–1443
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Huang YS, Chen YC, Chen ML, Cheng A, Hung IC, Wang JT, Sheng WH, Chang SC. Comparing visual inspection, aerobic colony counts, and adenosine triphosphate bioluminescence assay for evaluating surface cleanliness at a medical center. Am J Infect Control 2015; 43:882-6. [PMID: 25952617 DOI: 10.1016/j.ajic.2015.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Environmental cleaning is essential in reducing microbial colonization and health care-associated infections in hospitals. However, there is no consensus for the standard method to assess hospital cleanliness, and comparisons of newer methodology, such as adenosine triphosphate bioluminescence assay, with the traditional methods are limited. METHODS A prospective study was conducted at a medical center between January 2013 and August 2013. In each selected room, 10-12 high-touch surfaces were sampled before and after terminal cleaning. The adequacy of cleaning was evaluated by visual inspection, aerobic colony counts (ACCs), and adenosine triphosphate (ATP) bioluminescence assay. RESULTS Eighty-five environmental surfaces from 8 rooms were evaluated by all 3 methods. The overall inadequacy defined by visual inspection, ACC, and ATP level was 11.8%, 20.0%, and 50.6% before cleaning and 4.7%, 5.9%, 21.2% after cleaning, respectively. A correlation between the ACC and ATP was found (r = 0.285, P < .001) using log10 values. Using ACCs <2.5 colony forming units/cm(2) as the cutoff for cleanliness, the ATP assay had better sensitivity than visual inspection (63.6% vs 27.3%). The receiver operating characteristics of the ATP assay indicated that the optimal ATP cutoff value was estimated to be 5.57 relative light units/cm(2). CONCLUSION ATP bioluminescence assay is a sensitive and rapid tool in evaluating the quality of terminal cleaning. We emphasize the value of using a quantitative method to monitor environmental cleaning at hospitals.
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