Tag Archives: C.difficile infection prevention

Researchers Examined the Effect of Disinfectant on C. difficile Spores and How They Survived Afterwards On Surfaces Including Isolation Gowns, Stainless Steel and Vinyl Flooring

In lab studies, researchers found that C. diff spread easily from disposable gowns often employed in surgery or infection control to stainless steel and vinyl surfaces.

“The [bacteria] also transferred to vinyl flooring, which was quite disturbing. We didn’t realize they would,” said Tina Joshi, a lecturer in molecular microbiology at the University of Plymouth in the United Kingdom and lead author of the new study.

“These bugs evolve. These bugs like to stay one step ahead. And even though we’re using disinfectants and antibiotics appropriately, they still will become resistant in time. It’s inevitable,” Joshi said.

The bacteria, called Clostridioides difficile or C. diff., cause almost a half million infections every year in the United States, according to the Centers for Disease Control and Prevention.

The infection, which is spread by fecal to oral transmission, causes severe diarrhea, and can lead to intestinal inflammation and kidney failure. Those most at risk are people who have been given strong antibiotics, as well as those with long hospital stays, or those living in long-term care facilities like the elderly.

That means that keeping these facilities clean is incredibly important. But new research, published Friday (7/12/19)  in the journal Applied and Environmental Microbiology, shows how difficult that can be.

In lab studies, researchers found that C. diff spread easily from disposable gowns often employed in surgery or infection control to stainless steel and vinyl surfaces.

These bugs evolve. These bugs like to stay one step ahead. And even though we’re using disinfectants and antibiotics appropriately, they still will become resistant in time. It’s inevitable.

What’s more, the bacteria didn’t die when the researchers tried to kill them with concentrated chlorine disinfectant.

“Even if we applied 1,000 parts per million of chlorine, it would allow spores to survive in the gowns,” Joshi told NBC News.

It’s possible that increasing the amount of chlorine might kill the spores, but if the spores are indeed becoming resistant to the disinfectant, it will only be a matter of time before the stronger concentrations can’t kill them.

“These bugs evolve. These bugs like to stay one step ahead. And even though we’re using disinfectants and antibiotics appropriately, they still will become resistant in time. It’s inevitable,” Joshi said.

C. diff infections can occur when a patient is given broad spectrum antibiotics to tackle another infection.

If the bacteria aren’t killed, hospital patients or people in nursing homes can become infected when they come into contact with contaminated surfaces, such as a bedside food tray.

But if traditional disinfectants are ineffective, as the new research suggests, what works?

One option is UV light, which could be useful in killing the bacteria. However, it can be challenging to make sure all surfaces are fully exposed to the light. At this point, Joshi said, highly concentrated bleach appears to be the best option.

For those who care for patients with compromised immune systems at home, the C. Diff Foundation says alcohol-based hand sanitizers are ineffective against the bacteria.

On its website, the group recommends using a cleaning solution of one cup bleach to nine cups of water, and leaving the mixture on surfaces for a minimum of 10 minutes. (Basic & Generic, not EPA registered product).

Meanwhile, if C. diff spores can survive on gowns and other surfaces, it is likely also the case that they can live on doctor’s coats and scrubs worn by hospital personnel all day.  (C Diff Foundation agrees)

“That’s a real infection control hazard, because these spores can stick to fibers. We’ve proven that in this paper,” Joshi said.

Erika Edwards

Erika Edwards is the health and medical news writer/reporter for NBC News and Today.

 

To read the article in its entirety please click on the following link to be redirected:

https://www.nbcnews.com/health/health-news/dangerous-bacteria-can-survive-disinfectant-putting-patients-risk-n1029231

 

 

Case Study Investigators Utilized a Bleach Product That Showed Significant Reduction In Contamination

 

 

By:Saskia v. Popescu Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children’s Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Clostridium difficile (C diff) infections are pretty much a nightmare for infection preventionists. They cause horrible illness in patients and the spore is environmentally hardy, which makes disinfection efforts extremely challenging. The US Centers for Disease Control and Prevention (CDC) estimates that, in the United States, half a million cases of C diff occur every year, and roughly 15,000 people die due to the infection. As a result of the severity of these infections and the challenges for infection control, it’s not surprising that surveillance and reporting is required not only by many state laws, but also reimbursement regulations through the Centers for Medicare and Medicaid Services (CMS). All of these factors make C diff prevention a major focus for hospitals.

Since the C diff spores are so environmental hardy, cleaning and disinfecting is particularly challenging. Bleach products are required to combat the spread of the spores on surfaces and fomites while soap and water is required for hand hygiene instead of alcohol-based hand sanitizer. These cleaning requirements pose problems though; sometimes bleach can be corrosive on medical equipment if manufacturer guidelines aren’t followed. Moreover, C diff can easily spread if patients aren’t isolated appropriately, if the room isn’t cleaned effectively, if hygiene failures occur, etc. One of the tough aspects of infection control in the face of C diff is the role of the asymptomatic carrier (i.e. the patient who is not experiencing symptoms that would trigger testing and isolation precautions but has the capacity to shed the spores).

A new study in the American Journal of Infection Control sought to address this often undervalued vector for transmission and the true burden of C diff spores in rooms after they were cleaned post-discharge and did not house a C diff patient. Investigators used the Louis Stokes Cleveland Veterans Affairs Medical Center, a 215-bed acute care facility, to test whether cleaning with bleach products in non-C diff rooms would impact contamination.

Prior to their study, daily and discharge cleaning for C diff rooms utilized bleach wipes, while a quaternary ammonium disinfectant was used for non-C diff rooms. Investigators used Clorox Healthcare Fuzion Cleaner, which is a bleach spray that has less corrosive effects. Although cleaning efficacy had previously been measured with fluorescent markets, the team relied on cultures to identify both C diff spore and methicillin-resistant Staphylococcus aureus (MRSA) contamination for this study.

Non-C diff rooms were tested for 3 weeks before the switch to the bleach-spray disinfectant and then, after the swap, tested again after cleaning of the room but before admission of a new patient. Ultimately, the goal was to determine how many rooms had environmental contamination with C diff spores before and after the change in disinfectants.

There were 51 non-C diff rooms tested after the post-discharge cleaning and prior to the switch to the bleach spray, and 39 non-C diff rooms were cultured after switching to the bleach product. The results were pretty astounding and definitely make the case for using bleach-based products in all post-discharge rooms.

Prior to switching products, 24% (12/51) of the rooms had contamination of at least one site (room and/or bathroom) and 10% had MRSA contamination. When cleaning practices were switched to use the bleach spray, the rate of contamination severely dropped—2 of 39 rooms. This trend was statistically significant and also seen in the MRSA contamination.

In this case, the investigators found that by using the bleach-based spray for the post-discharge cleaning of a non-C diff patient’s room, they reduced the contamination from 24% to 5%.

Although the study is limited to a single hospital, it encourages further investigation into general C diff contamination throughout hospitals and whether bleach-based cleaning should be performed upon all discharges, regardless of patient diagnosis with C diff infections.

As C diff continues to grow as a public health and health care concern, the role of environmental contamination will only become more critical. This study sheds light on a new cleaning strategy for hospital-wide disinfecting efforts to reduce microbial burden and C diff contamination. 

To view article in its entirety – please click on the following link to be redirected:

https://www.contagionlive.com/contributor/saskia-v-popescu/2019/02/fighting-c-diff-contamination-with-a-different-cleaning-approach?fbclid=IwAR3YS1CoSTiCyQ-FJ11N2UHWAMmzGUKnCLp7Uy2MxysbtZfAGTQ2EJANILU

Two New Jersey Health Providers, Virtua and the Deboarah Heart and Lung Center Recognized by New Jersey Hospital Assoc. for Reduced Hospital-Onset CDI

CONGRATULATIONS!!!

Two Burlington County NEW JERSEY health providers, Virtua and the Deborah Heart and Lung Center, were recently recognized by the New Jersey Hospital Association for excellence in quality and community outreach.

Virtua earned the association’s Excellence in Quality Improvement Award for its efforts to reduce the occurrence of hospital-onset Clostridium difficile infection, or C.diff, a bacterium that causes diarrhea and more serious intestinal conditions such as colitis, and education programs to reduce catheter-associated urinary tract infections (CAUTI) in home care.

Deborah was honored alongside Cooper University Health Care in Camden with the Community Outreach Award for its HeroCare program, delivering specialty medical care to active and retired military members.

The awards were presented during the association’s 99th annual meeting at the Hyatt Regency in Princeton on Friday.

To reduce hospital-onset C.diff, infection preventionists and Virtua Memorial in Mount Holly, Virtua Marlton in Evesham and Virtua Voorhees in Camden County put limitations on prescribing the antibiotic fluoroquinolone, which has been known to increase the risk of C. diff, and distributed education materials on the infection to staff.

At Virtua Marlton, which previously had the highest rate of C. diff, the health system instituted mattress covers in targeted units.

As a result of these initiatives over 18 months, hospital-onset C. diff infections were reduced by 32 percent across the system, and by 55 percent at Virtua Marlton.

“Hospital onset C. diff is an issue in hospitals across the country which results in potential harm to patients, increases length of stay, and increased health care costs. At Virtua, we decided to tackle this problem proactively and head on,” said Dr. John Matsinger,

Virtua’s executive vice president and chief clinical officer. “Virtua is honored to be acknowledged for the work by our clinicians to increase the safety of our patients and community. Keeping our patients safe is Virtua’s No. 1 priority.”

Also, Virtua Home Care was recognized for creating educational programs for employees, patients and family caregivers to lower the rate of CAUTI. There are fewer guides to preventing and measuring CAUTI in a home care setting than in acute or residential care.

Virtua Home Care established specific CAUTI education and measurement for its home program, and saw incidents of infection decline by nearly 92 percent. Virtua reported no CAUTI for the first three quarters of 2017.

Deborah, in Pemberton Township, and Cooper University Health Care earned the Community Outreach Award for its joint HeroCare program, which provides specialty medical services to active military members, veterans, National Guardsmen, and the family of all military associated with Joint Base McGuire-Dix-Lakehurst.

“It’s very nice to be recognized by our colleagues and our peers for the work that we’re doing for the program,” Christine Carlson-Glazer, Deborah’s government and community relations liaison, said of the award.

Staff housed at Deborah schedule appointments within 48 hours of requests and offer additional veterans services like post-traumatic stress disorder counseling, mental health or substance abuse help.

In less than a year, over 1,500 appointments have been scheduled.

Deborah is 1.3 miles from the Fort Dix entrance of the joint base, and as a result the two have a close connection, according to Carlson-Glazer. Deborah celebrated its 95th anniversary last year as the former Fort Dix installation recognized its centennial.

“It’s an amazing way for us to give back,” Carlson said. “We’re so proud of that.”

The Society for Healthcare Epidemiology of America (SHEA) Releases New Guidance for Infectious Disease Outbreak Preparedness in Hospitals

 

 

New Document Guides Hospitals in Responding to Infectious Disease Outbreaks

Healthcare epidemiologists play key role in emergency preparedness and response

New expert guidance document for hospitals to use in preparing for and containing outbreaks was published today by the Society for Healthcare Epidemiology of America, with the support of the Centers for Disease Control and Prevention. The guide was published in Infection Control and Hospital Epidemiology.

“This guidance details the role of the healthcare epidemiologist as an expert and leader supporting hospitals in preparing for, stopping, and recovering from infectious diseases crises,” said David Banach, MD, co-chair of the writing panel and Assistant Professor of Medicine at the University of Connecticut and Hospital Epidemiologist at UConn Health. “Armed with the resources to develop and support key activities, healthcare epidemiologists can utilize their skills and expertise in investigation and response to infectious disease outbreaks within a hospital’s incident command system.”

SHEA and CDC collaborated in 2016 to form the Outbreak Response Training Program to guide healthcare epidemiologists in how to maximize their facilities’ preparedness and response efforts to combat outbreaks such as Ebola, Zika, pandemic influenza, and other infectious diseases. The new document, Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals, leads epidemiologists through how to apply, use, and interact with emergency response structures, groups, and frameworks from the institutional to the federal levels, and provides an overview of essential resources. The principles in the guidance are intended for acute care hospitals, but may apply to other types of healthcare facilities, such as free-standing emergency departments and long-term care facilities.

According to the guidance document, during a crisis the epidemiologist provides medical and technical expertise and leads infection prevention and control efforts, coordinates with institutional stakeholders, and provides input into internal and external communications.

“We will always be faced with new and re-emerging pathogens,” said Lynn Johnston, MD, co-chair of the writing panel and professor of medicine and infectious diseases at Dalhousie University, Halifax, Canada. “This guidance is part of an ongoing effort to develop tools and strategies to prevent and manage contagious diseases to ensure patient and public safety.”

The document is part of a partnership between SHEA and CDC to prepare for emerging and re-emerging infections by providing training, educational resources, and expert guidance for dealing with outbreaks in healthcare facilities. The program is designed to train U.S. healthcare epidemiologists, who oversee infection control programs, to have the skills, abilities, and tools available to implement infection control practices and provide a leadership voice in responding to infectious threats.

To operationalize the guidance, SHEA will conduct an outbreak response workshop in January, develop and post toolkits based on the recommendations, and provide online training modules and webinars.

 

 

To view article in its entirety please click on the following link:

http://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/555-w-document-guides-hospitals-in-responding-to-infectious-disease-outbreaks