Re: Introduction of Steam and Microfibre cleaning

28/07/2014 at 10:58 am #71217 Quote

Thomson, Rachel EA

Participant

Author:
Thomson, Rachel EA

Email:
Rachel.Thomson@DHHS.TAS.GOV.AU

Organisation:

State:

Hi Glenys,

Thanks so much for your comments! It is certainly interesting to me to see if there are outcomes may be able to be described in terms of costs for cleaning rather than reduction in HAIs, but it will be really interesting to see if others can share.

Cheers
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

With the evidence for environmental cleaning and disinfection the main outcome if you were using any new infection control strategy would be a decrease in the acquisition of MROs (i.e. MRSA, VRE and Acinetobacter & Clostridium difficile).

Haven’t heard of any decrease in MROs acquisitions at site/s where it is being used (although happy to be corrected) and as per the abstract previously posted this strategy may not have good activity against C.difficile. This would be a problem in the setting of hospital transmission.

It seems this microfiber (used daily) steam (used only on discharge) is primarily a “facility lead cleaning program” rather than a targeted infection control strategy. The cost and time savings associate with this strategy primarily relate to savings generated as a result of replacing 2-step cleaning and disinfection program.

There was a nice publication from the Geelong ICT which showed that 2-step cleaning and disinfection was not necessary – have included the abstract for those who may not have seen it.

Am J Infect Control. 2013 Mar;41(3):227-31. doi: 10.1016/j.ajic.2012.03.021. Epub 2012 Sep 13.
The effectiveness of a single-stage versus traditional three-staged protocol of hospital disinfection at eradicating vancomycin-resistant Enterococci from frequently touched surfaces.
Friedman ND1, Walton AL, Boyd S, Tremonti C, Low J, Styles K, Harris O, Alfredson D, Athan E.
Author information
Abstract
BACKGROUND:
Environmental contamination is a reservoir for vancomycin-resistant enterococcus (VRE) in hospitals.
METHODS:
Environmental sampling of surfaces was undertaken anytime before disinfection and 1 hour after disinfection utilizing a sodium dichloroisocyanurate-based, 3-staged protocol (phase 1) or benzalkonium chloride-based, single-stage clean (phase 2). VRE colonization and infection rates are presented from 2010 to 2011, and audits of cleaning completeness were also analyzed.
RESULTS:
Environmental samples collected before disinfection were significantly more likely to be contaminated with VRE during phase 1 than phase 2: 25.2% versus 4.6%, respectively; odds ratio (OR), 7.01 (P < .01). Environmental samples collected after disinfection were also significantly more likely to yield VRE during phase 1 compared with phase 2: 11.2% versus 1.1%, respectively; OR, 11.73 (P < .01). Rates of VRE colonization were higher during 2010 than 2011. Cleaning audits showed similar results over both time periods.
CONCLUSION:
During use of a chlorine-based, 3-staged protocol, significantly higher residual levels of VRE contamination were identified, compared with levels detected during use of a benzalkonium chloride-based product for disinfection. This reduction in VRE may be due to a new disinfection product, more attention to the thoroughness of cleaning, or other supplementary efforts in our institution.

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

Hi Glenys,

Yes I found that one in my research to date. I am interested in the experience of Australian Healthcare facilities, and I particularly interested in the impact (if any) on HAIs. It will be interesting to see if anyone can share some outcome data aligned to this practice change.

Thanks & speak soon
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

This research publication may be of interest/use.

J Hosp Infect. 2012 Oct;82(2):114-21. doi: 10.1016/j.jhin.2012.06.014. Epub 2012 Aug 15.
Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027.
Doan L1, Forrest H, Fakis A, Craig J, Claxton L, Khare M.

Abstract
BACKGROUND:
Clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial C. difficile transmission.
AIM:
To compare the clinical and cost effectiveness of eight C. difficile environmental disinfection methods for the terminal cleaning of hospital rooms contaminated with C. difficile spores.
METHODS:
This was a novel randomized prospective study undertaken in three phases. Each empty hospital room was disinfected, then contaminated with C. difficile spores and disinfected with one of eight disinfection products: hydrogen peroxide vapour (HPV; Bioquell Q10) 350-700 parts per million (ppm); dry ozone at 25 ppm (Meditrox); 1000 ppm chlorine-releasing agent (Actichlor Plus); microfibre cloths (Vermop) used in combination with and without a chlorine-releasing agent; high temperature over heated dry atomized steam cleaning (Polti steam) in combination with a sanitizing solution (HPMed); steam cleaning (Osprey steam); and peracetic acid wipes (Clinell). Swabs were inoculated on to C. difficile-selective agar and colony counts were performed pre and post disinfection for each method. A cost-effectiveness analysis was also undertaken comparing all methods to the current method of 1000 ppm chlorine-releasing agent (Actichlor Plus).
FINDINGS:
Products were ranked according to the log(10) reduction in colony count from contamination phase to disinfection. The three statistically significant most effective products were hydrogen peroxide (2.303); 1000 ppm chlorine-releasing agent (2.223) and peracetic acid wipes (2.134).
CONCLUSION:
The cheaper traditional method of using a chlorine-releasing agent for disinfection was as effective as modern methods.
Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

Hi all,

We are currently undertaking a major review in relation to environmental hygiene within our own organisation. As part of this we are considering the potential infection control outcomes relating to the introduction of novel cleaning processes, with a particular interest in steam and microfibre cleaning. I am aware of the body of work being led by a number of health services, including Southern Health, but I am particularly interested in any recorded impact on patient outcomes as a result of introducing steam and microfibre cleaning by other healthcare services.

In our organisation we publicly report on a number of surveillance data including

* MRSA acquisitions (colonisation and infection) [these are reported to our State surveillance unit although not publicly reported at this time]

* VRE acquisitions (colonisation and infection)

* MRGN acquisitions (colonisation and infection)

* SAB, including HCA as separate from Community Onset

* Clostridium difficile infection, in particular HCA

I attach for the interest of subscribers the link to the publicly reported HCAI data in Tasmania, which our hospital data.
http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0013/161023/Surveillance_Report_No_21_Quarter_1_2014.pdf

My question is; are any list members able or willing to share with me their HCAI data both before and after introducing steam and microfibre cleaning?

I would be happy to receive replies off-line if this enquiry.

Thanks
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

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