Many hands, light work: A partnership approach to reducing Clostridioides difficile burden on an oncology unit

An increase in hospital-onset Clostridioides difficile prompted an interprofessional team to implement enhanced environmental service cleaning practices and adopt a routine cleaning program undertaken by clinical staff. These interventions resulted in a reduction of hospital-onset Clostridioides difficile from 7.27 cases per 10,000 patient days to 1.54 cases per 10,000 patient days.

Cu-based thin rolled foils: relationship among alloy composition, micromechanical and antiviral properties against SARS-CoV-2

The healthcare-associated infections (HAIs) and pandemics caused by multidrug-resistant (MDR) and new-generation pathogens threaten the whole world community. Cu and its alloys have been attracting widespread interest as anti-contamination materials due to the rapid inactivation of MDR-superbugs and viruses. Applying thin Cu-based foils on pre-existing surfaces in hygiene-sensitive areas represents a quick, simple, cost-effective self-sanitising practice. However, the influence of chemical composition and microstructure should be deeply investigated when evaluating the antimicrobial capability and durability of Cu-based materials. The effect of composition on micromechanical and antiviral properties was investigated by comparing Cu15Zn and Cu18Ni20Zn (foil thickness from 13 to 27 μm) with Phosphorous High-Conductivity (PHC) Cu. The influence of recrystallisation annealing of PHC Cu was also investigated. Microstructural characterisation was carried out by optical (OM) and scanning electron (FEG-SEM) microscopy, Energy-dispersive Spectroscopy (EDS) and Electron-Backscattered Diffraction (EBSD). The micromechanical behaviour was assessed by microhardness, microscale abrasion and scratch tests. Cu-based foils were exposed to SARS-CoV-2 for different time points in quasi-dry conditions (artificial sweat solution), evaluating their antiviral capability by quantitative Reverse-Transcriptase Polymerase Chain Reaction (qRT-PCR). Surface morphology, contact angle measurements and Cu release were measured. All Cu-based surfaces completely inactivated SARS-CoV-2 in 10 min: pure Cu was the best option regarding antiviral efficiency, while Cu15Zn showed the best trade-off between micromechanical and antiviral properties.

Applicability of the ATP assay in monitoring the cleanliness of hospital environments

BACKGROUND

The adenosine triphosphate (ATP) assay is widely used for simple and rapid evaluation of the cleanliness of environmental surfaces. However, there remain concerns regarding the reliability of the ATP assay in hospital settings. This study aimed to assess whether the ATP assay could detect inadequate cleaning within hospital environments as well as monitor the effectiveness of routine cleaning.

METHODS

The cleanliness of seven types of high-touch surfaces in operating rooms that were routinely cleaned was evaluated by testing the ATP assay and aerobic colony counts (ACC). For pressure redistribution mattresses (Soft-nurse®) that were found to be particularly at risk of infection, cleaning methods were improved, and the effectiveness of these improvements was monitored using the same two methods.

RESULTS

The ATP assay quantitatively detected contamination on seven high-touch surfaces but showed no correlation with ACC. However, a significant positive correlation between luminescence and ACC was found on one specific surface, allowing for determining a theoretical cutoff value. Additionally, the ATP assay effectively identified the risk of future infection, which the ACC test could not assess.

CONCLUSIONS

The ATP assay can monitor the effectiveness of routine cleaning by setting a theoretical cutoff value for each subject. The method provides quantitative and meaningful values when used with an understanding of its limitations.

The impact of bedside wipes in multi-patient rooms: a prospective, crossover trial evaluating infections and survival

BACKGROUND

Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms.

AIM

To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality.

METHODS

Clustered randomized crossover trial at Shamir Medical Center, Israel (October 2016 to January 2018). Clusters were randomly assigned to use for cleaning either single-use quaternary ammonium wipes (Clinell) or standard practices (reusable cloths and buckets with bleach). Six-month intervention periods were implemented in alternating sequence, separated by a washout period. Five high-touch surfaces were monitored by fluorescent markers. Study outcomes were compared between periods using generalized estimating equations, Poisson regression, and Cox proportional hazards models.

FINDINGS

Overall, 7725 patients were included (47,670 person-days), 3793 patients in rooms with intervention cleaning and 3932 patients in rooms with standard practices. During the intervention, there was no significant difference in HAI rates (incidence rate ratio: 1.6; 95% confidence interval (CI): 0.7-3.5; P = 0.3). However, in intervention rooms, the frequency of environmental cleaning was higher (odds ratio: 3.73; 95% CI: 2.0-7.1; P < 0.0001), MDRO environmental contamination rate was insignificantly lower (odds ratio: 0.7; 95% CI: 0.5-1.0; P = 0.06), new MDRO acquisition rate was lower (hazard ratio: 0.4; 95% CI: 0.2-1.0; P = 0.04), and in-hospital mortality rate was lower (incidence rate ratio: 0.8; 95% CI: 0.7-1.0; P = 0.03).

CONCLUSION

Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI rates but did improve the frequency of cleaning, reduce MDRO environmental contamination, and was associated with reduced incidence of new MDRO acquisitions and reduced mortality. This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.

Investigation of SARS-CoV-2 Genome in the Indoor Air and High-Touch Surfaces

This study aimed to investigate the presence/absence of SARS-CoV-2 genome in the air and high-touch surfaces. This cross-sectional study was conducted from late-2020 to mid-2021 in the sections of Intensive Care Unit (ICU), emergency, infectious disease ward, and nursing station of the COVID-19 patient reception center in Kerman, Iran. The presence/absence of SARS-CoV-2 genome in the 60 samples of high-touch surfaces and 23 air samples was analyzed by reverse transcription polymerase chain reaction (RT-PCR). Fisher's exact test was used to compare the number of positive samples in different sampling sites. The genome of SARS-CoV-2 was found in the eight samples (13.32%) taken from the high-touch surfaces (two samples in COVID-19 ICU, two samples in general ICU, two samples in emergency ward, and two samples in nursing station) and two air samples (8.70%) (one sample in the general ICU and one sample in the emergency ward). Statistical analysis showed that there was no significant difference between the type of sampling site and the positive cases of SARS-CoV-2 in the surface samples (p value = 0.80) and air samples (p value = 0.22). According to the results, the SARS-CoV-2 can find in the high-touch surfaces and indoor air of the COVID-19 patient reception centers. Therefore, suitable safety and health measures should be taken, including regular and accurate disinfection of surfaces and equipment and proper ventilation to protect healthcare workers and prevent disease transmission. More studies are recommended to investigate the SARS-CoV-2 concentration in the high-touch surfaces and air samples in the similar researches, efficacy of different disinfectants used on the high-touch surfaces and compare the effect of type of ventilation (natural or mechanical) on the viral load.

Ultraviolet germicidal irradiation is effective against SARS-CoV-2 in contaminated makeup powder and lipstick

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is mainly transmitted by airborne droplets generated by infected individuals. Since this and many other pathogens are able to remain viable on inert surfaces for extended periods of time, contaminated surfaces play an important role in SARS-CoV-2 fomite transmission. Cosmetic products are destined to be applied on infection-sensitive sites, such as the lips and eyelids. Therefore, special biosafety precautions should be incorporated into the routine procedures of beauty parlors and shops. Indeed, innovative cosmetics companies are currently searching for disinfection protocols that ensure the customers' safety in makeup testing. Here, we propose an ultraviolet germicidal irradiation (UVGI) strategy that can be used to reduce the odds of COVID-19 fomite transmission by makeup testers. It is well-known that UVGI effectively inactivates pathogens on flat surfaces and clear fluids. However, ultraviolet-C (UVC) radiation at 254 nm penetrates poorly in turbid and porous materials, such as makeup and lipstick formulations. Thus, we investigated the virucidal effect of UVGI against SARS-CoV-2 deposited on such substrates and compared their performance to that of flat polystyrene surfaces, used as controls. Concentrated infectious SARS-CoV-2 inoculum (106 PFU/mL) deposited on lipstick and makeup powder was completely inactivated (>5log10 reduction) following UVC exposures at 1,260 mJ/cm2, while flat plastic surfaces required 10 times less exposure (126 mJ/cm2) to reach the same microbicidal performance. We conclude that UVGI comprises an effective disinfection strategy to promote biosafety for cosmetics testers. However, appropriate UVC dosimetry must be implemented to overcome inefficiencies caused by the optical properties of turbid materials in lipsticks and makeup powders.

Detection of SAR-CoV-2 on surfaces in food retailers in Ontario

The COVID-19 pandemic has generated increased interest in potential transmission routes. In food retail settings, transmission from infected customers and workers and customers through surfaces has been deemed plausible. However, limited information exists on the presence and survival of SARS-CoV-2 on surfaces, particularly outside laboratory settings. Therefore, the purpose of this project was to assess the presence of the virus at commonly found surfaces at food retail stores and the potential role that these spaces play in virus transmission. Samples (n=957) were collected twice a week for a month in food-retail stores within Ontario, Canada. High-touch surfaces were identified and surveyed in 4 zones within the store (payment stations, deli counters, refrigerated food section and carts and baskets). The samples were analyzed using a molecular method, i.e., reverse transcriptase quantitative Polymerase Chain Reaction (RT-qPCR). Regardless of the store's location, the sampling day or time, the location of the surface within the store or the surface material, all samples tested negative for SARS-CoV-2. These results suggest that the risk of exposure from contaminated high-touch surfaces within a food retailer store is low if preventive measures and recommended sanitizing routines are maintained.

Comparative evaluation of a novel fluorescent marker and environmental surface cultures to assess the efficacy of environmental cleaning practices at a tertiary care hospital

BACKGROUND

Cleaning high-touch surfaces serves as a crucial step towards controlling the transmission of multidrug-resistant pathogens in hospital environments. The process can be made most effective if scientifically monitored using a simple, feasible and reliable technique, especially in resource-poor settings.

AIM

To identify a novel florescent marker (FM) comparable to the already existing commercial FM systems and to assess its efficacy in evaluating cleaning of high-touch surfaces in a hospital environment.

METHODS

A liquid detergent used for washing purposes was identified as a novel FM. Pre- and post-cleaning sampling were performed from 250 high-touch surfaces in different patient-care areas using this marker and aerobic colony counts. Concordance between the two methods was assessed and compared by Cohen's kappa coefficient. The sensitivity, specificity, positive predictive and negative predictive values for the new FM method were calculated against the microbiological method.

FINDINGS

A good correlation (κ = 0.60) with overall concordance of 79.6% was observed between the two methods. The sensitivity, specificity, positive predictive value and negative predictive value of the FM were 79.58% (95% confidence interval (CI): 72-85.85%), 79.63% (95% CI: 70.79-86.78), 83.70% (95% CI: 76.38-89.50) and 74.78% (95% CI: 65.83-82.38), respectively.

CONCLUSIONS

The FM used in the present study proved to be a simple and cost-effective alternative to commercially available FMs for assessing environmental cleaning practices on a daily basis in resource-poor settings. Additional studies making direct comparisons of the FM used here with the established FMs are warranted before it can be generalized for use.

Environmental services impact on healthcare-associated Clostridium difficile reduction

BACKGROUND

Healthcare-associated Clostridium difficile infection (CDI) can result from organisms found on hospital environmental surfaces. Without proper cleaning of hospital environmental surfaces, cross-contamination can occur, resulting in a healthcare-associated infection. In 2011, an environmental services (EVS) model was developed in Hospital A that resulted in a reduction in healthcare-associated CDI. The purpose of this study was to determine if implementing Hospital A's EVS model in Hospital B would decrease healthcare-associated CDI incidence.

METHODS

A quasi-experimental design was used. The study was conducted in Hospital B, a 53-bed acute care community-based hospital, between January 2013 and December 2017. A retrospective review of all CDI LabID A/B toxin enzyme immunoassay events was performed using the National Healthcare Safety Network surveillance definitions. The data were calculated based on incidence rates per 1,000 patient days and the National Healthcare Safety Network standard infection ratio formula. No new disinfectants, antibiotic restrictions, or new isolation techniques were instituted during this time period.

RESULTS

There was a 100% reduction in healthcare-associated CDI in Hospital B from 2013's baseline rate of 0.48 per 1,000 patient days to 0.00 per 1,000 patient days (0.48, 0.00, P = 0.020).

CONCLUSIONS

This study highlights the importance of EVS education and accountability as well as recognition of the role played by EVS in reducing healthcare-associated CDI within healthcare facilities.

Antimicrobial properties of a novel copper-based composite coating with potential for use in healthcare facilities

Background

Healthcare-associated infections (HAIs) have a major impact on public health worldwide. Particularly, hospital surfaces contaminated with bacterial pathogens are often the origin of both sporadic cases and outbreaks of HAIs. It has been demonstrated that copper surfaces reduce the microbial burden of high touch surfaces in the hospital environment. Here we report the antimicrobial characterization of a novel composite coating with embedded copper particles, named Copper Armour™.

Methods

The Copper Armour™ bactericidal activity was evaluated in in vitro assays against several bacterial pathogens, including Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli O157:H7 and Listeria monocytogenes. Additionally, its antimicrobial properties were also evaluated in a pilot study over a nine-week period at an adult intensive care unit. For this, four high touch surfaces, including bed rails, overbed table, bedside table and IV Pole, were coated with Cooper Armour™, and its microbial burden was determined over a nine-week period.

Results

Copper Armour™ coated samples showed an in vitro reduction in bacterial burden of > 99.9% compared to control samples. Moreover, pilot study results indicate that Copper Armour™ significantly reduces the level of microbial contamination on high-touch surfaces in the hospital environment, as compared with standard surfaces.

Conclusions

Based on its antimicrobial properties, Copper Armour™ is a novel self-sanitizing coating that exhibits bactericidal activity against important human pathogens and significantly reduces the microbial burden of hospital surfaces. This composite could be used as a self-sanitizing coating to complement infection control strategies in healthcare facilities.

Long-acting water-stable organosilane agent and its sustained effect on reducing microbial load in an intensive care unit

BACKGROUND

Contaminated hospital surfaces contribute significantly to the transmission of health care-associated infections. Although disinfectants reduce bioburden by up to 99%, bacterial growth can rebound within hours to precleaning levels. We tested the effectiveness of an innovative, long-acting water-stable organosilane (WSO) to achieve sustained decreases in bioburden on hard surfaces.

METHODS

A 5-month prospective, randomized, double-blind controlled study was performed. Eighteen intensive care unit rooms were randomly divided into placebo or treatment groups. Hard surfaces in all rooms were cleaned using the same protocol, except the placebo surfaces were cleaned with an inert saline solution and the treatment surfaces were treated with the WSO. Binomial regression with repeated measures were used to assess mean reductions in total bioburden as measured by colony forming units.

RESULTS

The placebo resulted in average reductions in total colony forming units of 35% to 40% (relative risk reduction [RRR], 0.65; P < .01) and the WSO group averaged reductions of colony forming units by 66% to 99% (RRR, 0.55; P < .001). Total Staphylococcus aureus increased among the placebo rooms 30% (RRR, 0.69; P < .001), whereas in treatment rooms there was a reduction of 50%-60% (RRR, 0.57; P < .01). Although both sets of rooms saw reductions in bioburden or colony forming units, application of the WSO resulted in larger reductions. There was also greater variability in reductions in the placebo arm.

CONCLUSION

This is the first randomized, double-blind controlled study of an innovative WSO on high-touch hard surfaces at risk for high bioburdens. Sustained reductions of bioburden with the monthly application of this unique WSO may be associated with significant reductions in the risk of health care-associated infections.

Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcus aureus

Background

Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited.

Methods

In this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions – whole room cleaning and wipe cleaning of touched surfaces – were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention.

Results

Whole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings.

Conclusions

Daily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-2120-z) contains supplementary material, which is available to authorized users.

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

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.

A randomized, double-blind comparison of the effectiveness of environmental cleaning between infection control professionals and environmental service workers

The hospital environment is a reservoir for pathogens, and environmental service workers (ESWs) play an important role in infection prevention. A randomized, double-blind comparison was carried out in a 23-bed intensive care unit of a traditional Chinese medical-Western medical hospital. Aerobic colony counts (ACC) and methicillin-resistant Staphylococcus aureus (MRSA) were used to compare the effectiveness of environmental cleaning between infection control professionals and ESWs. The results suggest that high-touch surfaces around MRSA patients are often not sufficiently cleaned and are even cross-contaminated by ESWs after cleaning. Further educational intervention is needed for improvement of environmental cleaning.