Infection Control Today

SEP 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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16 ICT September 2018 www.infectioncontroltoday.com to cleaning-specifc knowledge as well as correct product use; however, there were no knowledge improvements for disinfectant contact time. There was no change across many of the attitude questions, particularly relating to environmental services team culture, as these scored consistently high throughout the intervention. As Allen, et al. (2018) observe, "By combining an infection prevention bundle with multi-modal elements and an imple- mentation science framework we have demonstrated a novel integrated approach to bridge the evidence-practice gap for hospital hygiene. It builds on previous research on individual cleaning and disinfection inter- ventions and products. The results from this study lend weight to previous researchers' arguments that improvements in patient outcomes, cooperation and practice change from a bundle of interventions are greater than that seen from single interventions." They add, "The improvements in both attitudes and subsequent performance demonstrated in this research may represent a change in individual EVS personnel motivation or interdisciplinary cooperation at the site. The positive results shown in this research support the arguments by Matlow and colleagues who demonstrated that personal EVS personnel motivation is directly related to improved cleaning performance, and Zoutman and colleagues who observed that better cooperation between infection control and environmental services is correlated with lower MRSA rates. While these studies measured slightly different outcomes to this study, they do infer that interpersonal factors affect performance. Future research involving EVS is needed to more conclusively demonstrate this association between improving the knowledge and attitudes of EVS personnel and improved performance." Environmental Contamination in the ICU Several studies have investigated environ- mental hygiene in the intensive care unit. Wille, et al. (2018) sought to assess the degree of environmental contamination close to and distant from patients, and contamination of healthcare workers' (HCWs) hands with nosocomial pathogens under real-life conditions and to investigate potential transmission events. Over the course of three weeks, agar contact samples were taken close to and distant from patient areas and from HCWs' hands in eight ICUs of a tertiary-care hospital. Each ICU was visited once without announcement. Among 523 samples, the researchers found that HCWs' hands were most frequently contaminated with potentially pathogenic bacteria (15.2 percent), followed by areas close to patients (10.9 percent) and areas distant from patients (9.1 percent). Gram-positive bacteria were identifed most often (67.8 percent), with Enterococcus spp. being the most prevalent species (70 percent vancomycin sensitive and 30 percent vancomycin resistant) followed by Staph- ylococcus aureus, of which 64 percent were classifed as methicillin-resistant Staphy- lococcus aureus. Molecular typing documented identical strains among patient, environment and hand isolates. As Wille, et al. (2018) observe, "This point prevalence survey identifed a high level of environmental contamination, with relevant pathogens including MDRM being present in areas distant from patients and areas close to patients. In general, areas distant from patients are considered to be of little importance in terms of transmission of organisms. Areas close to patients were frequently contaminated despite the recommended infection control measures, including twice-daily environmental disin- fection. In addition, HCWs' hands (15.2 percent) revealed a considerable number of facultative pathogenic microorganisms. These data raise concern about the potential role of contamination as a reservoir for resistant species, and subsequent development of ICU-acquired colonization and infection." The reasoning is that hospital workers may not adhere closely to local infection control guidelines, and it is possible that the formation of bioflms may complicate proper surface decontamination. In addition, resistance to disinfectants may be an issue, say the researchers. "Despite carrying out patient-related precautions and twice-daily decontamination of surfaces close to patients with certifed disinfectants based on QACs, high levels of microbial contamination were found. Hence, one can argue that the execution of environmental disinfection is poorly implemented, and probably refects non-adherence to infection control guidelines. Multiple studies have shown that cleaning and disinfection of surfaces in hospitals is suboptimal. Only 40 percent to 50 percent of surfaces that should be cleaned are wiped by housekeepers, and frequent turnover of personnel may contribute to the problem." The researchers emphasize, "The identifcation of MDRM in areas distant from patients highlights the need to evaluate the in-house hygiene standards at the study hospital, and discussion is required regarding whether extended cleaning and disinfection procedures are indicated in areas distant from patients. This measure is supported by the presence of identical strains from patients, the environment and staff. Based on the results of seven potential transmission events, it is concluded that pathogens might be transmitted from patients to HCWs and the environment, or vice versa. Furthermore, identical strains from patients discharged two weeks prior to sampling suggest that the patients' microbial footprint is not eliminated in the hospital surrounding." Smith, et al. (2018) endeavored to correlate environmental contamination of air and surfaces in the ICU; as well as to examine any association between environmental contamination and ICU-acquired staphylo- coccal infection. Patients, air, and surfaces were screened on 10 sampling days in a mechanically ventilated 10-bed ICU for a 10-month period. Near-patient hand-touch sites (N = 500) and air (N = 80) were screened for total colony count and Staphylococcus aureus. Air counts were compared with sur face counts according to proposed standards for air and surface bioburden. Patients were monitored for ICU-acquired staphylococcal infection throughout. Overall, 235 of 500 (47 percent) surfaces failed the standard for aerobic counts. Half of passive air samples failed the 'index of microbial air' contamination, and 15/40 active air samples failed the clean air standard. As Smith, et al. (2018) observe, "On 10 out of 40 occasions, either MSSA or MRSA or both were recovered from surfaces or air; for these 10 occasions, nine showed surface hygiene failures from bed sites adjacent to a specifc sampling point. This refects previous work that noted the association of MSSA/ MRSA with higher surface counts. The more microbial soil in the vicinity, the more likely it is that a pathogen can be isolated. Surfaces in the side-room were cleaner than the rest of ICU although the data varied. This was attributed to the fact that the door was kept shut when the room was occupied and the room itself was often left unused. More people-traffc and positive correlation with Ò Despite carrying out patient-related precautions and twice-daily decontamination of surfaces close to patients with certifed disinfectants based on QACs, high levels of microbial contamination were found.

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