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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Page 24 of 32

24 ICT December 2018 test bacterium was MRSA and the bacterial load was lower (1.5 × 104 cfus) than in the present study. Conventional laundering (60°C/140°F) reduces E. faecium counts in polycotton healthcare textiles by 3–4 log10 ranks, while additional tumble drying or ironing is required for complete eradication [4]. For terminal decontamination, UV-C light is clearly less effective, although a consistent and significant reduction of bacteria can be achieved. Furthermore, one of the main limitations of the device used is the fact that it is not possible to enter the room during the decontamination process due to the potentially dangerous amount of UV-C radiation. In conclusion, UV-C decontamination is less effcient than laundering but may be a feasible adjunct to preserve the microbiological safety of healthcare textiles in place. It is important to note that UV-C decontamination does not only work on smooth surfaces in a clinical setting but also on fabrics, albeit to a lesser extent." Rutala, et al. (2014) tested the ability of an improved hydrogen peroxide solution to decontaminate privacy curtains in inpatient and outpatient areas. The microbial contamination of the curtains was assessed before and after the curtains were sprayed with improved hydrogen peroxide. The disinfectant reduced the microbial load on the privacy curtains by 96.8 percent in 37 patient rooms. The researchers also performed a wipe procedure on curtains in 10 intensive care unit (ICU) patient rooms following isolation precautions for MRSA and/or VRE. A 6.75-in × 9-in large IHP wipe was applied to the front of the curtain (i.e., the patient side) using a gloved hand placed on the back of the curtain as support. This was repeated on the opposite side but in no case were sites cultured that had just had gloved hand contact. After allowing a 2-minute contact time with the disinfectant, the post-disinfection samples were collected. The IHP was found to reduce 96.8 percent of the pathogens on the privacy curtains in 37 patient rooms. In the ICU rooms of patients subject to contact precautions, the microbial contamination of the curtains ranged from 0-341 CFU with an average of 43 MRSA and/or VRE per curtain (median, 7 MRSA and/or VRE per curtain). Post-disinfection, MRSA and VRE were completely eliminated (100% reduction). In three cases, VRE was found on the curtains of a patient subject to MRSA contact precautions and in one case MRSA was found on the curtain of a patient subject to contact precautions for VRE. In all 4 of these rooms, a patient with the same pathogen occupied that room during the previous 8-60 days. Sood, et al. (2014) investigated disin- fectants used on privacy curtains. The researchers inoculated curtain swatches with suspensions of clinical specimens of MRSA, VRE and Clostridium diffcile before using a gloved hand to touch the inoculated curtain swatch and transfer to clean agar plates. Three different commonly used disinfectants were then sprayed onto these swatches before using a clean gloved hand to touch the swatch and transfer onto new agar plates. All plates were incubated at 35°C for 24 and 72 hours. Bacterial growth before and after disinfection was assessed and compared. 3.1 percent hydrogen peroxide effectively eliminated transfer of C. diffcile, MRSA and VRE from inoculated curtains. Rinck (2010) assessed antimicrobial (AM) activity of standard versus AM curtains and to compare direct and indirect costs associated with each. Two samples of AM and one sample of standard (ST) curtain were evaluated for AM activity by placing fabric samples directly onto agar inoculated with clinical isolates or quality control organisms. Control discs were: vancomycin for Staphyloccocus aureus, coagu- lase-negative staphylococci and enterococci; chloramphenicol for VRE, and meropenem for gram-negative bacteria. The researcher reports that at her 634-bed academic teaching hospital privacy curtains were regularly changed at room discharge for isolation cases and when visibly soiled for non-isolation. Cost estimates of ST and AM curtains were obtained from distributor. Indirect costs of curtain washing and staff time were calculated based on the number of isolation discharges and average wage for environmental services staff. An estimate of opportunity cost of lost room availability due to time for curtain change was calculated. A total of 15 clinical and ATCC quality control organisms, including MRSA, VRE, P. aeruginosa, K. pneumoniae, E. coli, Enterobacter cloacae and A. baumannii, were tested. One of the AM fabrics exhibited broad- spectrum antibacterial activity comparable to that of an antibiotic control disc, while the other showed much less activity. No antimicrobial activity was detected with the ST sample. 475 privacy curtains are in use daily. A Word About Contaminated Hospital Bed Sheets Washing contaminated hospital bedsheets in a commercial washing machine with industrial detergent at high disinfecting temperatures failed to remove all traces of Clostridium diffcile (C. diffcile), suggesting that linens could be a source of infection among patients and even other hospitals, according to a recent study published in Infection Control and Hospital Epidemiology. "The fndings of this study may explain some sporadic outbreaks of C. difficile infections in hospitals from unknown sources, however, further research is required in order to establish the true burden of hospital bedsheets in such outbreaks," says Katie Laird, PhD, head of the Infectious Disease Research Group in the School of Pharmacy at De Montfort University in the United Kingdom and lead author of the study. "Future research will assess the parameters required to remove C. diffcile spores from textiles during the laundry process." Researchers inoculated swatches of cotton sheets with C. diffcile. The swatches were then laundered with sterile uncontaminated pieces of fabric using one of two different methods — either in a simulated industrial washing cycle using a washer extractor with and without detergent or naturally contaminated linens from the beds of patients with C. diffcile infection were put through a full commercial laundry where they were washed in a washer extractor (infected linen wash) with industrial detergent, pressed, dried, and finished according to current the National Health Service in the United Kingdom's healthcare laundry policy (Health Technical Memorandum 01-04 Decontami- nation of Linen for Health and Social Care (2016). Researchers measured the levels of contamination before and after washing. Both the simulated and the commercial laundering via a washer extractor process failed to meet microbiological standards of containing no disease-causing bacteria, the study found. The full process reduced C. diffcile spore count by only 40 percent, and this process resulted in bacteria from the contaminated sheets being transferred to the uncontaminated sheets after washing. Researchers concluded that thermal disinfection conditions currently required by the UK National Health System are inadequate for the decontamination of C. diffcile spores. There may be potential to spread C. diffcile back into the hospital environment as linens could be a source for outbreaks at other healthcare facilities through businesses that collect, launder and redistribute rented linens to multiple hospitals and care facilities, as is the case at NHS facilities. The research team, which also includes PhD student Joanna Tarrant, is working closely with the Textiles Services Association in the UK to continue research to find which combination of laundering parameters I n an at te m pt to h e lp clar i f y t h e difference in U.S. practice from that of a recent article appearing in ICHE questioning the effectiveness of the wash process to remove C. diff from hospital textiles, the Association for Linen Management (ALM) has provided a crosswalk between the two methods. The UK approach to processing healthcare linen relies primarily on thermal applications, ALM clarifes.

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