Biocleaning in operating theatres: validation of cleaning techniques by revealing residual traces of blood.

BACKGROUND: In the operating theatre the biocleaning process is essential after each passage to guarantee the non-transmission of potentially pathogenic microbial agents from patient to patient. AIM: To evaluate the quality of this biocleaning, the Operational Hygiene Team used a very sensitive method to detect residual traces of blood: luminol (3-aminophthalhydrazide) on the basis of methods used by the police. METHODS: Luminol was used after conventional one-step biocleaning with the usual detergent/disinfectant, after bleach disinfection before biocleaning, and after biocleaning with a steam cleaner. FINDINGS: Lunimol revealed extended traces of blood corresponding to the passage of the strip on the floor, in the corners of the room and on certain pieces of furniture which are difficult to clean. However, no luminescence was detected on the surfaces cleaned by a single passage of the steam cleaner. CONCLUSIONS: In all cases, the rooms appeared visually clean and traces of blood only became visible when revealed by luminol. We also showed that usual detergents or disinfectants do not remove blood and instead actually spread it over surfaces that may seem visually clean. These results led us to modify our procedure and also confirmed our wish to generalize the use of the steam cleaning technique for immediate cleaning. Furthermore, our tests show the relevance of luminol as a validation tool for the quality and method of biocleaning.

Successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus capitis.

Background: Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus capitis NRCS-A is able to settle and diffuse. Objective: The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus capitis NRCS-A in a NICU. Methods: Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. Results: During the studied period, 37 infants were infected or colonized by S. capitis. The incidences of infection or colonization by S. capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p < 0.001). During the different periods, antibiotics consumption and bacterial epidemiology of the ward were stable. Conclusions: The use of steam vapor system was associated with a significantly decreased incidence of S. capitis NRCS-A infection or colonization and could constitute an effective and safe procedure to control and eradicate its diffusion inside NICUs.

Extended spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak reveals incubators as pathogen reservoir in neonatal care center.

In the context of a 3-month extended-spectrum beta-lactamase-producing Klebsiella pneumonia (ESBL-KP) outbreak in a neonatal care center (NCC), hygiene practices and hospital environment were investigated. ESBL-KP strains isolated from patients and environment were compared by molecular typing. The density of incidence of multi-drug-resistant bacteria (MDRB) was calculated from January 2014 to September 2016. The 3-month ESBL-KP outbreak involved 19 patients. Clinical strains from the 19 patients displayed the same molecular profile between them, and with a strain isolated from an incubator after cleaning. Furthermore, 52.4% of incubator mattresses were positive for diverse pathogens. Hygiene practices were acceptable except for external practitioners and parents. In addition to classical infection control (IC) measures, the replacement of mattresses and the improvement of incubators disinfection stopped the outbreak. The protocol of disinfection was revised and microbiological control was implemented. A significant decrease of MDRB incidence was concomitant (p value = 0.03219) but 3 months later, MDRB incidence increased again.Conclusion: This investigation highlighted incubators and mattresses as critical materials associated to infectious risk in NCC. NCC and IC teams should implement efficient protocol for incubators disinfection and monitoring. What is Known: • Environment in neonatal intensive care units is often suspected as reservoir for Enterobacteriaceae outbreaks but is scarcely investigated. • Incubators and mattresses offer wet and warm conditions suitable for pathogens multiplication, but microbiological survey is not performed routinely for assessing bacterial contamination. What is New: • Incubators and mattresses serve as reservoir for pathogens and relay in outbreak. • An infection control protocol associating efficient disinfection and microbiology analysis is proposed.