O066: Thermal disinfection of bedpans: European ISO 15883-3 guideline requirements are insufficient to ensure elimination of ARE and OXA-48 outbreak-strains

Reproducible elimination of Clostridium difficile spores using a clinical area washer disinfector in 3 different health care sites

BACKGROUND

Following a Clostridium difficile infection outbreak, the Infection Prevention and Control team at our institution queried the risk of transmission via bedpans reprocessed in washer disinfectors (WDs). This study's objective was to determine the effectiveness of the mechanical action, detergent, and temperature on the eradication of C difficile spores in 1 type of WD model.

MATERIALS AND METHODS

Three types of reusable bedpans/pots were inoculated with sterile human feces that contained 1 × 10(7) CFU/mL C difficile spores. The 0.3 mL fecal-spore suspension was inoculated in sealed cryovials. These items were reprocessed using the longest wash cycle of WDs in 9 clinical units, and then tested for residual C difficile spores. The number of colonies on each replicate organism detection and counting plate was recorded after anaerobic incubation at 35°C for 48 hours, and the log reduction was calculated.

RESULTS

All 9 WDs met the manufacturer's operational specifications. Forty-three (96%) of 45 bedpans had no viable spores (>5.9 log10C difficile spore reduction). Two bedpans had 1 to 2 spores remaining. Viable C difficile spores were isolated from all 9 cryovials.

DISCUSSION AND CONCLUSIONS

Results demonstrated that when operating the WD as stipulated, C difficile spores were satisfactorily eliminated from bedpan surfaces. Temperature alone was insufficient to kill C difficile spores. It also suggested the importance of staff training, machine maintenance, and WD purchase specifications.

Moist Heat Disinfection and Revisiting the A0 Concept

Moist heat is employed in the medical device, pharmaceutical, and food processing industries to render products and goods safe for use and human consumption. Applications include its use to pasteurize a broad range of foods and beverages, the control of microbial contamination of blood products, and treatment of bone tissue transplants and vaccines. In the pharmaceutical industry, water heated to 65°C to 80°C is used to sanitize high-purity water systems. In healthcare, it has been employed for decades to disinfect patient care items ranging from bedpans to anesthesia equipment. There is a good understanding of the conditions necessary to achieve disinfection of microorganisms at temperatures ranging from 65°C to 100°C. Based on this information, the efficacy of moist heat processes at a range of exposure times and temperatures can be quantified based on mathematical models such as the A0 calculation. While the A0 concept is recognized within the European healthcare community, it has yet to be widely adopted within the United States. This article provides information regarding the A0 concept, a brief overview of the classification of thermal disinfection for use with healthcare applications within the United States, and recent data on reinvestigating the thermal disinfection of a selected panel of microorganisms and a mixed culture biofilm.