Course Access
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
ABN 47533508426
Of Thomson, Rachel EA (DHHS)
cleaning
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
rachel.thomson@dhhs.tas.gov.au
Level 4, H Block
48 Liverpool Street
Hobart, 7000
Of Glenys Harrington
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
ABN 47533508426
Of Thomson, Rachel EA (DHHS)
cleaning
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_R
eport_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
rachel.thomson@dhhs.tas.gov.au
Level 4, H Block
48 Liverpool Street
Hobart, 7000
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