Does hospital cleanliness correlate with meticillin-resistant Staphylococcus aureus bacteraemia rates (original) (raw)
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The Lancet Infectious Diseases, 2008
In the UK, we continue to debate the importance of hospital cleaning in relation to increasing numbers of patients acquiring meticillin-resistant Staphylococcus aureus (MRSA). However, there is little direct evidence for the eff ectiveness of cleaning because it has never been aff orded scientifi c status. Hospital hygiene is usually assessed visually, but this does not necessarily correlate with microbiological risk. A more robust case for hospital cleaning can be presented by considering the evidence for all the stages of the staphylococcal transmission cycle between human beings and their environment. Cleaning has already been accepted as an important factor in the control of other hardy environmental pathogens, such as Clostridium diffi cile, vancomycin-resistant enterococci, norovirus, and Acinetobacter spp. This Review will show why the removal of dirt might have more impact on the control of MRSA than previously thought. Introduction of additional cleaning services is easier than improvements in hand-hygiene compliance.
Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study
BMC Medicine, 2009
Background: Increasing hospital-acquired infections have generated much attention over the last decade. There is evidence that hygienic cleaning has a role in the control of hospital-acquired infections. This study aimed to evaluate the potential impact of one additional cleaner by using microbiological standards based on aerobic colony counts and the presence of Staphylococcus aureus including meticillin-resistant S. aureus. Methods: We introduced an additional cleaner into two matched wards from Monday to Friday, with each ward receiving enhanced cleaning for six months in a cross-over design. Ten hand-touch sites on both wards were screened weekly using standardised methods and patients were monitored for meticillin-resistant S. aureus infection throughout the year-long study. Patient and environmental meticillin-resistant S. aureus isolates were characterised using molecular methods in order to investigate temporal and clonal relationships. Results: Enhanced cleaning was associated with a 32.5% reduction in levels of microbial contamination at handtouch sites when wards received enhanced cleaning (P < 0.0001: 95% CI 20.2%, 42.9%). Near-patient sites (lockers, overbed tables and beds) were more frequently contaminated with meticillin-resistant S. aureus/S. aureus than sites further from the patient (P = 0.065). Genotyping identified indistinguishable strains from both handtouch sites and patients. There was a 26.6% reduction in new meticillin-resistant S. aureus infections on the wards receiving extra cleaning, despite higher meticillin-resistant S. aureus patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7%, 92.3%). Adjusting for meticillin-resistant S. aureus patient-days and based upon nine new meticillin-resistant S. aureus infections seen during routine cleaning, we expected 13 new infections during enhanced cleaning periods rather than the four that actually occurred. Clusters of new meticillin-resistant S. aureus infections were identified 2 to 4 weeks after the cleaner left both wards. Enhanced cleaning saved the hospital £30,000 to £70,000. Conclusion: Introducing one extra cleaner produced a measurable effect on the clinical environment, with apparent benefit to patients regarding meticillin-resistant S. aureus infection. Molecular epidemiological methods supported the possibility that patients acquired meticillin-resistant S. aureus from environmental sources. These findings suggest that additional research is warranted to further clarify the environmental, clinical and economic impact of enhanced hygienic cleaning as a component in the control of hospital-acquired infection.
Journal of Hospital Infection, 2004
Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called 'superbugs' with their experience of dirty hospitals, but the precise role of cleaning in the control of these organisms in unknown. Hence the importance of a clean environment is likely to remain speculative unless it becomes an evidence-based science. This proposal is a call for bacteriological standards with which to assess clinical surface hygiene in hospitals, based on those used by the food industry. The first standard concerns any finding of a specific 'indicator' organism, the presence of which suggests a requirement for increased cleaning. Indicators would include Staphylococcus aureus, including methicillin-resistant S. aureus, Clostridium difficile, vancomycin-resistant enterococci and various Gram-negative bacilli. The second standard concerns a quantitative aerobic colony count of , 5 cfu/cm 2 on frequent hand touch surfaces in hospitals. The principle relates to modern risk management systems such as HACCP, and reflects the fact that pathogens of concern are widespread. Further work is required to evaluate and refine these standards and define the infection risk from the hospital environment.
The role of environmental cleaning in the control of hospital-acquired infection
Journal of Hospital Infection, 2009
Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the socalled 'superbugs' with their experience of dirty hospitals but the precise role of environmental cleaning in the control of these organisms remains unknown. Until cleaning becomes an evidence-based science, with established methods for assessment, the importance of a clean environment is likely to remain speculative. This review will examine the links between the hospital environment and various pathogens, including meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter. These organisms may be able to survive in healthcare environments but there is evidence to support their vulnerability to the cleaning process. Removal with, or without, disinfectants, appears to be associated with reduced infection rates for patients. Unfortunately, cleaning is often delivered as part of an overall infection control package in response to an outbreak and the importance of cleaning as a single intervention remains controversial. Recent work has shown that hand-touch sites are habitually contaminated by hospital pathogens, which are then delivered to patients on hands. It is possible that prioritising the cleaning of these sites might offer a useful adjunct to the current preoccupation with hand hygiene, since hand-touch sites comprise the less well-studied side of the hand-touch site equation. In addition, using proposed standards for hospital hygiene could provide further evidence that cleaning is a cost-effective intervention for controlling hospital-acquired infection.
The role of the Hospital environment in the Staphylococcal infections
Staphylococcus spp. are common causes of healthcare-associated infections (HAIs) that can be transmitted through various routes. The hospital environment can serve as a reservoir for these pathogens. This review examines the role of environmental contamination in the transmission of Staphylococcus spp. infections and how to prevent and control it. It describes the definition of the hospital environment and its potential sources of contamination, including surfaces, fomites, air, and water. It summarizes the evidence on the frequency and extent of environmental contamination by Staphylococcus spp., especially methicillin-resistant S. aureus (MRSA), and its impact on HAIs. It also discusses strategies to reduce environmental contamination, such as cleaning, disinfection, hand hygiene, isolation precautions, and decolonization. It highlights the challenges and gaps in knowledge that need to be addressed to improve infection prevention and control practices. The review concludes that environmental contamination plays a significant role in the transmission of Staphylococcus spp. infection and that more research is needed to evaluate the effectiveness of interventions to reduce it.
Infection Control & Hospital Epidemiology, 2008
Objectives.To evaluate the adequacy of discharge room cleaning and the impact of a cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) on environmental surfaces in intensive care unit (ICU) rooms.Design.Prospective environmental study.Setting and sample.Convenience sample of ICU rooms in an academic hospital.Methods and intervention.The intervention consisted of (1) a change from the use of pour bottles to bucket immersion for applying disinfectant to cleaning cloths, (2) an educational campaign, and (3) feedback regarding adequacy of discharge cleaning. Cleaning of 15 surfaces was evaluated by inspecting for removal of a preapplied mark, visible only with an ultraviolet lamp (“black light”). Six surfaces were cultured for MRSA or VRE contamination. Outcomes of mark removal and culture positivity were evaluated by X2 testing and generalized linear mixed models, clustering by room.Results.The black-lig...
BMC Infectious Diseases, 2013
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections. An important control strategy is hand hygiene; however, non-compliance has been a major problem in healthcare settings. Furthermore, modeling studies have suggested that the law of diminishing return applies to hand hygiene. Other additional control strategies such as environmental cleaning may be warranted, given that MRSA-positive individuals constantly shed contaminated desquamated skin particles to the environment. Methods: We constructed and analyzed a deterministic environmental compartmental model of MRSA fate, transport, and exposure between two hypothetical hospital rooms: one with a colonized patient, shedding MRSA; another with an uncolonized patient, susceptible to exposure. Healthcare workers (HCWs), acting solely as vectors, spread MRSA from one patient room to the other. Results: Although porous surfaces became highly contaminated, their low transfer efficiency limited the exposure dose to HCWs and the uncolonized patient. Conversely, the high transfer efficiency of nonporous surfaces allows greater MRSA transfer when touched. In the colonized patient's room, HCW exposure occurred more predominantly through the indirect (patient to surfaces to HCW) mode compared to the direct (patient to HCW) mode. In contrast, in the uncolonized patient's room, patient exposure was more predominant in the direct (HCW to patient) mode compared to the indirect (HCW to surfaces to patient) mode. Surface wiping decreased MRSA exposure to the uncolonized patient more than daily surface decontamination. This was because wiping allowed higher cleaning frequency and cleaned more total surface area per day. Conclusions: Environmental cleaning should be considered as an integral component of MRSA infection control in hospitals. Given the previously under-appreciated role of surface contamination in MRSA transmission, this intervention mode can contribute to an effective multiple barrier approach in concert with hand hygiene.
Are hygiene standards useful in assessing infection risk?
American Journal of Infection Control, 2008
Background. We monitored the surface level cleanliness of a five-bedded surgical intensive care unit (SICU) over a ten-week period in order to evaluate proposed hygiene standards. Methods. Ten environmental sites within SICU were sampled twice weekly along with collection of clinical and patient activity data. The standards designate aerobic colony counts (ACCs) >2.5cfu/cm 2 from hand-touch sites and the presence of Staphylococcus aureus as hygiene failures. Results. Nearly a quarter of 200 samples failed the standards, mostly from hand-touch sites on curtains, beds and medical equipment. The total number of fails each week was associated with bed occupancy (p=0.04), trending towards association with SICU-acquired infections (p=0.11). Environmental S.aureus was associated with the proportion of beds occupied (p = 0.02). Indistinguishable genotypes were found between patient and environmental staphylococci, with timescales supporting staphylococcal transmission in both directions. Conclusions. Hygiene standards based on microbial growth levels and the presence of S.aureus reflect patient activity and provide a means to risk manage infection. They also exposed a staphylococcal reservoir that could represent a more tangible risk to patients. Standards for surface level cleanliness deserve further evaluation.
Journal of the American Geriatrics Society, 2012
BackgroundVariation in MRSA prevalence across nursing homes is poorly understood. Differences in environmental cleaning may be one source of variable MRSA burden.DesignProspective study of environmental contamination and cleaning quality.Setting/Participants10 California nursing homes.MeasurementsWe categorized nursing homes into two groups based upon high and low differences in MRSA point prevalence and admission prevalence (delta prevalence) from nares screenings of nursing home residents. We evaluated environmental cleaning and infection control practices by (a) culturing common area objects for MRSA, (b) assessing removal of intentionally-applied marks visible only under ultraviolet light (c) administering surveys on infection control and cleaning.ResultsOverall, 16% (78/500) of objects were MRSA-positive, and 22% (129/577) of UV-visible marks were removed. A higher proportion of MRSA-positive objects was found in the high vs. low nursing home groups (19% vs. 10%, p=0.005). Infection control and cleaning policies varied, including the frequency of common room cleaning (mean 2.5 times daily, range 1–3) and time spent cleaning per room (mean 18 min, range 7–45). In multivariate models, MRSA-positive objects were associated with high delta prevalence nursing homes (OR=2.8, p=0.005), facilities spending less time cleaning each room (OR = 2.9, p<0.001) and facilities where common rooms were cleaned less frequently (OR =1.5, p=0.01).ConclusionsWe found substantial variation in MRSA environmental contamination, infection control practices, and cleaning quality. MRSA environmental contamination was associated with larger differences between MRSA point and admission prevalence, less frequent common room cleaning, and less time spent cleaning per room. This suggests that modifying cleaning practices may reduce both MRSA environmental contamination and burden among nursing homes.
American Journal of Infection Control, 2011
Background: Environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) poses a significant risk in the epidemiology of infection. This study aimed to assess the effectiveness of disinfection in clinical areas by assessment of the wiperinse method to MRSA in the immediate patient environment, on both the bed rails and the cleaning wipes. Methods: The environmental disinfection procedures of 8 MRSA-positive hospitalized patients in 2 orthopedic wards were evaluated. A total of 56 pre-and postdisinfection samples from the bed rails as well as pre-and postuse wipes samples were collected. Results: The average MRSA loads on the bed rails before and after disinfections were 4.4 colony-forming units (cfu)/cm 2 and 0.4 cfu/cm 2 , respectively, the process reducing MRSA survival from a mean of 20.70 log to 21.65 log. The mean difference of MRSA survival detected on the wipes after each wiping ranged from 0.13 to 0.42 log. Conclusion: The presence of MRSA in the proximity of the patient, ie, the bed rails as well as the cleaning tool (the wipe), was demonstrated in this study. If thorough rinsing was not conducted between wiping, bacteria accumulated on the wipes, which can result in cross transmission.