Tag Archives: Infection Preventionist

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. 

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

The Society for Healthcare Epidemiology of America (SHEA) Issued Contact Precautions Guidelines On Multidrug-resistant Infections and C. difficile Infections

The Society for Healthcare Epidemiology of America (SHEA) January 2018 issued guidelines on how long hospitals should continue contact precautions for multidrug-resistant infections and Clostridium difficile infections to avoid the spread of potentially deadly organisms through hospitals.

“Because of the virulent nature of multi-drug resistant infections and C. difficile infections, hospitals should consider establishing policies on the duration of contact precautions to safely care for patients and prevent spread of these bacteria,” said David Banach, MD, MPH, an author of the study and hospital epidemiologist at the University of Connecticut Health Center in Farmington, in a society news release. “Unfortunately, current guidelines on contact precautions are incomplete in describing how long these protocols should be maintained. We outlined expert advice for hospitals to consider in developing institutional policies to more effectively use contact precautions to safely care for patients.”

Dr Banach and members of the SHEA Guidelines Committee, which includes experts in infection control and prevention, studied available evidence and practical considerations and surveyed SHEA members to develop the updated guidance document. The available evidence, however, is insufficient to issue a formal guideline.

The recommendations were published online January 11 in Infection Control & Hospital Epidemiology.

The guidance, which covers methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Enterobacteriaceae, as well as C difficile, emphasizes the need for clinicians to consider the amount of time since the last positive sample. Specific recommendations include:

  • For patients not receiving antibiotics with activity against methicillin-resistant S aureus ((MRSA), the committee recommends using negative screening cultures to decide when to stop contact protocols. The optimal number of negative cultures is unclear, but 1 to 3 are often used. Hospitals may want to extend contact precautions for high-risk patients with chronic wounds and those from long-term care facilities. The ideal length of extension is unknown, but 6 months is common.
  • For highly resistant Enterobacteriaceae, such as carbapenemase-producing carbapenem-resistant Enterobacteriaceae, or Enterobacteriaceae with few treatment options, hospitals should maintain contact precautions indefinitely.
  • For C difficile infections, contact precautions should be continued for at least 48 hours after the resolution of diarrhea, and clinicians should consider extending precautions if C difficile infection rates remain high despite appropriate prevention and control measures.
  • With cases of vancomycin-resistant enterococci (VRE)  infection, negative stool or rectal swab cultures should be used to determine when to discontinue precautions. One to three negative cultures at least 1 week apart are commonly used.

The authors note that there was insufficient evidence to formally recommend use of molecular testing to help guide decisions on length of contact precautions. However, they said they assume that polymerase chain reaction tests have better sensitivity compared with culture.

Hospitals should carefully gauge their own risks, priorities, and resources when adopting policy on duration of precautions, as costs and practicality of implementation differ, the authors note. In addition, guidance should be reevaluated by infection control leadership, especially when there are outbreaks.

“The duration of contact precautions can have a significant impact on the health of the patient, the hospital, and the community,” coauthor Gonzolo Bearman, MD, MPH, from the Division of Infectious Diseases at Virginia Commonwealth University, Richmond, said in the news release. “This guidance is a starting point, however stronger research is needed to evaluate and optimize the use.”

The guidance was endorsed by the Association for Professionals in Infection Control and Epidemiology, the Society of Hospital Medicine, and the Association of Medical Microbiology and Infectious Disease Canada.

This study was supported in part by the SHEA Research Network. Various coauthors report ties to Springer Nature for book and journal editing and grants from the National Institutes of Health, the Agency for Healthcare Research and Quality, Veterans Affairs’ Health Services Research and Development, the Centers for Disease Control and Prevention, Medimmune, Nanosphere Inc, Techlab, The Children’s Hospital of Philadelphia, Premier EHEC and CHRO-Magar 0157, Pfizer, and the University of Louisville. Coauthors also report consultant roles or fees with Xenex/Clorox, Ecolab and Gilead.

 

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https://www.medscape.com/viewarticle/891242