Surface cleaning effectiveness in a walk-in emergency care unit: Influence of a multifaceted intervention

Frota, P.O. et al. American Journal of Infection Control. Published online: 24 August 2016

Highlights

  • The interventions immediately improved the effectiveness of cleaning.
  • These improvements disappeared after four months of interventions.
  • Microfiber cloths did not impact any increase in cleaning effectiveness.
  • Continuous education and feedback on cleaning practices appear to be warranted.
  • This policy should be adapted to the particularities of each health care setting.

Abstract

Background: Cleaning of surfaces is essential in reducing environmental bioburdens and health care-associated infection in emergency units. However, there are few or no studies investigating cleaning surfaces in these scenarios. Our goal was to determine the influence of a multifaceted intervention on the effectiveness of routine cleaning of surfaces in a walk-in emergency care unit.

Methods: This prospective, before-and-after interventional study was conducted in 4 phases: phase I (situational diagnosis), phase II (implementation of interventions—feedback on results, standardization of cleaning procedures, and training of nursing staff), phase III (determination of the immediate influence of interventions), and phase IV (determination of the late influence of interventions). The surfaces were sampled before and after cleaning by visual inspection, adenosine triphosphate bioluminescence assay, and microbiologic culture.

Results: We sampled 240 surfaces from 4 rooms. When evaluated by visual inspection and adenosine triphosphate bioluminescence, there was a progressive reduction of surfaces found to be inadequate in phases I-IV (P < .001), as well as in culture phases I-III. However, phase IV showed higher percentages of failure by culture than phase I (P = .004).

Conclusions: The interventions improved the effectiveness of cleaning. However, this effect was not maintained after 2 months.

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The innovators: Irish lab develops coating to ward off superbug

Hickey, S. The Guardian. Published online: 15 May 2016.

Image shows electron micrograph of Escherichia coli.

Infections such as MRSA which have developed resistance to drugs have become a notorious threat in hospitals, where the bacteria can survive on surfaces for up to seven months. But a new discovery by scientists in Ireland could soon be working to combat them.

A research team led by Prof Suresh Pillai has developed a coating for everyday objects that prevents the spread of MRSA and E coli bacteria. The coating, which can be used on items such as smartphones, door handles and remote controls as well as surgical surfaces, has a 99.99% success rate in killing the bugs.

John Browne, the chief executive of Dublin-based company Kastus, which is working to commercialise the solution, says: “It is very hard to get rid of these things once they are there. Some studies have shown that with a deep clean on an [intensive care unit] ward where there is a critical care bed in one room … the entire room is cleaned with bleach over a 24-hour period and the bacteria are back on the surface within 24 hours.”

Read the full commentary here

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Occupational health risks associated with the use of germicides in health care

Weber, D.J. et al. American Journal of Infection Control.Volume 44, Issue 5, Supplement, 2 May 2016, Pages e85–e89

http://www.public-domain-image.com/free-images/miscellaneous/window-cleaning-in-protective-rubber-gloves-washing-windows/attachment/window-cleaning-in-protective-rubber-gloves-washing-windows

Image source: Cade Martin, Dawn Arlotta // CC0

Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant Staphylococcus aureus, vancomycin-resistantEnterococcus, Clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical devices between use by different patients is also recommended.

Environmental surfaces and noncritical shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary ammonium compounds, improved hydrogen peroxides, and hypochlorites.

Concern has been raised that the use of germicides by health care personnel may increase the risk of these persons for developing respiratory illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms. Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants.

The scientific evidence does not support that the use of low-level disinfectants by health care personnel is an important risk for the development of asthma or contact dermatitis.

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Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals

Boyce, J.M. Antimicrobial Resistance & Infection Control. Published online: 11 April 2016

https://static-content.springer.com/image/art%3A10.1186%2Fs13756-016-0111-x/MediaObjects/13756_2016_111_Fig1_HTML.gif

Image source: Boyce, J.

Image shows Contact agar plate cultures showing bacterial colonies recovered from a patient’s overbed table before (left) and after (right) the surface was cleaned by a housekeeper using contaminated quaternary ammonium disinfectant. Colonies on right are Serratia marcescens and Achromobacter xylosoxidans

Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer’s recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices.

Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating “self-disinfecting” surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation.

Newer “no-touch” (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These “no-touch” technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections.

In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.

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Staphylococcus aureus dry-surface biofilms are not killed by sodium hypochlorite: implications for infection control

Almatroudi, A. et al. Journal of Hospital Infection. Published online: 12 April 2016

Image shows Staphylococcus aureus – macro photo x 10 of culture, characteristic gold/yellow colonies.

Background: Dry hospital environments are contaminated with pathogenic bacteria in biofilms, which suggests that current cleaning practices and disinfectants are failing.

Aim: To test the efficacy of sodium hypochlorite solution against Staphylococcus aureus dry-surface biofilms.

Methods: The Centers for Disease Control and Prevention Biofilm Reactor was adapted to create a dry-surface biofilm, containing 1.36×107 S. aureus/coupon, by alternating cycles of growth and dehydration over 12 days. Biofilm was detected qualitatively using live/dead stain confocal laser scanning microscopy (CLSM), and quantitatively with sonicated viable plate counts and crystal violet assay. Sodium hypochlorite (1000 to 20,000 parts per million) was applied to the dry-surface biofilm for 10 min, coupons were rinsed three times, and residual biofilm viability was determined by CLSM, plate counts and prolonged culture up to 16 days. Isolates before and after exposure underwent minimum inhibitory concentration (MIC) and minimum eradication concentration (MEC) testing, and one pair underwent whole-genome sequencing.

Findings: Hypochlorite exposure reduced plate counts by a factor of 7 log10, and reduced biofilm biomass by a factor of 100; however, staining of residual biofilm showed that live S. aureus cells remained. On prolonged incubation, S. aureus regrew and formed biofilms. Post-exposure S. aureus isolates had MICs and MECs that were not significantly different from the parent strains. Whole-genome sequencing of one pre- and post-exposure pair found that they were virtually identical.

Conclusions: Hypochlorite exposure led to a 7-log kill but the organisms regrew. No resistance mutations occurred, implying that hypochlorite resistance is an intrinsic property of S. aureus biofilms. The clinical significance of this warrants further study.

Read the abstract here