Infection Control Today

NOV 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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Aerosols generated from a contaminated oor can reach breathing height, are within respirable size range, and could transmit infection. 4 Soles of Shoes of medical staff are a s source of infection. Doctors shoes were positive for infectious bacteria 56% before rounds and 65% after rounds. Of objects examined in this study (including hands) shoes are the largest reservoir of alert bacteria. 2 In the OR contamination was found on 98% of outdoor shoes, 68% of morning theater shoes and 56% of end-of-day theatre shoes. Further- more, oor bacteria may contribute up to 15% of airborne bacterial CFUs in the OR. 3 1 T. Rashid, K. Poblete, J. Amadio, I. Hasan, K. Begum, M.J. Alam, K.W. Garey Evaluation of a shoe sole UVC device to reduce pathogen colonization on oors, surfaces and patients. Journal of Hospital Infection, Oct 17, 2017 2 Paduszynska, K.; Gagis, L.; Rucinska, M; Pomorski, L. Physicians as an infective vector at a department of surgery. Polski Przeglad Chirurgiczny 2014; 86, 11, 511-517 3 Amirfeyz R, Tasker A, Ali S, Bowker K, Blom A. Theatre shoes - a link in the common pathway of postoperative wound infection The Royal College of Surgeons of England 2007; 89: 605-608 4 4 Paton S, Thompson K, Paks SR, Bennett AM. Reaerosolization of Spores from Flooring Surfaces to Assess the Risk of Dissemination and Transmission of Infections. Applied and Environmental Microbiology 2015 Aug; 81(15): 4914-4919 fl oors become rapidly re-contaminated from airborne microorganisms and those trans- ferred from shoes, equipment wheels, and body substances. Nevertheless, healthcare institutions or contracted cleaning companies may choose to use an EPA-registered detergent/disinfectant for cleaning low-touch surfaces (e.g., fl oors) in patient-care areas because of the diffi culty that personnel may have in determining if a spill contains blood or body fl uids (requiring a detergent/disinfectant for clean-up) or when a multidrug-resistant organism is likely to be in the environment. Methods for cleaning non-porous floors include wet mopping and wet vacuuming, dry dusting with electrostatic materials, and spray buffi ng. Methods that produce minimal mists and aerosols or dispersion of dust in patient-care areas are preferred." The recommendation from the dated CDC guidance is to "keep housekeeping surfaces (e.g., fl oors, walls, and tabletops) visibly clean on a regular basis and clean up spills promptly." Additionally, the CDC indicated, "After the last surgical procedure of the day or night, wet vacuum or mop operating room fl oors with a single-use mop and an EPA-registered hospital disinfectant." These guidelines have not been updated by HICPAC since their issuance. More recently, Koganti, et. al. (2016) observed, "… hospital fl oors are often heavily contaminated but are not considered an important source for pathogen dissemination because they are rarely touched. However, fl oors are frequently contacted by objects that are subsequently touched by hands (e.g., shoes, socks, slippers). In addition, it is not uncommon for high-touch objects such as call buttons and blood pressure cuffs to be in contact with the fl oor (authors' unpublished observations)." The authors posited that fl oors may be an "underappreciated reservoir for pathogen transmission" and set out to examine the potential for the dissemination of microorganisms from fl oors of isolation rooms to the hands of patients and to high-touch surfaces inside and outside of rooms. Ten ambulator y patients in contact precautions for C. diffi cile infection or carriage of MRSA were enrolled in this study. For each patient, a section of the fl oor adjacent to the bed was inoculated with sterile water containing a bacteriophage and allowed to dry. Patients were not aware of the precise area of inoculation and hospital personnel were not aware of the study. The protocol for cleaning of contact precautions rooms included daily disinfection of high-touch surfaces with bleach wipes each morning but fl oors were cleaned only if visibly soiled; compliance with daily disinfection was monitored with fl uorescent markers with more than 85 percent of sites demonstrating marker removal during the study. Preliminary experiments demonstrated that the inoculum persisted on wood laminate fl oors for at least three days, with a 1 to 2 log decrease in recovery attributed to desiccation. The authors found that of the 10 patients on four wards, seven had samples collected for three days; two patients were discharged after one day and one patient was discharged after two days. Inoculum was detected on multiple surfaces of all patient rooms by one day after inoculation. On days 1 and 3, the concentration of inoculum was higher for surfaces less than or equal to 3 feet vs. more than 3 feet from the bed and more sites were contaminated at less than or equal to 3 feet. Inoculum contamination was not signifi cantly different at less than or equal to 3 feet vs. more than 3 feet on day 2. Contamination was common on high-touch surfaces in adjacent rooms, in the nursing station, and on portable equipment. Portable equipment included wheelchairs, medication carts, vital signs equipment, and pulse oximeters. All negative control swabs were negative for inoculum.

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