Infection Control Today

DEC 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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20 ICT December 2018 www.infectioncontroltoday.com Editor's note: This is the second in a series on fomites in the healthcare environment that are under the radar but deserve renewed attention. U biquitous as they are in the hospital, healthcare textiles and other soft surfaces can fl y under the radar in terms of the role they may play in the transmission of infectious agents. An increasing number of experts are investigating these contam- inated textiles (including privacy curtains, upholstery, apparel, etc.) as a vehicle for cross-contamination and transmission of multidrug-resistant organisms (MDROs) such as Clostridium diffi cile, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii and Pseudomonas aeruginosa. Studies indicate that microorganisms shed by patients can contaminate hospital surfaces at concentrations suffi cient for transmission, and that these pathogens survive and persist for extended periods despite attempts to disinfect or remove them and can be transferred to the hands of healthcare personnel. As Mitchell, et al. (2015) note, "…while considerable effort is placed on cleaning and disinfection of non-porous or high-touch environmental surfaces, much less effort is placed on the procedures for cleaning and decontaminating porous, soft surfaces or healthcare textiles (e.g. privacy curtains, linen, upholstery, patient furniture or room furnishings) … The complex role that these textiles play in acquisition and retention of pathogens is further complicated by varied laundering conditions and requirements, including whether the employer allows employees to launder their work-related apparel at home. While the Centers for Disease Control and Prevention (CDC) and other government agencies around the world provide guidance for laundering contaminated textiles, achieving optimal water temperature, drying time and dedicated process fl ow can be diffi cult to achieve in healthcare facilities, and nearly impossible in homes." Suspicions about certain healthcare textiles being neglected were confi rmed by DeAngelis, et al. (2013) who reported that hospitals responding to a survey indicated they only changed privacy curtains when they were visibly soiled. The researchers sent a 20-question survey to select geographic members of the Association for Professionals in Infection Control and Epidemiology (APIC), with 50 surveys submitted for analysis. Ninety-six percent of respondents (47/49) answered 'yes' to whether their facility uses privacy curtains in patient rooms. Fifty-fi ve percent (21/38) had a written policy in place specifying how often privacy curtains need to be cleaned and 53 percent (19/36) had a written policy on how often privacy curtains need to be changed. With regard to how often the privacy curtains are cleaned in a standard hospital room, 37 percent (14/38) answered 'only when visibly soiled' as recommended by APIC Text of Infection Control and Epidemiology, 13 percent (5/38) answered 'every month', 13 percent (5/38) answered 'every 3 months' and another 13 percent (5/38) answered 'once per year.' Thirty-nine percent (15/38) responded 'other.' The researchers report that privacy curtains were most often changed or cleaned when a patient had been discharged from an isolation room for a multi-drug resistant organism. Fifty-six percent (19/34) of respondents use curtains in the ambulatory care center. Approximately 45 percent clean or change the curtains in the ambulatory care center only when visibly soiled. Eighty-six percent (24/28) of respondents felt that improvement could be made in the management of hospital curtains and 82 percent felt that hospital curtains are a potential source of transmission of health care associated infections. Let's examine the literature for the latest studies and a review of what is currently known about healthcare textile/soft surface contamination and transmission. Without timely intervention, privacy curtains in hospitals can become breeding grounds for resistant bacteria, posing a threat to patient safety, say Shek, et al. (2018) who conducted a longitudinal, prospective, pilot study which tracked the contamination rate of 10 freshly laundered privacy curtains in a burn unit of a Canadian hospital. While the curtains had minimal contamination when they were fi rst hung, the curtains that were hung in patient rooms became increasingly contaminated over time – and by day 14, 87.5 percent of the curtains tested positive for MRSA. In contrast, control curtains that were not placed in patient rooms stayed clean the entire 21 days. None of the rooms where the curtains were placed were occupied by patients with MRSA. Four curtains were placed in a four-bed room; four were placed in two double rooms; and two controls were placed in areas without direct patient or caregiver contact. Researchers took samples from areas where people hold curtains, suggesting that the increasing contamination resulted from direct contact. "We know that privacy curtains pose a high risk for cross-contamination because they are frequently touched but infrequently changed," says Kevin Shek, BSc, the study's lead author. "The high rate of contamination that we saw by the 14th day may represent an opportune time to intervene, either by cleaning or replacing the curtains." By day 21, almost all curtains exceeded 2.5 CFU/cm. "Keeping the patient's environment clean is a critical component in preventing health- care-associated infections," says 2018 APIC president Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. "Because privacy curtains could be a mode of disease transmission, maintaining a schedule of regular cleaning offers another potential way to protect patients from harm while they are in our care." The study authors acknowledge the small sample size of this pilot study and recommend additional research to understand the clinical consequences of contaminated curtains. They note, "To our knowledge, this is the fi rst By Kelly M. Pyrek cover story Hospital Privacy Curtains and Bed Sheets: Soft Surface Contamination and Transmission

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