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Bhan A, Green CV, Liang Philpotts L, Doherty M, Greenfield AS, Courtney A, Shenoy ES. Educational interventions to improve compliance with disinfection practices of noncritical portable medical equipment: A systematic review. Infect Control Hosp Epidemiol 2024; 45:360-366. [PMID: 37929604 DOI: 10.1017/ice.2023.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To describe educational interventions that have been implemented in healthcare settings to increase the compliance of healthcare personnel (HCP) with cleaning and disinfection of noncritical portable medical equipment (PME) requiring low-level disinfection (LLD). DESIGN Systematic review. METHODS Studies evaluating interventions for improving LLD practices in settings with HCP, including healthcare students and trainees, were eligible for inclusion. RESULTS In total, 1,493 abstracts were identified and 1,416 were excluded, resulting in 77 studies that underwent full text review. Among these, 68 were further excluded due to study design, setting, or intervention. Finally, 9 full-text studies were extracted; 1 study was excluded during the critical appraisal process, leaving 8 studies. Various forms of interventions were implemented in the studies, including luminescence, surveillance of contamination with feedback, visual signage, enhanced training, and improved accessibility of LLD supplies. Of the 8 included studies, 4 studies reported successes in improving LLD practices among HCP. CONCLUSIONS The available literature was limited, indicating the need for additional research on pedagogical methods to improve LLD practices. Use of visual indicators of contamination and multifaceted interventions improved LLD practice by HCP.
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Affiliation(s)
- Aarushi Bhan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Chloe V Green
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Megan Doherty
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Amy Courtney
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Erica S Shenoy
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control, Mass General Brigham, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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2
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Rutala WA, Boyce JM, Weber DJ. Disinfection, sterilization and antisepsis: An overview. Am J Infect Control 2023; 51:A3-A12. [PMID: 37890951 DOI: 10.1016/j.ajic.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection. METHODS We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics. RESULTS The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation. CONCLUSIONS When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - John M Boyce
- J.M. Boyce Consulting, Boyce Consulting, LLC, Middletown, CT
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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Chatterjee P, Coppin JD, Martel JA, Williams MD, Choi H, Stibich M, Simmons S, Passey D, Allton Y, Jinadatha C. Assessment of microbial bioburden on portable medical equipment in a hospital setting. SAGE Open Med 2023; 11:20503121231162290. [PMID: 37026103 PMCID: PMC10071208 DOI: 10.1177/20503121231162290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/19/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: Although routine disinfection of portable medical equipment is required in most hospitals, frontline staff may not be able to disinfect portable medical equipment at a rate that adequately maintains low bioburden on high-use equipment. This study quantified bioburden over an extended time period for two types of portable medical equipment, workstations on wheels and vitals machines, across three hospital wards. Methods: Bioburden was quantified via press plate samples taken from high touch surfaces on 10 workstations on wheels and 5 vitals machines on each of 3 medical surgical units. The samples were taken at three timepoints each day over a 4-week period, with random rotation of timepoints and portable medical equipment, such that frontline staff were not aware at which timepoint their portable medical equipment would be sampled. The mean bioburden from the different locations and portable medical equipment was estimated and compared with Bayesian multilevel negative binomial regression models. Results: Model estimated mean colony counts (95% credible interval) were 14.4 (7.7–26.7) for vitals machines and 29.2 (16.1–51.1) for workstations on wheels. For the workstations on wheel, colony counts were lower on the mouse, 0.22 (0.16–0.29), tray, 0.29 (0.22, 0.38), and keyboard, 0.43 (0.32–0.55), when compared to the arm, as assessed by incident rate ratios. Conclusions: Although routine disinfection is required, bioburden is still present across portable medical equipment on a variety of surfaces. The difference in bioburden levels among surfaces likely reflects differences in touch patterns for the different portable medical equipment and surfaces on the portable medical equipment. Although the association of portable medical equipment bioburden to healthcare-associated infection transmission was not assessed, this study provides evidence for the potential of portable medical equipment as a vector for healthcare-associated infection transmission despite hospital disinfection requirements.
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Affiliation(s)
| | | | | | | | - Hosoon Choi
- Central Texas Veterans Health Care
System, Temple, TX, USA
| | - Mark Stibich
- Xenex Disinfection Services, San
Antonio, TX, USA
| | | | | | - Yonhui Allton
- Central Texas Veterans Health Care
System, Temple, TX, USA
| | - Chetan Jinadatha
- Central Texas Veterans Health Care
System, Temple, TX, USA
- Chetan Jinadatha, Central Texas Veterans
Health Care System, 1901 South 1st Street, Temple, TX 76504, USA.
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4
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Crowley P, Chatterjee P, Coppin JD, Choi H, Williams M, Martel JA, Stibich M, Simmons S, Passey D, Allton Y, Jinadatha C. Effect of a "feedback prompt" from a disinfection tracking system on portable medical equipment disinfection. Am J Infect Control 2022; 50:1322-1326. [PMID: 35081426 PMCID: PMC9307688 DOI: 10.1016/j.ajic.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Portable medical equipment (PME) may contribute to transmission of multidrug-resistant organisms without proper disinfection. We studied whether a Disinfection Tracking System (DTS) with feedback prompt, attached to PME, can increase the frequency of PME disinfection. METHODS DTS devices were placed on 10 workstations-on-wheels (WOWs) and 5 vitals machine (VM). After a 25 day "screen-off" period, the DTS device screens were turned on to display the number of hours since the last recorded disinfection event for a 42 day period. We used a Bayesian multilevel zero-inflated negative binomial model to compare the number of events in the display "screen-off" to the "screen-on" period. RESULTS During the "screen-off" period, there were 1.26 and 0.49 mean disinfection events and during the "screen-on" period, there were 1.76 and 0.50 mean disinfection events for WOWs and VM, respectively, per day. The model estimated mean events per device per day in the the "screen-on" period for WOW's were 1.32 (1.10 - 1.57) times greater than those in the "screen-off" period and the "screen-on" period for VM devices was 1.37 (0.89 - 2.01) times greater than those in the "screen-off" period. CONCLUSIONS The rate of disinfection events for WOWs increased following the implementation of the DTS feedback prompt.
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Affiliation(s)
| | | | | | - Hosoon Choi
- Central Texas Veterans Health Care System – Temple, TX, USA
| | | | | | - Mark Stibich
- Xenex Disinfection Services – San Antonio, TX, USA
| | | | | | - Yonhui Allton
- Central Texas Veterans Health Care System – Temple, TX, USA
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Wu H, Liao K, Yang C, Zhou N, Dou H, Xu Z, Chu L, Song C, Luo C. Psychological experience of Juvenile patients’ parents in Fangcang shelter hospital during the Omicron wave of COVID-19 pandemic in Shanghai, China: a qualitative study. BMC Public Health 2022; 22:2203. [PMCID: PMC9703436 DOI: 10.1186/s12889-022-14689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Objective
To explore the psychological experience of Juvenile patient’s parents in Fangcang shelter hospital during the Omicron wave of COVID-19 pandemic.
Methods
A qualitative study was conducted by using a phenomenological research method. Sixteen parents of juvenile patients with COVID-19 were recruited from National Exhibition and Convention Center (Shanghai, China) Fangcang shelter hospital (FSH) using purposive sampling. Data were collected by face-to-face in-depth interviews over 27 days, from April 9 to May 6, 2022. The interview data were analyzed using Colaizzi seven-step analysis method.
Results
The psychological experiences of the parents of juvenile patients in the Fangcang shelter hospital were summarized into three themes: "perception regarding the FSH", "worried about the unmet needs of juvenile patients ", and "the psychological burden after discharge". These themes were classified into 9 sub-themes, including the acceptance of FSH, adaptability to FSH, concerns about cross-infection in the FSH, special needs of infants and young children, psychological needs of preschool children, the learning demands of school-age children, concern about re-positive, fear of sequelae, worry about social acceptance.
Conclusion
Juvenile patients and their parents in the Fangcang shelter hospitals have both positive and negative experiences. It is suggested that facilities for minors should be planned in advance. Humanistic care for adolescent patients and health education for the public are also critical.
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Martel JA, Chatterjee P, Coppin JD, Williams M, Choi H, Stibich M, Simmons S, Passey D, Jinadatha C. Capturing portable medical equipment disinfection data via an automated novel disinfection tracking system. Am J Infect Control 2021; 49:1287-1291. [PMID: 34565497 DOI: 10.1016/j.ajic.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Portable Medical Equipment (PME) such as workstations-on-wheels (WOWs) and vital signs machines (VMs) have been linked to healthcare-associated infections. Routine visual monitoring of PME disinfection is difficult. An automated Disinfection Tracking System (DTS) was used to record and report the number of disinfection events of PME in a hospital setting. METHODS The study was conducted in 2 acute-care units for 25-days to determine the pattern of recorded events from DTS on PME. Devices record disinfection events as moisture events and automatically store on a central database. DTS devices with "screen-on" feedback and "screen-off" devices with no display were placed on 10 WOWs and 5 VMs on separate units. RESULTS A total of 421 moisture events were recorded for the "screen-on" and 345 for the "screen-off", during the 25-day implementation period on the 2 different hospital units. The highest number of events occurred between 6:00am-7:00am, with 69 & 75 moisture events recorded for Units 1 and 2, respectively. CONCLUSIONS The pattern of disinfection events for WOWs and VMs demonstrated that most events occurred regularly at the times corresponding with nursing shift change. The DTS has the potential to continuously record, and report data related to PME disinfection.
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Affiliation(s)
- Julie Ann Martel
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Piyali Chatterjee
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - John David Coppin
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Marjory Williams
- Department of Nursing Research, Central Texas Veterans Health Care System, Temple, TX
| | - Hosoon Choi
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Mark Stibich
- Anderson Cancer Center, Xenex Disinfection Services, San Antonio, TX
| | - Sarah Simmons
- Anderson Cancer Center, Xenex Disinfection Services, San Antonio, TX
| | - Deborah Passey
- Anderson Cancer Center, Xenex Disinfection Services, San Antonio, TX
| | - Chetan Jinadatha
- Department of Medicine, Central Texas Veterans Health Care System, Temple, TX.
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Cunliffe AJ, Askew PD, Stephan I, Iredale G, Cosemans P, Simmons LM, Verran J, Redfern J. How Do We Determine the Efficacy of an Antibacterial Surface? A Review of Standardised Antibacterial Material Testing Methods. Antibiotics (Basel) 2021; 10:1069. [PMID: 34572650 PMCID: PMC8472414 DOI: 10.3390/antibiotics10091069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Materials that confer antimicrobial activity, be that by innate property, leaching of biocides or design features (e.g., non-adhesive materials) continue to gain popularity to combat the increasing and varied threats from microorganisms, e.g., replacing inert surfaces in hospitals with copper. To understand how efficacious these materials are at controlling microorganisms, data is usually collected via a standardised test method. However, standardised test methods vary, and often the characteristics and methodological choices can make it difficult to infer that any perceived antimicrobial activity demonstrated in the laboratory can be confidently assumed to an end-use setting. This review provides a critical analysis of standardised methodology used in academia and industry, and demonstrates how many key methodological choices (e.g., temperature, humidity/moisture, airflow, surface topography) may impact efficacy assessment, highlighting the need to carefully consider intended antimicrobial end-use of any product.
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Affiliation(s)
- Alexander J. Cunliffe
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | - Peter D. Askew
- (Industrial Microbiological Services Ltd.) IMSL, Pale Lane, Hartley Whitney, Hants RG27 8DH, UK; (P.D.A.); (G.I.)
| | - Ina Stephan
- (Bundesanstalt für Materialforschung und -prüfung) BAM, Unter den Eichen 87, 12205 Berlin, Germany;
| | - Gillian Iredale
- (Industrial Microbiological Services Ltd.) IMSL, Pale Lane, Hartley Whitney, Hants RG27 8DH, UK; (P.D.A.); (G.I.)
| | | | - Lisa M. Simmons
- Department of Engineering, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | - Joanna Verran
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | - James Redfern
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
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8
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Evaluation of a continuously active disinfectant for decontamination of portable medical equipment. Infect Control Hosp Epidemiol 2021; 43:387-389. [PMID: 34034834 PMCID: PMC8961336 DOI: 10.1017/ice.2021.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A single spray application of a continuously active disinfectant on portable equipment resulted in significant reductions in aerobic colony counts over 7 days and in recovery of Staphylococcus aureus and enterococci: 3 of 93 cultures (3%) versus 11 of 97 (11%) and 20 of 97 (21%) in quaternary ammonium disinfectant and untreated control groups, respectively.
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9
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Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens. Infect Control Hosp Epidemiol 2021; 42:1076-1081. [PMID: 33431099 DOI: 10.1017/ice.2020.1367] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the timing and routes of contamination of the rooms of patients newly admitted to the hospital. DESIGN Observational cohort study and simulations of pathogen transfer. SETTING A Veterans' Affairs hospital. PARTICIPANTS Patients newly admitted to the hospital with no known carriage of healthcare-associated pathogens. METHODS Interactions between the participants and personnel or portable equipment were observed, and cultures of high-touch surfaces, floors, bedding, and patients' socks and skin were collected for up to 4 days. Cultures were processed for Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Simulations were conducted with bacteriophage MS2 to assess plausibility of transfer from contaminated floors to high-touch surfaces and to assess the effectiveness of wearing slippers in reducing transfer. RESULTS Environmental cultures became positive for at least 1 pathogen in 10 (59%) of the 17 rooms, with cultures positive for MRSA, C. difficile, and VRE in the rooms of 10 (59%), 2 (12%), and 2 (12%) participants, respectively. For all 14 instances of pathogen detection, the initial site of recovery was the floor followed in a subset of patients by detection on sock bottoms, bedding, and high-touch surfaces. In simulations, wearing slippers over hospital socks dramatically reduced transfer of bacteriophage MS2 from the floor to hands and to high-touch surfaces. CONCLUSIONS Floors may be an underappreciated source of pathogen dissemination in healthcare facilities. Simple interventions such as having patients wear slippers could potentially reduce the risk for transfer of pathogens from floors to hands and high-touch surfaces.
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10
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Daily Disinfection of the Hospital Room and Non-critical Items: Barriers and Practical Approaches. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00743-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stephenson B, Lanzas C, Lenhart S, Ponce E, Bintz J, Dubberke ER, Day J. Comparing intervention strategies for reducing Clostridioides difficile transmission in acute healthcare settings: an agent-based modeling study. BMC Infect Dis 2020; 20:799. [PMID: 33115427 PMCID: PMC7594474 DOI: 10.1186/s12879-020-05501-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is one of the most common healthcare infections. Common strategies aiming at controlling CDI include antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions. Mathematical models provide a framework to evaluate control strategies. Our objective is to evaluate the effectiveness of control strategies in decreasing C. difficile colonization and infection using an agent-based model in an acute healthcare setting. Methods We developed an agent-based model that simulates the transmission of C. difficile in medical wards. This model explicitly incorporates healthcare workers (HCWs) as vectors of transmission, tracks individual patient antibiotic histories, incorporates varying risk levels of antibiotics with respect to CDI susceptibility, and tracks contamination levels of ward rooms by C. difficile. Interventions include two forms of antimicrobial stewardship, increased environmental decontamination through room cleaning, improved HCW compliance, and a preliminary assessment of vaccination. Results Increased HCW compliance with CDI patients was ranked as the most effective intervention in decreasing colonizations, with reductions up to 56%. Antibiotic stewardship practices were highly ranked after contact precaution compliance. Vaccination and reduction of high-risk antibiotics were the most effective intervention in decreasing CDI. Vaccination reduced CDI cases to up to 90%, and the reduction of high-risk antibiotics decreased CDI cases up to 23%. Conclusions Overall, interventions that decrease patient susceptibility to colonization by C. difficile, such as antibiotic stewardship, were the most effective interventions in reducing both colonizations and CDI cases.
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Affiliation(s)
- Brittany Stephenson
- Department of Engineering, Computing, and Mathematical Sciences, Lewis University, 1 University Parkway, Romeoville, 60446, IL, USA.
| | - Cristina Lanzas
- Department of Population Health and Pathobiology, North Carolina State University, 1052 William Moore Drive, Raleigh, 27606, NC, USA
| | - Suzanne Lenhart
- Department of Mathematics, University of Tennessee, 1403 Circle Drive, Knoxville, 37996, TN, USA
| | - Eduardo Ponce
- Department of Electrical Engineering and Computer Science, University of Tennessee, 1520 Middle Drive, Knoxville, 37996, TN, USA
| | - Jason Bintz
- School of Arts and Sciences, Johnson University, Knoxville, 37998, TN, USA
| | - Erik R Dubberke
- Division of Infectious Disease, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, 63110, MO, USA
| | - Judy Day
- Department of Mathematics, University of Tennessee, 1403 Circle Drive, Knoxville, 37996, TN, USA.,Department of Electrical Engineering and Computer Science, University of Tennessee, 1520 Middle Drive, Knoxville, 37996, TN, USA
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12
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Antimicrobial activity of a continuously active disinfectant against healthcare pathogens. Infect Control Hosp Epidemiol 2020; 40:1284-1286. [PMID: 31556367 DOI: 10.1017/ice.2019.260] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only ∼2 log10 reduction occurred with carbapenem-resistant Enterobacter spp and K. pneumoniae, and antibiotic-susceptible K. pneumoniae.
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13
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Community-acquired in name only: A cluster of carbapenem-resistant Acinetobacter baumannii in a burn intensive care unit and beyond. Infect Control Hosp Epidemiol 2020; 41:531-538. [PMID: 32106898 DOI: 10.1017/ice.2020.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe an investigation into 5 clinical cases of carbapenem-resistant Acinetobacter baumannii (CRAB). DESIGN Epidemiological investigation supplemented by whole-genome sequencing (WGS) of clinical and environmental isolates. SETTING A tertiary-care academic health center in Boston, Massachusetts. PATIENTS OR PARTICIPANTS Individuals identified with CRAB clinical infections. METHODS A detailed review of patient demographic and clinical data was conducted. Clinical isolates underwent phenotypic antimicrobial susceptibility testing and WGS. Infection control practices were evaluated, and CRAB isolates obtained through environmental sampling were assessed by WGS. Genomic relatedness was measured by single-nucleotide polymorphism (SNP) analysis. RESULTS Four clinical cases spanning 4 months were linked to a single index case; isolates differed by 1-7 SNPs and belonged to a single cluster. The index patient and 3 case patients were admitted to the same room prior to their development of CRAB infection, and 2 case patients were admitted to the same room within 48 hours of admission. A fourth case patient was admitted to a different unit. Environmental sampling identified highly contaminated areas, and WGS of 5 environmental isolates revealed that they were highly related to the clinical cluster. CONCLUSIONS We report a cluster of highly resistant Acinetobacter baumannii that occurred in a burn ICU over 5 months and then spread to a separate ICU. Two case patients developed infections classified as community acquired under standard epidemiological definitions, but WGS revealed clonality, highlighting the risk of burn patients for early-onset nosocomial infections. An extensive investigation identified the role of environmental reservoirs.
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14
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Reid D, Ternes K, Winowiecki L, Yonke C, Riege B, Fregoli F, Passey D, Stibich M, Olmsted RN. Germicidal irradiation of portable medical equipment: Mitigating microbes and improving the margin of safety using a novel, point of care, germicidal disinfection pod. Am J Infect Control 2020; 48:103-105. [PMID: 31493936 DOI: 10.1016/j.ajic.2019.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
Portable medical equipment (PME) can be an important reservoir of pathogens causing health care-associated infections. To address this, a novel, portable ultraviolet disinfection pod (UVDP) that allows for full 360-degree disinfection was developed. This investigation examined efficacy of the UVDP against microorganisms on clean, patient-ready PME. We found that the UVDP significantly reduced the number of recoverable bacteria on PME.
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15
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Ragusa R, Giorgianni G, Faro G, Lazzara A, Bellia MA, Marranzano M. Are Visitors Dangerous Carriers of Pathogens in The Hospital? an Observational Study in an University Hospital in Sicily. Hosp Top 2019; 97:80-86. [PMID: 31124745 DOI: 10.1080/00185868.2019.1616511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.
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Affiliation(s)
- Rosalia Ragusa
- a Health Technology Assessment Committee, University Hospital "G. Rodolico," Catania , Italy
| | - Gabriele Giorgianni
- b School of Specialization in Hygiene, University of Catania , Catania , Italy
| | - Giuseppina Faro
- c Department of Advanced Medical, Surgical and Advanced Sciences , University of Catania , Catania , Italy
| | - Antonio Lazzara
- d Medical Directorate Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele , Catania , Italy
| | | | - Marina Marranzano
- f Department of Advanced Medical, Surgical and Advanced Sciences , University of Catania , Catania , Italy
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Donskey CJ. Beyond high-touch surfaces: Portable equipment and floors as potential sources of transmission of health care-associated pathogens. Am J Infect Control 2019; 47S:A90-A95. [PMID: 31146857 DOI: 10.1016/j.ajic.2019.03.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Efforts to improve environmental cleaning and disinfection typically focus primarily on high-touch surfaces in patient rooms. This review highlights evidence that portable equipment and other shared devices and floors may be underappreciated as sources of dissemination of health care-associated pathogens. Practical approaches to address these sites of contamination are emphasized.
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Affiliation(s)
- Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, and Case Western Reserve University School of Medicine, Cleveland, OH.
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Donskey CJ. Decontamination devices in health care facilities: Practical issues and emerging applications. Am J Infect Control 2019; 47S:A23-A28. [PMID: 31146846 DOI: 10.1016/j.ajic.2019.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
"No-touch" decontamination devices are increasingly used as an adjunct to standard cleaning and disinfection in health care facilities. Although there is evidence that these devices are effective in reducing contamination, there are several areas of controversy regarding their use. This review addresses some of the questions frequently posed by infection prevention and environmental services personnel about decontamination devices.
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Affiliation(s)
- Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
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18
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Rutala WA, Weber DJ. Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach. Am J Infect Control 2019; 47S:A96-A105. [PMID: 31146858 DOI: 10.1016/j.ajic.2019.01.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.
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Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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Abstract
All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object. Critical (items that contact sterile tissue, such as surgical instruments), semicritical (items that contact mucous membranes, such as endoscopes), and noncritical (devices that contact only intact skin, such as stethoscopes) items require sterilization, high-level disinfection, and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program, as well as other uses, such as surgical hand antisepsis and preoperative skin preparation.
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20
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Jencson AL, Cadnum JL, Wilson BM, Donskey CJ. Spores on wheels: Wheelchairs are a potential vector for dissemination ofpathogens in healthcare facilities. Am J Infect Control 2019; 47:459-461. [PMID: 30471969 DOI: 10.1016/j.ajic.2018.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022]
Abstract
In a hospital and affiliated long-term care facility, we found that shared wheelchairs were frequently contaminatedwith healthcare-associated pathogens, including Clostridium difficile spores. A network graph of 851 wheelchair transports over 3days demonstrated frequent movement between inpatient wards andoutpatient clinics, radiology, and physical therapy. These results highlight the potential for shared wheelchairs to serve as a vector for pathogen transmission.
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Affiliation(s)
- Annette L Jencson
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Brigid M Wilson
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
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Stephens B, Azimi P, Thoemmes MS, Heidarinejad M, Allen JG, Gilbert JA. Microbial Exchange via Fomites and Implications for Human Health. CURRENT POLLUTION REPORTS 2019; 5:198-213. [PMID: 34171005 PMCID: PMC7149182 DOI: 10.1007/s40726-019-00123-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE OF REVIEW Fomites are inanimate objects that become colonized with microbes and serve as potential intermediaries for transmission to/from humans. This review summarizes recent literature on fomite contamination and microbial survival in the built environment, transmission between fomites and humans, and implications for human health. RECENT FINDINGS Applications of molecular sequencing techniques to analyze microbial samples have increased our understanding of the microbial diversity that exists in the built environment. This growing body of research has established that microbial communities on surfaces include substantial diversity, with considerable dynamics. While many microbial taxa likely die or lay dormant, some organisms survive, including those that are potentially beneficial, benign, or pathogenic. Surface characteristics also influence microbial survival and rates of transfer to and from humans. Recent research has combined experimental data, mechanistic modeling, and epidemiological approaches to shed light on the likely contributors to microbial exchange between fomites and humans and their contributions to adverse (and even potentially beneficial) human health outcomes. SUMMARY In addition to concerns for fomite transmission of potential pathogens, new analytical tools have uncovered other microbial matters that can be transmitted indirectly via fomites, including entire microbial communities and antibiotic-resistant bacteria. Mathematical models and epidemiological approaches can provide insight on human health implications. However, both are subject to limitations associated with study design, and there is a need to better understand appropriate input model parameters. Fomites remain an important mechanism of transmission of many microbes, along with direct contact and short- and long-range aerosols.
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Affiliation(s)
- Brent Stephens
- Department of Civil, Architectural, and Environmental Engineering, Illinois Institute of Technology, Alumni Memorial Hall 228E, 3201 South Dearborn Street, Chicago, IL 60616 USA
| | - Parham Azimi
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Megan S. Thoemmes
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
| | - Mohammad Heidarinejad
- Department of Civil, Architectural, and Environmental Engineering, Illinois Institute of Technology, Alumni Memorial Hall 228E, 3201 South Dearborn Street, Chicago, IL 60616 USA
| | - Joseph G. Allen
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Jack A. Gilbert
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
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22
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Jinadatha C, Villamaria FC, Coppin JD, Dale CR, Williams MD, Whitworth R, Stibich M. Interaction of healthcare worker hands and portable medical equipment: a sequence analysis to show potential transmission opportunities. BMC Infect Dis 2017; 17:800. [PMID: 29281998 PMCID: PMC5745722 DOI: 10.1186/s12879-017-2895-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background While research has demonstrated the importance of a clean health care environment, there is a lack of research on the role portable medical equipment (PME) play in the transmission cycle of healthcare-acquired infections (HAIs). This study investigated the patterns and sequence of contact events among health care workers, patients, surfaces, and medical equipment in a hospital environment. Methods Research staff observed patient care events over six different 24 h periods on six different hospital units. Each encounter was recorded as a sequence of events and analyzed using sequence analysis and visually represented by network plots. In addition, a point prevalence microbial sample was taken from the computer on wheels (COW). Results The most touched items during patient care was the individual patient (850), bedrail (375), bed-surface (302), and bed side Table (223). Three of the top ten most common subsequences included touching PME and the patient: computer on wheels ➔ patient (62 of 274 total sequences, 22.6%, contained this sequence), patient ➔ COW (20.4%), and patient ➔ IV pump (16.1%). The network plots revealed large interconnectedness among objects in the room, the patient, PME, and the healthcare worker. Conclusions Our results demonstrated that PME such as COW and IV pump were two of the most highly-touched items during patient care. Even with proper hand sanitization and personal protective equipment, this sequence analysis reveals the potential for contamination from the patient and environment, to a vector such as portable medical equipment, and ultimately to another patient in the hospital. Electronic supplementary material The online version of this article (10.1186/s12879-017-2895-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chetan Jinadatha
- Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX, 76504, USA. .,Department of Medicine, College of Medicine, Texas A&M Health Science Center, 8447 Riverside PKWY, Bryan, TX, 77807, USA.
| | - Frank C Villamaria
- Department of Research, Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX, 76504, USA
| | - John D Coppin
- Department of Research, Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX, 76504, USA
| | - Charles R Dale
- Xenex Healthcare Services, 121 Interpark, Suite 104, San Antonio, TX, 78216, USA
| | - Marjory D Williams
- Department of Research, Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX, 76504, USA
| | - Ryan Whitworth
- Xenex Healthcare Services, 121 Interpark, Suite 104, San Antonio, TX, 78216, USA
| | - Mark Stibich
- Xenex Healthcare Services, 121 Interpark, Suite 104, San Antonio, TX, 78216, USA
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Deshpande A, Donskey CJ. Practical Approaches for Assessment of Daily and Post-discharge Room Disinfection in Healthcare Facilities. Curr Infect Dis Rep 2017; 19:32. [PMID: 28770497 DOI: 10.1007/s11908-017-0585-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Cleaning and disinfection in healthcare facilities is essential to ensure patient safety. This review examines practical strategies used to assess and improve the effectiveness of daily and post-discharge manual cleaning in healthcare facilities. RECENT FINDINGS Effective implementation of cleaning interventions requires objective monitoring of staff performance with regular feedback on performance. Use of fluorescent markers to assess thoroughness of cleaning and measurement of residual ATP can provide rapid and objective feedback to personnel and have been associated with improved cleaning. Direct observation of cleaning and interviews with front-line staff are useful to identify variations and deficiencies in practice that may not be detected by other methods. Although not recommended for routine monitoring, cultures can be helpful for outbreak investigations. Monitoring and feedback can be effective in improving cleaning and disinfection in healthcare facilities. Ongoing commitment within institutions is needed to sustain successful cleaning and disinfection programs.
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Affiliation(s)
- Abhishek Deshpande
- Department of Medicine, Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, OH, 44195, USA. .,Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106, USA
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