Plastic wrap combined with alcohol wiping is an effective method of preventing bacterial colonization on mobile phones

INTRODUCTION

Using mobile phones for communication in emergency departments is a common practice; however, several studies have demonstrated that they may act as vectors for bacteria and viruses. This study evaluated the effectiveness of plastic wrapping in decreasing bacterial contamination on mobile phone surfaces.

METHOD

We used culture dishes and a luminometer to detect bacterial colonies and contamination on the phone surfaces.

RESULT

Our experiment showed that bacterial colonies exist on mobile phones before and after work. We found that wiping with 75% alcohol sanitizers effectively reduces the number of colonies on either a mobile phone or a temporary plastic covering. In addition, we found that bacterial colonies do not contaminate or adhere to plastic wrap any easier than to mobile phones.

CONCLUSION

These results demonstrated the effectiveness of plastic wrap for protecting mobile phone surfaces against bacterial colonization. In addition, applying a layer of plastic wrap protects the phone from potential damage due to the alcohol.

The environmental stress sensitivities of pathogenic Candida species, including Candida auris, and implications for their spread in the hospital setting

Candida auris is an emerging pathogenic yeast of significant clinical concern because of its frequent intrinsic resistance to fluconazole and often other antifungal drugs and the high mortality rates associated with systemic infections. Furthermore, C. auris has a propensity for persistence and transmission in health care environments. The reasons for this efficient transmission are not well understood, and therefore we tested whether enhanced resistance to environmental stresses might contribute to the ability of C. auris to spread in health care environments. We compared C. auris to other pathogenic Candida species with respect to their resistance to individual stresses and combinations of stresses. Stress resistance was examined using in vitro assays on laboratory media and also on hospital linen. In general, the 17 C. auris isolates examined displayed similar degrees of resistance to oxidative, nitrosative, cationic and cell wall stresses as clinical isolates of C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, C. guilliermondii, C. lusitaniae and C. kefyr. All of the C. auris isolates examined were more sensitive to low pH (pH 2, but not pH 4) compared to C. albicans, but were more resistant to high pH (pH 13). C. auris was also sensitive to low pH, when tested on contaminated hospital linen. Most C. auris isolates were relatively thermotolerant, displaying significant growth at 47°C. Furthermore, C. auris was relatively resistant to certain combinations of combinatorial stress (e.g., pH 13 plus 47°C). Significantly, C. auris was sensitive to the stress combinations imposed by hospital laundering protocol (pH > 12 plus heat shock at >80°C), suggesting that current laundering procedures are sufficient to limit the transmission of this fungal pathogen via hospital linen.

False positive results of Bowie and Dick type test used for hospital steam sterilizer with slower come-up ramps: A case study

Objective

To determine if the standardized B&D type test for hospital steam sterilizer is correctly indicating cycle failures in slower come-up ramps cycles.

Methods

Two commercially available B&D type test were challenged in a quality control sterilizer. A common failure was simulated in triplicate cycles, using a standardized cycle configuration, and then compared to triplicate cycles of a common cycle configuration. Tests procedures were conducted according to B&D manufacturer test standard and results were compared to standardized endpoint specifications.

Results

We found that B&D type tests are only capable of detecting the presence of non-condensable gases if the sterilization equipment is adjusted to meet all the cycle requirements of the test. False positive results were obtained with come-up ramp time of 3 min. Correct results were only obtained with come-up ramp of 1.7–1.9 min.

Conclusions

Until the ISO 17665 and AAMI ST-79 standards are revised, equipment qualification experts should observe come-up time duration criterion for B&D type test cycles according to ISO 11140–4. Sterile Processing Department professionals must add the come-up ramp criterion to cycle evaluation before clearing the equipment for routine use. This will allow B&D correct performance, reducing the infection risk from unsterilized medical device.

Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

BACKGROUND

The impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further.

METHODS

Patients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients' hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing.

RESULTS

A total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces.

CONCLUSIONS

Our data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections.

Efficacy Of Hydrogen Peroxide Fumigation In Improving Disinfection Of Hospital Rooms And Reducing The Number Of Microorganisms

BACKGROUND

The hospital acquired infections are very common in any health care setting due to certain bacteria, viruses and fungi. In order to find out a solution to this problem, this preliminary study was designed to find out the efficiency of hydrogen peroxide fumigation in reducing the number of microorganisms and improving the disinfection of hospital rooms. It was a prospective cross over study, conducted in Arar Central Hospital, North region, Arar, Kingdom of Saudi Arabia, for the period of one year, from March 2015 to February 2016. Objective of the study was to determine the efficacy of hydrogen peroxide fumigation in the improvement of disinfection of hospital rooms.

METHODS

A total of 10 environmental samples were taken immediately after the patient was discharged (R1), 10 after terminal cleaning (R2), and 10 after the Bioxeco hydrogen peroxide fumigation (R3) in 20 different rooms of the hospital including ICU, general medical wards and operating rooms. (T=600).

RESULTS

Almost 95% rooms cultured (environmental surfaces) after patient was discharged (R1) revealed microorganism growth, 80% after terminal cleaning (R2) and 2% after Bioxeco Hydrogen Peroxide fumigation revealed growths of microorganisms like bacteria and fungi on the culture plates (R3). The highest rate of room contamination was found in the rooms where the patients had stayed for a longer period of time.

CONCLUSION

Hydrogen peroxide fumigation has been proved to be an efficient disinfectant in a health care setting.

Use of silicon nanoparticle surface coating in infection control: Experience in a tropical healthcare setting

BACKGROUND

A nano-scale surface coating containing silicon nanoparticles (Bacterlon®) creates a hydrophobic surface which prevents the growth of bacteria. Study objective was to evaluate the performance of this silicon nano-coating in Sri Lankan healthcare setting.

METHODS

This prospective study was conducted from September 2015 to December 2015 in an Intensive Care Unit and a medical ward in Base Hospital Homagama and a bacteriology laboratory in Medical Research Institute, Colombo, Sri Lanka. Silicon nanoparticle coating was applied to 19 high touch surfaces from those three sites. During the follow-up period, these test sites and non-coated control sites were used for routine work and were cleaned routinely as per institute protocol. Swabbing was done for coated and non-coated sites once a week for 12 weeks at unannounced times. Surfaces were categorized in to low (≤10 CFU/cm²) and high (>10-99 CFU/cm²) contamination by Aerobic Bacterial Count (ABC) in non-coated sites at any given time.

RESULTS

In low and high contaminated surfaces, an improvement in the mean percentage bioburden reduction from 36.18% to 50.16% was observed from 4th week to 12th week with silicon nanoparticles and a significant reduction (p < 0.05) was seen in ABC in each of the coated surface compared with their non-coated counterpart by the 12th week. The frequency of isolation of Acinetobacter spp. on coated surfaces had a significant reduction (p < 0.01).

CONCLUSION

Silicon nanoparticle coating demonstrates a significant reduction of the bacterial bioburden in low and high contaminated surfaces for 12 weeks in a tropical healthcare setting.

Microbiological assessment of cleanliness of surfaces and equipment in a children's operating theatre on the example of a selected hospital

INTRODUCTION

The operating theatre is one of the most important places in a hospital. Due to the presence of numerous reservoirs of microorganisms and the invasiveness of surgical procedures it is necessary to ensure high hygiene standards in these locations.

OBJECTIVE

The aim of the study was to carry out a qualitative assessment of the microbiological cleanliness of the surfaces and equipment in an operating theatre.

MATERIAL AND METHODS

The results of microbiological tests of the surfaces and equipment of the Children's Operating Theatre in Clinical Provincial Hospital No. 2 in Rzeszów, southeast Poland, during 2007-2012 were reviewed retrospectively.

RESULTS AND CONCLUSIONS

For the analysis, a total of 1,819 swabs were collected, of which 1.05% were positive. Positive results were obtained mainly from samples taken from moist places (57.9%). Among the microorganisms isolated, Gram-negative bacteria constituted the majority (57.9%), Pseudomonas bacteria were found most frequently (31,6%). Isolated microbes can be the etiological agent of nosocomial infections.

The effectiveness of antibacterial curtains in comparison with standard privacy curtains against transmission of microorganisms in a hospital setting

Studies have shown a correlation between a cleaner patient environment and lower infection rates and reduced risk of transmission. Privacy curtains are potentially important sites of bacterial contamination in hospitals. Privacy curtains integrated with antimicrobial properties have been shown to increase the time to first contamination compared with standard privacy curtains. In this study, we examined the difference in bacterial colonization of different curtains. We experimentally contaminated antibacterial Fantex protective curtains and compared the bacterial counts to natural contamination of privacy curtains. There was a significant reduction in the CFU/cm2 on antibacterial Fantex protective privacy curtains after 24 hours of experimental contamination with Pseudomonas aeruginosa, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum-producing organisms (Escherichia coli or Klebsiella pneumoniae), compared to standard privacy curtains. Levels of environmental contamination with S. epidermis, Streptococcus viridians, E. coli, S. haemolyticus, S. aureus, S. capitis, non-fermenting Gram-negative bacteria, and Bacillus species were also significantly less on the Fantex curtains after two months hanging in the emergency department. Healthcare facilities may find that addressing surfaces, including use of antibacterial privacy curtains, is an effective horizontal strategy for addressing healthcare-associated infections across the board.

Studies of antimicrobial resistance in rare mycobacteria from a nosocomial environment

BACKGROUND

Nontuberculous mycobacteria (NTM) are ubiquitous in nature and recognized agents of opportunistic infection, which is often aggravated by their intrinsic resistance to antimicrobials, poorly defined therapeutic strategies and by the lack of new drugs. However, evaluation of their prevalence in anthropogenic environments and the associated antimicrobial resistance profiles have been neglected. In this work, we sought to determine minimal inhibitory concentrations of 25 antimicrobials against 5 NTM isolates recovered from a tertiary-care hospital surfaces. Antimicrobial susceptibilities of 5 other Corynebacterineae isolated from the same hospital were also determined for their potential clinical relevance.

RESULTS

Our phylogenetic study with each of the NTM isolates confirm they belong to Mycobacterium obuense, Mycobacterium mucogenicum and Mycobacterium paragordonae species, the latter initially misidentified as strains of M. gordonae, a species frequently isolated from patients with NTM disease in Portugal. In contrast to other strains, the M. obuense and M. mucogenicum examined here were resistant to several of the CLSI-recommended drugs, suggestive of multidrug-resistant profiles. Surprisingly, M. obuense was susceptible to vancomycin. Their genomes were sequenced allowing detection of gene erm (erythromycin resistance methylase) in M. obuense, explaining its resistance to clarithromycin. Remarkably, and unlike other strains of the genus, the Corynebacterium isolates were highly resistant to penicillin, ciprofloxacin and linezolid.

CONCLUSIONS

This study highlights the importance of implementing effective measures to screen, accurately identify and control viable NTM and closely related bacteria in hospital settings. Our report on the occurrence of rare NTM species with antibiotic susceptibility profiles that are distinct from those of the corresponding Type strains, along with unexpected resistance mechanisms detected seem to suggest that resistance may be more common than previously thought and also a potential threat to frail and otherwise vulnerable inpatients.

Environmental Reservoirs of Nosocomial Infection: Imputation Methods for Linking Clinical and Environmental Microbiological Data to Understand Infection Transmission

The transmission of hospital-acquired Carbapenem-resistant Enterobacteriaceae (CRE) is a serious and growing concern in hospitals worldwide. Previous research of CRE found that traditional patient-to-patient transmission of the bacteria does not fully account for all cases of transmission. Recent efforts to further understand modes of transmission found identical genomes of CRE in patient sinks as was found in cultures collected from patients, indicating that environmental reservoirs could be playing a larger role in transmission than was first realized. This study evaluated imputation methods for linking multiscale clinical and environmental microbiological data. We then utilized the imputed data set to model the risk of CRE presence in sinks between culture dates. We demonstrated that imputation based on expert knowledge of the unique factors of the physical hospital layout and patterns of occurrence throughout hospital sinks provided the best representation of sink positivity and also identified several significant risk factors for explaining environmental contamination. This work helps to more clearly define the mechanism and risk of transmission from a wastewater source to hospitalized patients in a world with increasingly antibiotic-resistant bacteria which can thrive in wastewater environments and cause infections in vulnerable patients.

Reemergence of Mycobacterium chimaera in Heater-Cooler Units despite Intensified Cleaning and Disinfection Protocol

Invasive Mycobacterium chimaera infections after open-heart surgery have been reported internationally. These devastating infections result from aerosols generated by contaminated heater–cooler units used with extracorporeal circulation during surgery. Despite intensified cleaning and disinfection, surveillance samples from factory-new units acquired during 2014 grew nontuberculous mycobacteria after a median of 174 days.

VIM-Klebsiella oxytoca outbreak in a Neonatal Intensive Care Unit. This time it wasn't the drain

Objective

We describe an outbreak of VIM-carbapenemase Klebsiella oxytoca (VIM-Kox) in a NICU

Materials and methods

Prospective Epidemiological Surveillance:

Molecular typing was performed using the DiversiLab (bioMérieux) system on all VIM-Kox isolated from environment or patients (one by neonate).

Results

We identified 20 VIM-Kox cases, the most only presented colonization, but 4 showed infection. Three of the ten sinks (drains) in our NICU, were positive for VIM-Kox. Another four drains harbored P.aeruginosa, S. maltophilia and/or Enterobacter sp. Nevertheless the VIM-Kox bacteria in the sinks (drains) were not the same as those in the patients, who showed three different strains.

Conclusions

A VIM-Kox colonization or infection outbreak in a NICU is described. Rather than environment, not even drains, the source of the outbreak was other patients. The outbreak was relatively brief, as a result of the rapidness with which appropriate measures were taken and followed.

Quantitative assessment of interactions between hospitalized patients and portable medical equipment and other fomites

In an observational study, we demonstrated that hospitalized patients frequently had direct or indirect interactions with medical equipment and other fomites that are shared among patients, and these items were often contaminated with health care-associated pathogens. There is a need for protocols to ensure routine cleaning of shared portable equipment.

Rapid Detection of Staphylococcus aureus and Related Species Isolated from Food, Environment, Cosmetics, a Medical Device, and Clinical Samples Using the VITEK MS Microbial Identification System

Staphylococcus spp. is considered as one of the most common human-pathogenic bacteria, causing illnesses ranging from nonthreatening skin infections to lethal diseases, including sepsis, pneumonia, bloodstream infections, and food poisoning. The emergence of methicillin-resistant Staphylococcus aureus strains has increased morbidity and mortality and resulted in a major healthcare burden worldwide. Single and multilocus sequence typing have been extensively used in the identification of Staphylococcus species. Nevertheless, these assays are relatively time-consuming and require high-quality DNA. Matrix-assisted laser desorption ionization-time-of-flight has been used recently for the rapid identification of several bacterial species. In this study, we have examined 47 Staphylococcus isolates recovered from food, environment, clinical samples, cosmetic products, and a medical device and 3 American Type Culture Collection Staphylococcus reference isolates using bioMérieux VITEK MS and VITEK 2 systems to determine isolate identity. Sequencing of the 16S ribosomal RNA gene was performed to confirm and compare the species identification data generated by VITEK 2 and VITEK MS systems. Although the VITEK 2 system could not identify one of the isolates, VITEK MS identified all 50 Staphylococcus spp. isolates tested. Results of this study clearly suggest that VITEK MS can be used in the rapid identification of Staphylococcus isolates of public health importance.

[Perché la legionellosi è una tra le più temibili ICA]

La Legionellosi è una polmonite che può presentare un decorso variabile a seconda se i soggetti colpiti risiedono nel loro domicilio, sono ospiti di strutture recettive o sono ospedalizzati. In ambito ospedaliero, che annovera questa patologia tra le più pericolose Infezioni Correlate all'Assistenza (ICA), si registrano decisamente i casi più gravi e assai spesso letali. Gli errori nella Valutazione del Rischio e negli interventi di risanamento contribuiscono alla proliferazione all'interno delle condutture idriche di un temibile microrganismo che può essere eliminato o ridotto solo con un approccio multidisciplinare.

Reduction of Environmental Contamination With Multidrug-Resistant Bacteria by Copper-Alloy Coating of Surfaces in a Highly Endemic Setting

OBJECTIVE To evaluate the efficacy of copper-coating in reducing environmental colonization in an intensive-care unit (ICU) with multidrug-resistant-organism (MDRO) endemicity DESIGN Interventional, comparative crossover trial SETTING The general ICU of Attikon University hospital in Athens, Greece PATIENTS Those admitted to ICU compartments A and B during the study period METHODS Before any intervention (phase 1), the optimum sampling method using 2 nylon swabs was validated. In phase 2, 6 copper-coated beds (ie, with coated upper, lower, and side rails) and accessories (ie, coated side table, intravenous [i.v.] pole stands, side-cart handles, and manual antiseptic dispenser cover) were introduced as follows: During phase 2a (September 2011 to February 2012), coated items were placed next to noncoated ones (controls) in both compartments A and B; during phase 2b (May 2012 to January 2013), all copper-coated items were placed in compartment A, and all noncoated ones (controls) in compartment B. Patients were randomly assigned to available beds. Environmental samples were cultured quantitatively for clinically important bacteria. Clinical and demographic data were collected from medical records. RESULTS Copper coating significantly reduced the percentage of colonized surfaces (55.6% vs 72.5%; P<.0001), the percentage of surfaces colonized by MDR gram-negative bacteria (13.8% vs 22.7%; P=.003) or by enterococci (4% vs 17%; P=.014), the total bioburden (2,858 vs 7,631 cfu/100 cm2; P=.008), and the bioburden of gram-negative isolates, specifically (261 vs 1,266 cfu/100 cm2; P=.049). This effect was more pronounced when the ratio of coated surfaces around the patient was increased (phase 2b). CONCLUSIONS Copper-coated items in an ICU setting with endemic high antimicrobial resistance reduced environmental colonization by MDROs. Infect Control Hosp Epidemiol 2017;38:765-771.

Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

OBJECTIVES

To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients.

METHODS

Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant.

RESULTS

Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p=0.996), and fungi (p=0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods.

CONCLUSIONS

Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.

Bacteriological Monitoring of Water Reservoirs in Oxygen Humidifiers: Safety of Prolonged and Multipatient Use of Prefilled Disposable Oxygen Humidifier Bottles

Bacterial colony counts in water specimens from oxygen humidifiers that used reusable water reservoirs were compared with counts in water specimens from humidifiers that used prefilled disposable reservoir bottles to evaluate the effects of prolonged and multipatient use of humidifiers. Bacteria were detected after 1 week of operation in water specimens collected from many humidifiers with reusable reservoirs, but no bacteria were detected in water specimens from disposable bottles for up to 12 weeks during use of the humidifier by multiple patients.

Low temperature benefits discussed

At a recent educational workshop event hosted by Advanced Sterilization Products, expert speakers including Authorising Engineers, and delegates, discussed some of their experiences of low temperature sterilisation of 'hi-tech' medical devices, and highlighted the benefits of a process which allows decontamination of instruments and, for example, parts of robotic surgery systems, that cannot be decontaminated using standard methods. Also examined,and reported on here in an article that first appeared in HEJ's sister publication, The Clinical Services Journal, were some of the disadvantages of low temperature sterilisation, the key considerations and options when choosing such a system, and a focus on how the technology's use had benefited a major London-based NHS Trust.

Liposome containing cinnamon oil with antibacterial activity against methicillin-resistant Staphylococcus aureus biofilm

The global burden of bacterial disease remains high and is set against a backdrop of increasing antimicrobial resistance. There is a pressing need for highly effective and natural antibacterial agents. In this work, the anti-biofilm effect of cinnamon oil on methicillin-resistant Staphylococcus aureus was evaluated. Then, cinnamon oil was encapsulated in liposomes to enhance its chemical stability. The anti-biofilm activities of the liposome-encapsulated cinnamon oil against MRSA biofilms on stainless steel, gauze, nylon membrane and non-woven fabrics were evaluated by colony forming unit determination. Scanning electron microscopy and laser scanning confocal microscopy analyses were employed to observe the morphological changes in MRSA biofilms treated with the encapsulated cinnamon oil. As a natural and safe spice, the cinnamon oil exhibited a satisfactory antibacterial performance on MRSA and its biofilms. The application of liposomes further improves the stability of antimicrobial agents and extends the action time.

Colonization of Personal Digital Assistants Carried by Healthcare Professionals

This study evaluated personal digital assistant (PDA) microbial colonization before and after cleaning with alcohol. Samples from 75 PDAs were processed. Before cleaning, 96% of the samples were culture positive. After cleaning, 75% became culture negative. PDAs cleaned with an alcohol swab demonstrated significant reduction in colonization.

Rapid Monitoring by Quantitative Polymerase Chain Reaction for Pathogenic Aspergillus During Carpet Removal From a Hospital

Monitoring for pathogenic Aspergillus species using a rapid, highly sensitive, quantitative polymerase chain reaction technique during carpet removal in a burn unit provided data that allowed patients to be safely returned to the refloored area sooner than if only conventional culture monitoring had been used.

Evaluation of Real-Time Polymerase Chain Reaction for the Detection of Methicillin-ResistantStaphylococcus aureuson Environmental Surfaces

We compared real-time polymerase chain reaction (RT-PCR) with in vitro culture for detecting methicillin-resistantStaphylococcus aureusin samples from environmental surfaces. The sensitivity of RT-PCR, compared with culture, was 92.5%, and the specificity was 51.4%. Because of poor specificity, the RT-PCR kit tested is not suitable for the detection of MRSA on hospital surfaces.

Should Electronic Faucets Be Recommended in Hospitals?

Microbiological examinations of electronic faucets newly installed in a hospital kitchen revealed high bacteria counts andPseudomonas aeruginosaduring a 6-month period of observation. Our data suggest that the use of electronic faucets poses a potential risk for nosocomial infection in high-risk areas of hospitals.

Biofilm formation in an experimental water distribution system: the contamination of non-touch sensor taps and the implication for healthcare

Hospital tap water is a recognised source of Pseudomonas aeruginosa. U.K. guidance documents recommend measures to control/minimise the risk of P. aeruginosa in augmented care units but these are based on limited scientific evidence. An experimental water distribution system was designed to investigate colonisation of hospital tap components. P. aeruginosa was injected into 27 individual tap 'assemblies'. Taps were subsequently flushed twice daily and contamination levels monitored over two years. Tap assemblies were systematically dismantled and assessed microbiologically and the effect of removing potentially contaminated components was determined. P. aeruginosa was repeatedly recovered from the tap water at levels above the augmented care alert level. The organism was recovered from all dismantled solenoid valves with colonisation of the ethylene propylene diene monomer (EPDM) diaphragm confirmed by microscopy. Removing the solenoid valves reduced P. aeruginosa counts in the water to below detectable levels. This effect was immediate and sustained, implicating the solenoid diaphragm as the primary contamination source.

Outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit

Acinetobacter baumannii is a ubiquitous microrganism often able to colonize and survive in different environments. Currently it is one of the most common pathogens responsible for nosocomial infections, including outbreaks, especially in long-term care facilities. The aim of this study was to show the results of an environmental investigation and genotyping analysis of multidrug-resistant Acinetobacter baumannii associated with an outbreak in an intensive care unit of a tertiary hospital located in Northern Sardinia, Italy. Positive cultures of MDR Acinetobacter baumannii were reported during the month of June 2012, after the collection of biological samples from ten patients. Acinetobacter baumannii was isolated during the following environmental investigation from the headboard of two beds. All the strains were genotyped by performing multiplex PCR to identify the presence of genes encoding carbapenemases. The results showed specific bands of bla(OXA-51-like) gene and of the bla(OXA-23-like) gene. PFGE highlighted minimal differences in genomic fingerprints, while the cluster analysis grouped the isolated microorganisms into two closely related clusters, characterized by Dice's similarity coefficient equal to 95.1%. MLST showed that the strains belonged to ST31. The results of the study highlight the need, especially in high-risk areas, to adopt strict hygiene practices, particularly hand hygiene, and to ensure an appropriate turnover of personal protective equipment, which could be responsible for the spread of biological agents, such as MDR Acinetobacter baumannii.

Collective efforts, better engagement

In this article, Dr Mike Simmons, Public Health Microbiologist at Public Health Wales, and the clinical lead for Public Health Wales Microbiology Services to the Hywel Dda Health Board, examines and explains healthcare-associated infections, or HCAls. He also highlights some of the key implications for healthcare engineers and estates managers in their day-to-day roles, and stresses the importance of interaction and collaboration between estates professionals and their clinical, infection control, nursing, and other hospital counterparts, in both reducing the number of such infections, and creating environments unconducive to their spread.

A survey of preventive measures used and their impact on central line-associated bloodstream infections (CLABSI) in intensive care units (SPIN-BACC)

BACKGROUND

The Quebec central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) Surveillance Program saw a decrease in CLABSI rates in most ICUs. Given the surveillance trends observed in recent years, we aimed to determine what preventive measures have been implemented, if compliance to measures was monitored and its impact on CLABSI incidence rates.

METHODS

All hospitals participating in the Quebec healthcare-associated infections surveillance program (SPIN-BACC - n = 48) received a 77-question survey about preventive measures implemented and monitored in their ICU. The questionnaire was validated for construct, content, face validity, and reliability. We used Poisson regression to measure the association between compliance monitoring to preventive measures and CLABSI rates.

RESULTS

Forty-two (88%) eligible hospitals completed the survey. Two components from the maximum barrier precautions were used less optimally: cap (88%) and full sterile body drape (71%). Preventive measures reported included daily review of catheter need (79%) and evaluation of insertion site for the presence of inflammation (90%). Two hospitals rewired lines even if an infection was suspected or documented.In adult ICUs, there was a statistically significant greater decrease in CLABSI rates in ICUs that monitored compliance to preventive insertion measures, after adjusting for teaching status and the number of hospital beds (p = 0.036).

CONCLUSIONS

Hospitals participating to the SPIN-BACC program follow recommendations for CLABSI prevention, but only a minority locally monitor their application. Compliance monitoring of preventive measures for catheter insertion was associated with a decrease in CLABSI incidence rates.

Epidemiological characterization of P. aeruginosa isolates of intensive care units in Egypt and Saudi Arabia

This study aimed to characterize Pseudomonas aeruginosa isolates in 2 intensive care units in Egypt and Saudi Arabia. P. aeruginosa isolates from patients' and staff hands and environmental samples were typed using antibiotyping and ERIC-PCR. In Egypt, isolates from suction apparatus tubing and drainage containers (A7) and AV tubing (A8) were linked to those from patients who had these antibiotypes. In Saudi Arabia, isolates from suction apparatus tubing (A6) and AV tubing (A7) were linked to patients with the same antibiotypes. In Egypt, patients' isolates had ERIC VII, VIll and IX patterns linked to suction apparatus tubing, AV machine tubes and drainage containers. In Saudi Arabia, patients' isolates had ERIC VIII and XI patterns linked to suction apparatus tubing and AV machines. In Egypt and Saudi Arabia, ERIC typing gave higher discriminatory indices (0.801 and 0.785 respectively) than the antibiotyping (0.7123 and 0.728 respectively). ERIC was superior to antibiotyping and should be used in tracing sources of infection.

Hospital door handle design and their contamination with bacteria: a real life observational study. Are we pulling against closed doors?

OBJECTIVE

To determine whether microbial contamination of door handles in two busy intensive care units and one high dependency unit was related to their design, location, and usage.

DESIGN

Observational study of the number of viable bacteria on existing door handles of different design at defined entry/exit points with simultaneous data collection of who used these doors and how often.

SETTING

Two busy specialised intensive care units and one high dependency unit in a tertiary referral NHS neurological hospital.

MAIN OUTCOME MEASURES

Surface bacterial density on door handles with reference to design, location, and intensity of use.

RESULTS

We found a significant correlation between the frequency of movements through a door and the degree to which it was contaminated (p=<0.01). We further found that the door's location, design and mode of use all influenced contamination. When compared to push plate designs, pull handles revealed on average a five fold higher level of contamination; lever handles, however, displayed the highest levels of bacterial contamination when adjusted for frequency of use. We also observed differences in contamination levels at doors between clinical areas, particularly between the operating theatres and one of the ICUs.

CONCLUSIONS

Door handles in busy, "real life" high acuity clinical environments were variably contaminated with bacteria, and the number of bacteria found related to design, location, mode and frequency of operation. Largely ignored issues of handle and environmental design can support or undermine strategies designed to limit avoidable pathogen transmission, especially in locations designed to define "thresholds" and impose physical barriers to pathogen transmission between clinical areas. Developing a multidisciplinary approach beyond traditional boundaries for purposes of infection control may release hitherto unappreciated options and beneficial outcomes for the control of at least some hospital acquired infections.

Antibacterial performance of polydopamine-modified polymer surfaces containing passive and active components

A growing number of device-related nosocomial infections, elevated hospitalization costs, and patient morbidity necessitate the development of novel antibacterial strategies for clinical devices. We have previously demonstrated a simple, aqueous polydopamine dip-coating method to functionalize surfaces for a wide variety of uses. Here, we extend this strategy with the goal of imparting antifouling and antimicrobial properties to substrates, exploiting the ability of polydopamine to immobilize polymers and induce metal nanoparticle formation. Polydopamine was deposited as a thin adherent film of 4 nm thickness from alkaline aqueous solution onto polycarbonate substrates, followed by grafting of antifouling polymer polyethylene glycol and in situ deposition of silver nanoparticles onto the polydopamine coated polycarbonate substrates. Elemental and morphological surface analyses confirmed successful grafting of polyethylene glycol brushes onto polydopamine-coated substrates, as well as spontaneous silver nanoparticle formation for polydopamine-coated substrates incubated in silver-nitrate solutions. Sustained silver release was observed over at least 7 days from silver-coated substrates, and the release kinetics could be modulated via additional polydopamine overlayers. In vitro functional assays employing gram negative and positive strains demonstrated dual fouling resistance and antibacterial properties of the coatings due to the fouling resistance of grafted polyethylene glycol and antibacterial effect of silver, respectively. Polycarbonate substrates coated only with silver using a method similar to existing commercial coatings provided an antibacterial effect but failed to inhibit bacterial attachment. Taking into account the previously demonstrated substrate versatility of polydopamine coatings, our findings suggest that this strategy could be implemented on a variety of substrate materials to simultaneously improve antifouling and antimicrobial performance.

Varied skill set needed for AE (D) role

IHEEM's AE (D) Panel plays an important role in managing and administering the UK's only official register of such specialist personnel, and indeed it is the Panel that selects qualified candidates for registration, interviews those considered "the right material", and confers registered AE (D) status on those that Panel members feel have the right combination of professional experience and expertise, academic qualifications, and knowledge, to fulfil the role. HEJ editor Jonathan Baillie examines the history of the AE (D) register and Panel, and talks to the latter's chairman, Eric Thomas, to find out more.

A technical platform for future success

Authorising Engineers (Decontamination), a group of highly skilled individuals acknowledged as lacking an effective representative professional body over the past decade by Graham Stanton, the chairman of a new IHEEM Decontamination Technical Platform (DTP) established recently to promote their professional interests, have much both to contribute to, and to gain from, the new Platform, he, and the body's secretary, Brian Kirk, explained to HEJ editor Jonathan Baillie at a recent meeting in London.

[Genetic diversity of Legionella pneumophila serogroup 1 in hospital water distribution systems in Shanghai]

OBJECTIVE

To classify Legionella pneumophila serogroup 1 (LP1) isolated from the water distribution systems in hospitals of Shanghai by using genotying methods, and therefore to explore the genetic relationship between different genotypes.

METHODS

LP1 was isolated from 8 hospitals in Shanghai, and strains of LP1 were subtyped using pulse field gel electrophoresis (PFGE). Genotyping results of PFGE were classified as dendrogram, and cluster analysis was used to compare the genetic characteristics of different strains.

RESULTS

Twenty-four strains of LP1 were isolated from 193 water specimens. LP1 belonged to 6 PFGE genotypes, of which 21 belonged to 3 predominant genotypes. Different hospitals shared the same genotype, while some strains isolated from the same hospital had different genotypes.

CONCLUSION

The genetic characteristics are stable in environmental LP1. Molecular biology techniques should be added to epidemiological study for hospital acquired legionellosis due to the genetic diversity in one hospital.

[Identification and isolation of non-tuberculous mycobacteria from environmental samples]

Non-tuberculous mycobacteria (NTM) found frequently in tap water and environment cause important opportunistic infections in immunocompromised patients. The aim of this study was to isolate and identify non-tuberculous mycobacteria in soil, raw milk and water distribution system samples in Mersin (a province located at Mediterranean region of Turkey). A total of 101 water, 124 soil and 40 milk samples collected from the central part and suburban parts of Mersin during November 2003-May 2004 period were included in the study. Water samples were collected from 29 different water distribution systems; soil samples from different parks and gardens and milk samples from raw milks sold at different districts. After the samples were processed by homogenization and decontamination, acid-fast staining and culture into Löwenstein-Jensen medium were performed. Acid-fast bacilli isolated from culture medium were identified by using conventional methods, polymerase chain reaction (PCR)-RFLP (Restriction Fragment Length Polymorphism) and INNO-LIPA Mycobacteria methods. NTM were identified from 4.9% (5/101) of water samples and 0.8% (1/124) of soil samples by culture and PCR. No NTM were detected in the raw milk samples. Three of the NTM strains isolated from water samples were defined as Mycobacterium chelonae type III and two as Mycobacterium kansasii type II. One NTM strain isolated from soil was defined as Mycobacterium fortuitum. It was of note that two of the five NTM positive water samples were tap water samples collected from hospitals. It was concluded that NTM colonization/contamination of water and environment in the hospitals was a potential risk factor in terms of nosocomial infections. Thus surveillance cultures of the water systems and the medical devices in the hospital are necessary to fix the source of NTM, to identify and type the strains and to establish effective control measures such as sterilization, disinfection, maintenance and modernization of water systems.

Design for life

A team of designers has been charged with redesigning hospital equipment that will help combat infection. Their prototypes are now in production.

Age-old technologies jostle for position

With the focus on combating hospital-acquired infection never greater, debate over the respective merits of using silver ion and copper-based anti-microbial surface treatments to "beat the bugs" will no doubt continue as new study evidence emerges for each. Health Estate Journal highlights the contrasting claims made by both "sides", and reports on two recent studies in particular, one expounding the advantages of copper, and the other painting an equally positive picture for silver.

Use of atmospheric non-thermal plasma as a disinfectant for objects contaminated with methicillin-resistant Staphylococcus aureus

BACKGROUND

Health care-associated infections because of methicillin-resistant strains of Staphylococcus aureus (MRSA) are increasing worldwide despite current infection control measures. Novel methods for disinfection of MRSA would be useful.

METHODS

We tested the effectiveness of atmospheric, non-thermal plasma discharge at killing S aureus, including USA300 strains, and at disinfecting experimentally contaminated hospital pagers.

RESULTS

Exposure of S aureus to plasma at different concentrations and for varying lengths of time resulted in up to a 4- to 5-log(10) kill on tryptic soy agar plates within 10 minutes and was not toxic to epithelial cells. USA300 strains of MRSA were more resistant to plasma-based killing than other tested strains. Disinfection of hospital pagers experimentally coated with clinically relevant amounts of MRSA could be achieved in as little as 30 seconds.

CONCLUSION

Generation of plasma is a promising method for disinfection of objects or surfaces that warrants further study in hospital settings. The USA300 strains of S aureus may be more resistant to disinfection than other strains.

New AE (D) role should benefit patient safety

With all aspects of hospital hygiene under the spotlight, Jonathan Baillie examines the important new role of Authorising Engineer (Decontamination), explains, with the help of experienced sterilisation/decontamination specialist Mick Compton, how the role developed, and discusses the key part that IHEEM will play as the only current UK institute with the authority to register AE (D)s as a mark of their competence and skills.

Genetic diversity of Mycobacterium avium isolates recovered from clinical samples and from the environment: molecular characterization for diagnostic purposes

Isolation of Mycobacterium avium complex (MAC) organisms from clinical samples may occur in patients without clinical disease, making the interpretation of results difficult. The clinical relevance of MAC isolates from different types of clinical samples (n = 47) from 39 patients in different sections of a hospital was assessed by comparison with environmental isolates (n = 17) from the hospital. Various methods for identification and typing (commercial probes, phenotypic characteristics, PCR for detection of IS1245 and IS901, sequencing of the hsp65 gene, and pulsed-field gel electrophoresis) were evaluated. The same strain was found in all the environmental isolates, 21 out of 23 (91.3%) of the isolates cultured from urine samples, and 5 out of 19 (26.3%) isolates from respiratory specimens. This strain did not cause disease in the patients. Testing best characterized the strain as M. avium subsp. hominissuis, with the unusual feature that 81.4% of these isolates lacked the IS1245 element. Contamination of certain clinical samples with an environmental strain was the most likely event; therefore, characterization of the environmental mycobacteria present in health care facilities should be performed to discard false-positive isolations in nonsterile samples, mainly urine samples. Molecular techniques applied in this study demonstrated their usefulness for this purpose.