OBJECTIVE: To determine the relationship between home disinfectant use and the prevalence of antibiotic resistance among environmental isolates of human pathogens. METHODS: Bacteria were cultured from 5 kitchen and 5 bathroom sites using quantitative methods. Antibiotic susceptibility was determined by standard methods. Home disinfectant use was assessed via a questionnaire. RESULTS: The overall total mean log10 counts (total CFU) for the kitchen and bathroom were 4.31 and 4.88, respectively. Gram-positive bacteria were more common in the bathroom (4.05) than in the kitchen (3.60), while Gram-negative bacilli were more common in the kitchen (4.23) than in the bathroom (3.86). The sink and bath drains were the most contaminated sites with 6.16-log10 of total CFU and 6.6-log10 in the kitchen and bathroom, respectively. Households reported cleaning frequency with a variety of commercial products. Most respondents used antibacterial products (eg, soaps, surface disinfectants) in the home. Antibiotic-resistant pathogens were infrequently isolated in the homes evaluated. CONCLUSIONS: Compared to pathogens causing community-acquired clinical infections in the ICARE study, pathogens isolated from households are less likely to demonstrate antibiotic resistance. In addition, no relationship between antibacterial use or frequency of cleaning or disinfection and antibiotic resistance was revealed.
Disinfectants , Humans , Disinfectants/pharmacology , Anti-Bacterial Agents/pharmacology , Toilet Facilities , Drug Resistance, Microbial , Gram-Negative Bacteria
We evaluated the robustness of sterilization technologies when spores and bacteria were placed on "dirty" instruments and overlaid with blood. The results illustrate that steam sterilization is the most effective sterilization technology with the largest margin of safety, followed by ethylene oxide and hydrogen peroxide gas plasma.
Ethylene Oxide , Steam , Humans , Hydrogen Peroxide/pharmacology , Sterilization/methods , Technology
We evaluated the ability of an ultraviolet-C (UV-C) room decontamination device to kill Candida auris and C. albicans. With an organic challenge (fetal calf serum), the UV-C device demonstrated the following log10 reductions for C. auris of 4.57 and for C. albicans of 5.26 with direct line of sight, and log10 reductions for C. auris of 2.41 and for C. ablicans of 3.96 with indirect line of sight.
Candida albicans , Candida , Humans , Candida auris , Serum Albumin, Bovine
We examined the microbial burden on hospital room environmental sites after standard (quaternary ammonium [Quat]) or enhanced disinfection (quat/ultraviolet light [UV-C], bleach, or bleach/UV-C). An enhanced terminal room disinfection reduced the microbial burden of epidemiologically important pathogens on high-touch surfaces in patient rooms, especially sites around the bed, better than standard room disinfection.
We investigated the microbial burden on the operating room environment when patients on contact precautions for a multidrug-resistant pathogen received surgery. Our study demonstrated that the perioperative environment was contaminated with aerobic bacteria and methicillin-resistant Staphylococcus aureus (MRSA) after surgery, and that MRSA persisted environmentally even after cleaning and disinfection, highlighting the need for meticulous cleaning and disinfection in the perioperative environment.
OBJECTIVE: To compare the microbicidal activity of low-temperature sterilization technologies (vaporized hydrogen peroxide [VHP], ethylene oxide [ETO], and hydrogen peroxide gas plasma [HPGP]) to steam sterilization in the presence of salt and serum to simulate inadequate precleaning. METHODS: Test carriers were inoculated with Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, vancomycin-resistant Enterococcus, Mycobacterium terrae, Bacillus atrophaeus spores, Geobacillus stearothermophilus spores, or Clostridiodes difficile spores in the presence of salt and serum and then subjected to 4 sterilization technologies: steam, ETO, VHP and HPGP. RESULTS: Steam, ETO, and HPGP sterilization techniques were capable of inactivating the test organisms on stainless steel carriers with a failure rate of 0% (0 of 220), 1.9% (6 of 310), and 1.9% (5 of 270), respectively. The failure rate for VHP was 76.3% (206 of 270). CONCLUSION: Steam sterilization is the most effective and had the largest margin of safety, followed by ETO and HPGP, but VHP showed much less efficacy.
Spores, Bacterial/drug effects , Sterilization/methods , Enterococcus , Escherichia coli , Ethylene Oxide/pharmacology , Humans , Hydrogen Peroxide/pharmacology , Nontuberculous Mycobacteria , Pseudomonas aeruginosa , Staphylococcus aureus , Steam , Temperature , Vancomycin Resistance
A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only â¼2 log10 reduction occurred with carbapenem-resistant Enterobacter spp and K. pneumoniae, and antibiotic-susceptible K. pneumoniae.
Anti-Infective Agents/pharmacology , Disinfectants/pharmacology , Infection Control/methods , Candida/drug effects , Cross Infection/prevention & control , Drug Resistance, Multiple, Bacterial/drug effects , Escherichia coli/drug effects , Humans , Klebsiella pneumoniae/drug effects , Microbial Sensitivity Tests , Staphylococcus aureus/drug effects , Vancomycin-Resistant Enterococci/drug effects
Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it can cause severe infections with frequent mortality in more than a dozen countries. It can survive on healthcare environmental surfaces for at least 7 days and can cause outbreaks in healthcare facilities. Clearly, infection prevention strategies, such as surface disinfection, will be essential to controlling Candida transmission. Unfortunately, data on the activity of antiseptics and disinfectants used in healthcare to inactivate this pathogen are limited.1-5 In this study, we investigated 12 different disinfectants (ie, 8 low- and intermediate-level disinfectants in 2 dilutions of sodium hypochlorite and 5 high-level disinfectants/chemical sterilants) and 9 antiseptics commonly used in healthcare facilities for their antimicrobial activity against C. auris and C. albicans.
Candidiasis/prevention & control , Cross Infection/prevention & control , Disease Outbreaks/prevention & control , Anti-Infective Agents, Local , Candida , Candida albicans , Candidiasis/transmission , Cross Infection/transmission , Disinfectants , Disinfection , Health Facilities , Humans
OBJECTIVE: Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques. SETTING: Prospective cohort study at 2 academic medical centers. DESIGN: A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 'marker' MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources. RESULTS: We enrolled 80 patient-room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort. CONCLUSIONS: Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient's stay is needed to better prevent acquisition of MDROs through the environment.
Cross Infection/microbiology , Disinfection , Drug Resistance, Multiple, Bacterial , Equipment Contamination , Gram-Negative Facultatively Anaerobic Rods/isolation & purification , Gram-Positive Endospore-Forming Rods/isolation & purification , Aged , Equipment and Supplies, Hospital , Female , Health Facilities , Humans , Male , Middle Aged , North Carolina , Patients' Rooms , Prospective Studies
In this prospective study, we monitored 4 epidemiologically important pathogens (EIPs): methicillin-resistane Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant (MDR) Acinetobacter to assess the effectiveness of 3 enhanced disinfection strategies for terminal room disinfection against standard practice. Our data demonstrated that a decrease in room contamination with EIPs of 94% was associated with a 35% decrease in subsequent patient colonization and/or infection.
Cross Infection/microbiology , Cross Infection/prevention & control , Disinfection/methods , Environmental Microbiology , Patients' Rooms/standards , Acinetobacter/isolation & purification , Acinetobacter/radiation effects , Clostridioides difficile/isolation & purification , Clostridioides difficile/radiation effects , Humans , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/radiation effects , Prospective Studies , Ultraviolet Rays , United States , Vancomycin-Resistant Enterococci/isolation & purification , Vancomycin-Resistant Enterococci/radiation effects
We evaluated the ability of high-intensity visible violet light with a peak output of 405 nm to kill epidemiologically important pathogens. The high irradiant light significantly reduced both vegetative bacteria and spores at some time points over a 72-hour exposure period.
Bacteria/radiation effects , Disinfection/methods , Environmental Microbiology , Light , Humans
We measured the disinfection of MRSA and Clostridium difficile spores using an ultraviolet C (UV-C) device, and we correlated those results to measurements and computer simulations of UV-C surface intensity. The results demonstrate both large differences in UV light intensity across various surfaces and how this leads to significant differences in disinfection.
Clostridioides difficile/radiation effects , Computer Simulation , Disinfection/methods , Methicillin-Resistant Staphylococcus aureus/radiation effects , Ultraviolet Rays , Clostridioides difficile/isolation & purification , Colony Count, Microbial , Cross Infection/microbiology , Cross Infection/prevention & control , Humans , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Patients' Rooms
Susceptibility to germicides for carbapenem/colistin-resistant Enterobacteriaceae is poorly described. We investigated the efficacy of multiple germicides against these emerging antibiotic-resistant pathogens using the disc-based quantitative carrier test method that can produce results more similar to those encountered in health care settings than a suspension test. Our study results demonstrated that germicides commonly used in health care facilities likely will be effective against carbapenem/colistin-resistant Enterobacteriaceae when used appropriately in health care facilities.
Anti-Infective Agents, Local/pharmacology , Carbapenem-Resistant Enterobacteriaceae/drug effects , Disinfectants/pharmacology , Enterobacter cloacae/drug effects , Escherichia coli/drug effects , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Colistin/pharmacology , Disk Diffusion Antimicrobial Tests , Drug Resistance, Multiple, Bacterial , Humans
BACKGROUND: Single outbreaks have often been reported in health care settings, but the frequency of outbreaks at a hospital over time has not been described. We examined epidemiologic features of all health care-associated outbreak investigations at an academic hospital during a 5-year period. METHODS: Health care-associated outbreak investigations at an academic hospital (2012-2016) were retrospectively reviewed through data on comprehensive hospital-wide surveillance and pulsed-field gel electrophoresis (PFGE) analysis. RESULTS: Fifty-one health care-associated outbreaks (annual range, 8-15), including 26 (51%) outbreaks in intensive care units (ICUs), and 263 infected-colonized patients involved in these outbreaks were identified. The frequency of pathogens varied by affected location, specifically multidrug-resistant organisms (20/26 outbreaks, 77% in ICUs vs 2/25 outbreaks, 8% in non-ICUs; P < .0001) and gastroenteritis because of Clostridium difficile, norovirus, or adenovirus (1/26 outbreaks, 4% in ICUs vs 17/25 outbreaks, 68% in non-ICUs; P < .0001). Outbreaks occurred in approximately one-third of all units (37%) with some repeated instances of the same pathogens. Of 16 outbreaks caused by a bacterial pathogen evaluated by PFGE, 12 (75%) included some indistinguishable strains, suggesting person-to-person transmission or a common source. CONCLUSIONS: This study demonstrated epidemiologic characteristics of multiple outbreaks between ICUs and non-ICUs and the value of molecular typing in understanding the epidemiology of health care-associated outbreaks.
Bacterial Infections/epidemiology , Cross Infection/epidemiology , Disease Outbreaks , Epidemiological Monitoring , Molecular Epidemiology/methods , Virus Diseases/epidemiology , Electrophoresis, Gel, Pulsed-Field , Hospitals, Teaching , Humans , Incidence , Molecular Typing , Retrospective Studies
BACKGROUND: Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter. METHODS: We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA. Rooms from which a patient with infection or colonisation with a target organism was discharged were terminally disinfected with one of four strategies: reference (quaternary ammonium disinfectant except for C difficile, for which bleach was used); UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C] light except for C difficile, for which bleach and UV-C were used); bleach; and bleach and UV-C. The next patient admitted to the targeted room was considered exposed. Every strategy was used at each hospital in four consecutive 7-month periods. We randomly assigned the sequence of strategies for each hospital (1:1:1:1). The primary outcomes were the incidence of infection or colonisation with all target organisms among exposed patients and the incidence of C difficile infection among exposed patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01579370. FINDINGS: 31â226 patients were exposed; 21â395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22â426 exposure days in the reference group (51·3 per 10â000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10â000 exposure days; relative risk [RR] 0·70, 95% CI 0·50-0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10â000 exposure days; RR 0·85, 95% CI 0·69-1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10â000 exposure days; RR 0·91, 95% CI 0·76-1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10â000 exposure days; RR 1·0, 95% CI 0·57-1·75; p=0·997). INTERPRETATION: A contaminated health-care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk. FUNDING: US Centers for Disease Control and Prevention.
Clostridioides difficile , Clostridium Infections/prevention & control , Cross Infection/microbiology , Cross Infection/prevention & control , Disinfection/methods , Drug Resistance, Multiple, Bacterial , Patients' Rooms/standards , Clostridium Infections/epidemiology , Cross-Over Studies , Disinfectants/administration & dosage , Female , Humans , Male , Middle Aged , Quaternary Ammonium Compounds/administration & dosage , Sodium Hypochlorite/administration & dosage , Ultraviolet Rays , United States/epidemiology
Cross Infection/transmission , Dermatomycoses/transmission , Equipment Contamination , Immunocompromised Host , Laundry Service, Hospital , Mucormycosis/transmission , Rhizopus , Cross Infection/diagnosis , Cross Infection/immunology , Cross Infection/prevention & control , Dermatomycoses/diagnosis , Dermatomycoses/immunology , Dermatomycoses/prevention & control , Fomites , Humans , Infection Control , Intensive Care Units , Mucormycosis/diagnosis , Mucormycosis/immunology , Mucormycosis/prevention & control , Retrospective Studies , Rhizopus/isolation & purification