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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32 ICT November 2018 contamination signifi cantly for all fl oor types and species tested. The log10 reduction was the highest for E. coli, followed by E. faecalis, S. aureus and C. diffi cile. Exposure of shoe soles to the UV-C device decreased contamination signifi cantly — a mean log10 reduction. Proportions of samples from furniture, bed and patient dummy samples decreased from 96 percent to 100 percent positive in controls to 5 percent to 8 percent positive in UV-C device experiments. Room decontamination robot s powered by U V- C can also play a role in fl oor decontamination. Mustapha, et al. (2018) demonstrated that manual post-discharge cleaning by environmental services personnel signifi cantly reduced fl oor contamination, and an automated ultraviolet C room disinfection device was effective as an adjunct to manual cleaning. During the study period, environmental services (EVS) personnel cleaned high-touch surfaces in all post-discharge rooms with bleach wipes, whereas fl oors were mopped with a quaternary ammoni- um-based disinfectant. Mop heads were changed between rooms. During admission, fl oors were cleaned only if visibly soiled. The researchers examined the effectiveness of fl oor cleaning and decontamination in rooms of a convenience sample of patients under contact precautions for MRSA colonization or infection. They collected cultures from the fl oor before post-discharge cleaning, after completion of manual post-discharge cleaning by EVS personnel, and after adjunctive use of a UV-C room decontamination device. The UV-C device was operated for 3- to 5-minute cycles by research personnel as recommended by the manufacturer. The cultures were collected from areas at three sites in the room, including just inside the door, beside the bed, and in the bathroom next to the toilet; separate but adjacent sites were sampled for the three time-points. The swabs were cultured for MRSA, C diffi cile, and Candida spp. They also assessed the effi cacy of the UV-C device for reducing MRSA on steel disks placed on the fl oor versus at a height of 0.91 m; the goal of this comparison was to determine if the UV-C device was as effective in killing bacteria on fl oors as at a height of 3 feet, which is the approximate height of bed rails and bedside tables that are typically cultured when evaluating the effi cacy of UV-C devices. The researchers found that of the 27 rooms cultured (81 total sites), the percentages with ≥1 positive precleaning fl oor cultures for MRSA, Candida spp, and C diffi cile were 33 percent (9/27), 30 percent (8/27), and 33 percent (9/27), respectively. For each of the pathogens, Mustapha, et al. (2018) discovered there was a statistically significant reduction in the percentage of positive cultures after cleaning by EVS personnel; for Candida spp and C diffi cile, all fl oor cultures were negative after EVS cleaning. For MRSA, 9 percent (7/81) of fl oor sites had positive cultures after EVS cleaning versus 1 percent after operation of the UV-C device. As Mustapha, et al. (2018) summarize, "A s has been r e p o r t e d p r e v i o u s l y, w e found that floors in patient rooms prior to post-discharge cleaning were fre quentl y contaminated with important h e a l t h c a r e – a s s o c i a t e d pathogens. We demonstrated that manual post-discharge cleaning by EVS personnel in our facility significantly reduced floor contamination with MRSA, Candida spp, and C difficile. A UV-C room decontamination device was effective in reducing floor contamination in laboratory testing and reduced residual MRSA contamination on floors in patient rooms. These findings suggest that manual cleaning can be effective in reducing floor contamination in health care facilities and UV-C may be useful as an adjunctive measure." They continue, "One caveat of our findings is that the efficacy of manual cleaning in reducing floor contamination is likely to vary with different cleaning products and with differences in the quality of cleaning by EVS personnel. In our facility, ongoing interventions are in place to monitor and improve cleaning per formance by EVS personnel. In addition, floors are mopped with a quaternar y ammonium – based disinfectant and mop heads are changed between rooms. In contrast, Wong et al. demonstrated that aerobic colony counts on floors increased after manual cleaning when a neutral detergent was used, and the solution and mop head were only changed after every third room. Although we found that manual cleaning resulted in a reduction in C difficile floor contamination, the reduction must be attributable to mechanical removal because quaternary ammonium disinfectants have no activity against spores. If mop heads are not changed between rooms, spores could easily be transferred from room to room." References: Ali Z, Qadeer A and Akhtar A. To determine the effect of wearing shoe covers by medical staff and visitors on infection rates, mortality and length of stay in intensive care unit. Pak J Med Sci. 2014 Mar-Apr; 30(2): 272–275. Ayliffe GAJ, Collins BJ, Lowbury EJL, Babb JR, Lilly HA. Ward fl oors and other surfaces as reservoirs of hospital infection. J Hyg (Camb). 65:515537. 1967. Accessible at: articles/PMC2130399/pdf/jhyg00106-0081.pdf Ayliffe GAJ, Collins BJ and Lowbury EJL. Cleaning and disinfection of hospital fl oors. Brit Med. J. 2:442. 1966. Chang HH, Dordel J, Donker T, Worby CJ, Feil EJ, Hanage WP, Bentley SD and Huang SS, et al. Identifying the effect of patient sharing on between hospital genetic differentiation of methicillin-resistant Staphylococcus aureus. Genome Med 8, 18. 2016. Deshpande A, Cadnum JL, Fertelli D, Sitzlar B, Thota P, Mana TS, Jencson A, Alhmidi H, Koganti S, Donskey CJ. Are hospital fl oors an underappreciated reservoir for transmission of healthcare-associated pathogens. Am J Infect Cont, 2017; 45: 336-338. Galvin, et al. Patient shoe covers: Transferring bacteria from the fl oor onto surgical bedsheets. Am J Infect Control, 2016; 44: 1417-1419. Gupta A, Anand AC, Chumber SK, Sashindran VK and Patrikar SR. Impact of Protective Footwear on Floor and Air Contamination of Intensive Care Units. Medical Journal Armed Forces India. Vol. 63, No. 4. Pages 334-336. October 2007. Jensen R. Developing a hospital fl oor cleaning program. Health Facilities Management. May 4, 2016. Accessible at: https://www.hfmmagazine. com/articles/2176-developing-a-hospital-fl oor- cleaning-program Koganti, et. al. Evaluation of hospital fl oors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker. Infect Cont & Hosp Epidemiol, 2016: 37 (11): 1374-1377. Langsrud S, Seifert L and Møretrø T. Characterization of the microbial fl ora in disinfecting footbaths with hypochlorite. J Food Prot 69, 2193–2198. 2006. Mahida and Boswell. Non-slip socks: A potential reservoir for transmitting multidrug resistant organisms in hospitals. J of Hosp Infect, 2016; 94: 273-295. Mustapha A, Alhmidi H, Cadnum JL, Jencson AL, Donskey CJ. Effi cacy of manual cleaning and an ultraviolet C room decontamination device in reducing healthcare-associated pathogens on hospital fl oors. Am J Infect Control. May;46(5):584-586. 2018. Rashid T, Poblete K, Amadio J, Hasan I, Begum K, Alam MJ and Garey KW. Evaluation of a shoe sole UVC device to reduce pathogen colonization on fl oors, surfaces and patients. J Hosp Infect. Jan;98(1):96-101. 2018. Rashid T, VonVille HM, Hasan I and Garey KW. Shoe soles as a potential vector for pathogen transmission: a systematic review. J Appl Microbiol. Nov;121(5):1223-1231. 2016. Ò One caveat of our f ndings is that the ef cacy of manual cleaning in reducing f oor contamination is likely to vary with y dif erent cleaning products and with dif erences in the quality of cleaning by EVS personnel.

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