Investigation of single-use versus reusable infectious waste containers as potential sources of microbial contamination

Do closed waste containers lead to less air contamination than opened? A clinical case study at Jena University Hospital, Germany

Nosocomial infections are a growing challenge at hospitals. This clinical study aimed to investigate the influence of waste container construction ((open (O), closed (C), and hands-free opening (HF)) on microbial air contamination in a hospital setting. The results are intended to help develop guidelines for waste containers for the collection of non-infectious waste at hospitals and medical facilities. The clinical experiment was conducted at the University Hospital Jena, Germany. Air Impactor samples were performed and microbiologically evaluated for bacteria and fungi both quantitatively and qualitatively. The results were statistically determined using generalized estimating equations. Quantitatively, the lowest bacterial counts in ambient air were found around closed waste containers (114.74 CFU/m³) in comparison to HF (129.28 CFU/m³) and O (126.28 CFU/m³). For fungi, the surrounding air of C (2.08 CFU/m³) and HF (1.97 CFU/m³) waste containers showed a lower impact of fungal air contamination than for O (2.32 CFU/m³). Overall, it was shown that C are more preferable to HF and O waste containers from the point of view of microbial air contamination at hospitals.

A microbiological study to investigate the carriage and transmission-potential of Clostridium difficile spores on single-use and reusable sharps containers

BACKGROUND

A 2015 study matching use of disposable and reusable sharps containers (DSCs, RSCs) with Clostridium difficile infection (CDI) incidence found a decreased incidence with DSCs. We conducted microbiologic samplings and examined the literature and disease-transmission principles to evaluate the scientific feasibility of such an association.

METHODS

(i) 197 RSCs were sampled for C. difficile at processing facilities; (ii) RSCs were challenged with high C. difficile densities to evaluate efficacy of automated decontamination; and (iii) 50 RSCs and 50 DSCs were sampled in CDI patient rooms in 7 hospitals. Results were coupled with epidemiologic studies, clinical requirements, and chain-of-infection principles, and tests of evidence of disease transmission were applied.

RESULTS

C. difficile spores were found on 9 of 197 (4.6%) RSCs prior to processing. Processing completely removed C. difficile. In CDI patient rooms, 4 of 50 RSCs (8.0%) and 8 of 50 DSCs (16.0%) had sub-infective counts of C. difficile (P = .27). DSCs were in permanent wall cabinets; RSCs were removed and decontaminated frequently.

CONCLUSION

With C. difficile bioburden being sub-infective on both DSCs and RSCs, sharps containers being no-touch, and glove removal required after sharps disposal, we found 2 links in the chain of infection to be broken and 5 of 7 tests of evidence to be unmet. We conclude that sharps containers pose no risk of C. difficile transmission.

Toxicity and Metal Corrosion of Glutaraldehyde-Didecyldimethylammonium Bromide as a Disinfectant Agent

The wide use of disinfectants has prompted resistance from the microbiome which will in turn reduce the bactericidal effect of disinfectants. Hence, glutaraldehyde (GA) and didecyldimethylammonium bromide (DDAB) were used to develop a combination disinfectant with high stability and antimicrobial effects, which was named GA-DDAB combination disinfectant (GD). The bactericidal mechanism against Escherichia coli was studied in our earlier work. In this study, we focused on GD's bactericidal efficacy in both the laboratory and environment, the genetic toxicity to mouse lymphoma L5178Y TK^+/− cells, acute peroral toxicity in mice, and its metal corrosion properties with a view to providing theoretical support for developing a high-efficiency, low toxicity, and weakly corrosive disinfectant for general use.

Relationship between sharps disposal containers and Clostridium difficile infections in acute care hospitals

BACKGROUND

Sharps disposal containers are ubiquitous in health care facilities; however, there is paucity of data on their potential role in pathogen transmission. This study assessed the relationship between use of single-use versus reusable sharps containers and rates of Clostridium difficile infections in a national sample of hospitals.

METHODS

A 2013 survey of 1,990 hospitals collected data on the use of sharps containers. Responses were linked to the 2012 Medicare Provider Analysis and Review dataset. Bivariate and multivariable negative binomial regression were conducted to examine differences in C difficile rates between hospitals using single-use versus reusable containers.

RESULTS

There were 604 hospitals who completed the survey; of these, 539 provided data on use of sharps containers in 2012 (27% response rate). Hospitals had, on average, 289 beds (SD ± 203) and were predominantly non-for-profit (67%) and nonteaching (63%). Most used reusable sharps containers (72%). In bivariate regression, hospitals using single-use containers had significantly lower rates of C difficile versus hospitals using reusable containers (incidence rate ratio [IRR] = 0.846, P = .001). This relationship persisted in multivariable regression (IRR = 0.870, P = .003) after controlling for other hospital characteristics.

CONCLUSION

This is the first study to show a link between use of single-use sharps containers and lower C difficile rates. Future research should investigate the potential for environmental contamination of reusable containers and the role they may play in pathogen transmission.

Resolving complexities in healthcare waste management: a goal programming approach

The wide variety of activities at healthcare facilities generates different types of waste. There is always a danger of spreading infection due to mishandling of infectious waste or sharps. Hence, a variety of policies and actions have been taken to improve healthcare waste management systems. A large body of literature is available which suggests methods for tackling different problematic situations but management is confronted with a variety of complex problems, such as the choice of technological options to control infection, legal and budget restrictions and the timely removal of waste, which can, at times, conflict with each other. Hence, a planning model is presented that is based on a trans-shipment goal programming approach wherein the waste flow is optimized for multiple objectives under different priority structures or with different relative importance (weights). The use of the model is demonstrated as a decision-making tool that would help the management to understand the effects of their policies on the system performance. The model is validated for a case application representing a real-life situation. It can be easily seen that, in the case in which the management is biased toward a higher level of safety protection towards infection control, they have to compromise on cost control and to some extent on environmental pollution control.

Bacterial and viral contamination of reusable sharps containers in a community hospital setting

BACKGROUND

Proper disposal of sharps in the clinical setting is a key factor in infection control. Previous research studies suggest that reprocessed, reusable medical devices and infectious waste containers are potential sources of microorganisms capable of causing infection in immunocompromised patients. This pilot study was a single-center, prospective, hospital-based, microbiologic evaluation of reusable sharps disposal containers returned to the hospital from a reprocessing company.

METHODS

A New England area, 130-bed community hospital performed the evaluation. Following delivery to the hospital's shipping/receiving area, 30 newly processed, reusable sharps disposal containers were swabbed for the presence of bacteria and viruses.

RESULTS

Twenty-seven containers (90%) tested positive for bacteria, and 10% of the recovered isolates were gram-negative rods. Nine out of 30 (30%) cultures were positive for viruses: HIV (10%), hepatitis A (6.7%), hepatitis B (6.7%), and hepatitis C (13.3%), and several containers tested positive for multiple viruses and bacteria.

CONCLUSION

Reusable sharps containers were returned to this medical facility with bacterial and viral contamination. Further testing is warranted to determine the scope of the problem and potential clinical implications.

Potential compromise of hospital hygiene by clinical waste carts

Bulk waste storage carts are common in hospitals and undoubtedly assist in the day-to-day management of clinical wastes. They are used for the transport and interim storage of primary clinical waste containers and are often located close to or within hospital buildings to receive such wastes from clinical departments. Examination of a random selection of bulk clinical waste carts at nine acute hospitals across Greater London revealed external soiling in all of 23 carts. Eight of 13 carts were also soiled on the inner surfaces, with evidence of bloodstains and free fluids in the base of five carts. Staphylococcus aureus and enterococci were recovered in low numbers from the lids (N=7) and wheels (N=10) of carts and Escherichia coli, Enterobacter spp. and Pseudomonas aeruginosa were recovered from the wheels of a further five carts. Two carts were heavily contaminated with Aspergillus spp. Pathogens originating from clinical wastes may be transferred from contaminated bulk waste carts to the wider hospital environment. It may be advisable to keep bulk carts outside clinical areas, and preferably outside all hospital buildings. This becomes particularly important in circumstances where carts supplied by contractors are not dedicated to a single hospital or National Health Service trust.

A Systematic Review of Quasi-Experimental Study Designs in the Fields of Infection Control and Antibiotic Resistance

We performed a systematic review of articles published during a 2-year period in 4 journals in the field of infectious diseases to determine the extent to which the quasi-experimental study design is used to evaluate infection control and antibiotic resistance. We evaluated studies on the basis of the following criteria: type of quasi-experimental study design used, justification of the use of the design, use of correct nomenclature to describe the design, and recognition of potential limitations of the design. A total of 73 articles featured a quasi-experimental study design. Twelve (16%) were associated with a quasi-experimental design involving a control group. Three (4%) provided justification for the use of the quasi-experimental study design. Sixteen (22%) used correct nomenclature to describe the study. Seventeen (23%) mentioned at least 1 of the potential limitations of the use of a quasi-experimental study design. The quasi-experimental study is used frequently in studies of infection control and antibiotic resistance. Efforts to improve the conduct and presentation of quasi-experimental studies are urgently needed to more rigorously evaluate interventions.