Infection Control Today

JUN 2019

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 June 2019 www.infectioncontroltoday.com T he prevention of healthcare-associated infection (HAI) acquisition has been a prime focus of quality improvement efforts in medical settings for nearly 20 years. In response to requirements issued by federal and state regulatory agencies to reduce nosocomial infections, as well as guidelines published by national quality organizations, healthcare insti- tutions have allocated vast resources directed at these efforts. These additional allocations have consisted of added staff including infection prevention, quality improvement, and environmental staff, training expenses, expenditures for new surface disinfectants, as well as signifi cant resources in monitoring devices used for interpretation of data related to the microbial testing of environmental surfaces. Despite the extensive efforts placed on such basic prevention practices as hand hygiene and environmental cleaning, HAIs still occur among tens of thousands of patients every year in the United States, with some succumbing fatally to an increasing number of pathogens including multidrug-resistant microorganisms (MDRO). How patients shed pathogens onto their surrounding surfaces and fabrics and how, in turn, the organisms are transferred to healthcare providers (HCPs) has been well researched. Patients laden with pathogenic microorganisms often transfer bacteria to various endogenous skin sites, with subsequent shedding of organisms onto bedding and attire, as well as surrounding environmental surfaces and equipment used in their care. These newly contaminated surfaces are frequently touched in a direct manner by the hands of HCPs, are contacted by their attire including gowns, aprons, gloves, and lab coats, or transferred onto equipment or other items placed on these surfaces. The weight of scientifi c trials has clearly identifi ed contaminated environmental surfaces as transfer sources for dissemination of pathogens often associated with HAIs. A recent study by Wolfensberger and colleagues focused on HCP procedures that only involved contact with an environmental source indicated transfer rates of >40% for pathogens such as Vancomycin-resistant Enterococcus (VRE), Methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium diffi cile. T h e e x t e n t t o w h i c h p a t h o g e n s contaminate a patient's environment during a hospital admission is concerning. One comprehensive study published in 2018 assessed the degree of environmental contamination in eight intensive care units. Results indicated that 15.2% of the hands of healthcare providers were contaminated, followed by 10.9% of areas close to the patient and 9.1% on surfaces distant in the patient's environment. Molecular typing used in the study indicated identical strains among the patients, hands of the HCPs, and environmental surfaces. Many additional studies have demonstrated pathogenic contamination of fl oors, privacy curtains, and personal items used by staff members. Further complicating the issue of environ- mental contamination are two known occurrences. First, many organisms are known to persist on materials commonly used in healthcare settings. Gram-positive organisms can persist on surfaces for periods >12-46 months. Spore-forming organisms are well known to exist on fomites for several months. Second, large studies examining more than 10,000 HAIs conducted at multiple hospitals indicates that newly admitted patients had a nearly six-fold increase in the risk of acquiring such pathogens as MRSA, VRE, or Acinetobacter when a prior admitted patient to the same room had one of these organisms. Are newly-admitted patients at risk for pathogen acquisition after terminal disinfection of a room? Chen, Rutala, Weber and colleagues' recent study as published in Infection Control and Hospital Epidemiology, has provided new insights on a perhaps deeper underlying problem. The authors used microbiologic and molecular methodologies to screen both environmental surfaces and patient body sites to determine possible links between environmental surface contamination and subsequent patient colonization with known MDRO organisms. The results of the study are sobering. Despite terminal room cleaning with UV towers, 55% of the rooms were found to be contaminated with at least one MDRO on the day of patient admission, while 11.3% of the studied patients acquired an MDRO attributed to contamination of surfaces. The adequacy of room decontamination appears to be marginal at best. Various large trials that used fl uorescent solutions as markers of cleaning effi cacy indicate that only 49% to 57% of room surfaces were cleaned appropriately. Additional studies reported that MDROs were recovered from 34% of room surfaces after routine cleaning and 17% from items where the rooms had been terminally disinfected. Hospitals have increasingly turned to new technologies that provide aerosolized chemical vapors or ultraviolet light (UV) methods to enhance levels of patient room decontamination. While these technologies have demonstrated reductions in HAIs in multiple studies, there are limitations in their application. Among the drawbacks in the use of mobile decontaminating equipment are limiting use to areas after transfer of patients and after terminal room cleaning, need for hiring and training of dedicated staff, time allocations for transportation, set up, and monitoring of procedure, "line-of-site" issues when using UV technologies, and ex tensive start-to-fi nish time periods which may be as long as 1.5 to 8 hours per room when using HP devices which requires the sealing of doors and vents. The findings associated with environ- mental contamination and the limitations with mobile technology provide evidence that rather than emphasizing selective application on a room - by-room basis the next development in room decon- tamination should provide an effective decontamination agent on a continuous basis simultaneously to all unit areas. A new novel technology inserted into the ducts of HVAC systems which produces hydrogen peroxide (H 2 O 2 ) from the existing humidified air has shown great promise in significantly decreasing pathogens associated with environmental contam- ination in preliminar y hospital testing. Due to the technology's ability to provide continuous pathogen reduction to all areas including nursing stations and work areas, it has demonstrated an added benefit of reducing employee absenteeism. By Robert A. Garcia, BS, MT(ASCP), CIC, FAPIC Evolving Technologies for Decontaminating Healthcare Environments In Practice

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