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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28 ICT November 2018 www.infectioncontroltoday.com As Koganti, et. al. (2016) observed, "It is likely that both patients and healthcare personnel contributed to dissemination of the virus. [Inoculum] present on patients' footwear was probably acquired during direct contact with the contaminated fl oor site adjacent to the bed. During removal of footwear, patients could easily acquire the virus on their hands, with subsequent transfer to touched surfaces and to other skin sites. The fi nding of contamination in adjacent rooms and in the nursing station clearly suggests that healthcare personnel contributed to dissemination after acquiring the virus during contact with contaminated surfaces or patients." The researchers added, "Our fi ndings have important implications. Studies are needed to assess the potential for modes of dissemination from fl oors other than footwear. For example, wheelchairs and other wheeled equipment could disseminate pathogens. If additional evidence demonstrates dissemination from fl oors, studies will be needed to assess the effi cacy of current fl oor cleaning strategies and to evaluate other methods to interrupt dissemination. Because non-sporicidal disinfectants are often used on fl oors in rooms of patients with C. diffi cile infection, there is need for data on how effectively the burden of spores is reduced on fl oors. Finally, studies in non-hospital settings are needed. For example, fl oors in community households have been shown to be frequently contaminated with C. diffi cile spores." Deshpande, et al. (2017) made a strong argument for a new focus on fl oors with their survey of fi ve hospitals. They found that fl oors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the fl oor. Contact with objects on fl oors frequently resulted in transfer of pathogens to hands. In this study, researchers cultured 318 fl oor sites from 159 patient rooms (two sites per room) in fi ve Cleveland-area hospitals. The hospital rooms included both C. diffi cile infection (CDI) isolation rooms and non-CDI rooms. Researchers also cultured hands (gloved and bare) as well as other high-touch surfaces such as clothing, call buttons, medical devices, linens, and medical supplies. The researchers found that floors in patient rooms were often contaminated with Methicillin-resistant Staphylococcus aureus (MRSA), VRE, and C. diffi cile, with C. diffi cile being the most frequently recovered pathogen found in both CDI isolation rooms and non-CDI rooms. Of 100 occupied rooms surveyed, 41 percent had one or more high-touch objects in contact with the fl oor. These included personal items, medical devices, and supplies. MRSA, VRE and C. diffi cile were recovered from 6 (18 percent), 2 (6 percent), and 1 (3 percent), respectively of bare or gloved hands that handled the items. "Efforts to improve disinfection in the hospital environment usually focus on surfaces that are frequently touched by the hands of healthcare workers or patients," observe Deshpande, et al. (2017) "Although healthcare facility fl oors are often heavily contaminated, limited attention has been paid to disinfection of fl oors because they are not frequently touched. The results of our study suggest that fl oors in hospital rooms could be an underappreciated source for dissemination of pathogens and are an important area for additional research." In their study, Rashid, et al. (2016) implicated the shoes of healthcare personnel as a potential vector. The researchers reviewed the literature to assess the evidence that shoe surfaces are vectors for infectious disease transmission and to evaluate the evidence for the effi cacy of disinfectants to decontaminate shoe surfaces. As the researchers note, "Despite a high likelihood of microbiological contamination, shoes are not often considered a vector for infectious diseases transmission. A search identifi ed no systematic review of this topic … After a thorough bibliographic search, studies were identifi ed that showed high rates of bacterial shoe sole contamination in the hospital-, community, and animal worker areas. Although several chemical and nonchemical decontamination strategies have been tested, none have shown to be able to consistently decontaminate shoe bottoms." They comment further, "In this review, many of the most common microbiologic pathogens including MRSA, Enterococcus, Cl. diffi cile, and Gram-negative bacteria were identifi ed on shoe soles. Disease transmission of MRSA has been shown to be increased in hospitals with increased patient sharing between hospitals as opposed to hospitals that do not share patients (Chang, et al. 2016). Movement of MRSA from hospital to hospital was commented to be likely due to patient spread; however, it is possible that shoe bottoms could have also accounted for the vector spread based on fi ndings from this meta-analysis. All these hypotheses will require generation of a transmission dynamic model from the bottoms of shoes to a patient. All of these data should be tested in the context of proper handwashing and other proven infection control practices." As Rashid and VonVille, et al. (2016) observe, "From the fl oor, it is plausible that air currents, human movements over the fl oor and other factors that aerosolize or provide an airborne opportunity for the organism may occur, thus causing human infections via inhalation, horizontal or cross-contamination from other persons, clothing or equipment that the organism resettles upon. It is furthermore plausible that due to the existence of these microbiological pathogens on shoe soles that the rapid spread of these organisms in the healthcare environment can be directly related to the organisms on fl oors getting picked up and carried by shoe soles and retransferred to fl oors in other areas by human movement. This potential transmission dynamic requires validation. Shoes become contaminated from a dirty fl oor and parallel methods to decontaminate fl ooring is also required. Perhaps most surprising fi nding from this study was the relative lack of consistent effi cacy to decon- taminate shoe bottoms using either chemical or nonchemical strategies. Although, most strategies had variable success, the complexity of maintaining sterility of the disinfectant strategy appeared to be the most complex and diffi cult to optimize component of the decontamination strategy. For example, Langsrud, et al. (2006) reported that chlorine-containing foo baths may act as a source of bacterial contamination in food factories. Taken together, these results suggest the shoe soles can be a likely vector for infectious diseases transmission and an effective decontamination strategy is direly needed." Shoes are not the only culprits. A few studies also indicate some risk from fl oors and that protective shoe coverings don't necessarily help. Gupta, et al. (2007) examined the effi cacy of protective footwear on bacterial fl oor colonization. The study was carried out in the intensive care unit (ICU) of a tertiary-care hospital and was divided into two phases of two weeks each, phase I with and phase II without use of protective footwear. Samples were taken at six sites: footwear exchange area; visitors /staff route; partitioned patient cubicle; central monitoring area; open patient cubicle and scrub areas. Floor and air samples were taken at different times of the day; bacteria were identifi ed and colony forming units (CFUs) measured from fl oor and colony forming units/metre3 (cfu/m3) from air sample cultures. Gupta, et al. (2007) Ò Although healthcare facility f oors are often heavily contaminated , limited d , limited attention has been paid to disinfection of f oors because they are not frequently touched.

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