Interaction of healthcare worker hands and portable medical equipment: a sequence analysis to show potential transmission opportunities.

BACKGROUND: While research has demonstrated the importance of a clean health care environment, there is a lack of research on the role portable medical equipment (PME) play in the transmission cycle of healthcare-acquired infections (HAIs). This study investigated the patterns and sequence of contact events among health care workers, patients, surfaces, and medical equipment in a hospital environment. METHODS: Research staff observed patient care events over six different 24 h periods on six different hospital units. Each encounter was recorded as a sequence of events and analyzed using sequence analysis and visually represented by network plots. In addition, a point prevalence microbial sample was taken from the computer on wheels (COW). RESULTS: The most touched items during patient care was the individual patient (850), bedrail (375), bed-surface (302), and bed side Table (223). Three of the top ten most common subsequences included touching PME and the patient: computer on wheels ➔ patient (62 of 274 total sequences, 22.6%, contained this sequence), patient ➔ COW (20.4%), and patient ➔ IV pump (16.1%). The network plots revealed large interconnectedness among objects in the room, the patient, PME, and the healthcare worker. CONCLUSIONS: Our results demonstrated that PME such as COW and IV pump were two of the most highly-touched items during patient care. Even with proper hand sanitization and personal protective equipment, this sequence analysis reveals the potential for contamination from the patient and environment, to a vector such as portable medical equipment, and ultimately to another patient in the hospital.

Efficacy of pulsed-xenon ultraviolet light on reduction of Mycobacterium fortuitum.

OBJECTIVES: Hospitals and healthcare facilities rely largely on isolation and environmental disinfection to prevent transmission of pathogens. The use of no-touch technology is an accepted practice for environmental decontamination in medical care facilities, but little has been published about the effect of ultraviolet light generated by a portable pulsed-xenon device use on Mycobacteria. We used Mycobacterium fortuitum which is more resistant to ultraviolet radiation and less virulent than Mycobacterium tuberculosis, to determine the effectiveness of portable pulsed-xenon devices on Mycobacterium in a laboratory environment. METHODS: To determine the effectiveness of pulsed-xenon devices, we measured the bactericidal effect of pulsed-xenon devices on Mycobacterium fortuitum. RESULTS: In five separate experiments irradiating an average of 106 organisms, the mean (standard deviation) log-kill at 5 min was 3.98 (0.60), at 10 min was 4.96 (0.42), and at 15 min was 5.64 (0.52). CONCLUSIONS: Our results demonstrate that using pulsed-xenon devices is a highly effective modality to reduce microbial counts with this relatively ultraviolet germicidal irradiation-resistant mycobacterium in a time-dependent manner.

Use of Ultraviolet Irradiation in Addition to Commonly Used Hospital Disinfectants or Cleaners Further Reduces the Bioburden on High-Touch Surfaces.

BACKGROUND: The reduction in microbial bioburden achieved by terminal disinfection in a hospital may vary considerably by type of disinfectant or cleaner and by environmental service (EVS) personnel. This study estimated whether supplemental ultraviolet (UV) irradiation after disinfection or cleaning reduced bioburden and whether the supplemental effect persisted after adjusting for disinfectant or cleaner type and EVS personnel. METHODS: Environmental samples for aerobic bacterial colonies (ABC) and methicillin-resistant Staphylococcus aureus (MRSA) were obtained from 5 high-touch surfaces in patient rooms at 3 time points: before manual cleaning, after manual cleaning using 1 of 3 disinfectants or 1 cleaner, and after UV irradiation. RESULTS: For ABC, the model-estimated mean (95% uncertainty interval) counts were 56% (48%-63%) lower for postmanual + UV compared with manual clean alone, and for MRSA they were 93% (62%-99%) lower for postmanual + UV vs manual clean alone. CONCLUSIONS: Although UV supplementation provides incremental benefit in bioburden reduction across all cleaners or disinfectants tested, it provides the greatest benefit when supplementing cleaners or disinfectants with the lowest disinfection properties. UV irradiation provides additional bioburden reduction to manual cleaning or disinfection, even when accounting for variability introduced by different disinfectants and EVS personnel.

Self-sanitizing copper-impregnated surfaces for bioburden reduction in patient rooms.

Novel self-sanitizing copper oxide-impregnated solid surfaces have the potential to influence bioburden levels, potentially lowering the risk of transmission of pathogens in patient care environments. Our study showed persistently lower microbial burden over a 30-hour sampling period on a copper-impregnated tray table compared with a standard noncopper surface in occupied patient rooms after thorough initial disinfection.

Origin of methicillin-resistant Staphylococcus aureus health care-associated infections: evaluation of the role of anterior nares.

Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a cause of extended hospitalizations and escalating health care costs. We typed 49 MRSA HAIs and their corresponding admission nasal MRSA isolates to determine strain-relatedness and better define the role of anterior nares in the causation of HAI and the value of decolonization. Based on repetitive extragenic palindromic sequencing polymerase chain reaction results, the majority of our patients possibly acquired MRSA HAI from nonnasal sources (36 out of 49; 74%). Among the remaining patients (13 out of 49; 26%) the nasal and clinical HAI isolates matched, indicating potential benefit of decolonization among this subsegment of patients. These findings may be relevant to institutions such as Veterans Health Administration hospitals that already have universal screening programs but are looking at ways to further reduce MRSA HAI incidence.

Comparison of Environmental MRSA Levels on High-Touch Surfaces in Contact Isolation and Noncontact Isolation Patient Rooms.

Environmental samples were collected from 100 hospital rooms, 32 noncontact rooms, and 68 contact isolation rooms. We isolated 202 and 1,830 MRSA colonies in noncontact and contact isolation rooms, respectively. The study identified MRSA isolates in hospital rooms of patients without colonization or infection with MRSA. Infect. Control Hosp. Epidemiol. 2015;36(12):1472-1475.

Is the pulsed xenon ultraviolet light no-touch disinfection system effective on methicillin-resistant Staphylococcus aureus in the absence of manual cleaning?

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has been shown to survive on ambient surfaces for extended periods of time. Leftover MRSA environmental contamination in a hospital room places future patients at risk. Manual disinfection supplemented by pulsed xenon ultraviolet (PX-UV) light disinfection has been shown to greatly decrease the MRSA bioburden in hospital rooms. However, the effect of PX-UV in the absence of manual disinfection has not been evaluated. METHODS: Rooms that were previously occupied by a MRSA-positive patient (current colonization or infection) were selected for the study immediately postdischarge. Five high-touch surfaces were sampled, before and after PX-UV disinfection, in each hospital room. The effectiveness of the PX-UV device on the concentration of MRSA was assessed employing a Wilcoxon signed-rank test for all 70 samples with MRSA in 14 rooms, as well as by surface location. RESULTS: The final analysis included 14 rooms. Before PX-UV disinfection there were a total of 393 MRSA colonies isolated from the 5 high-touch surfaces. There were 100 MRSA colonies after disinfection by the PX-UV device and the overall reduction was statistically significant (P < .01). CONCLUSIONS: Our study results suggest that PX-UV light effectively reduces MRSA colony counts in the absence of manual disinfection. These findings are important for hospital and environmental services supervisors who plan to adapt new technologies as an adjunct to routine manual disinfection.

Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection?

Whereas pulsed xenon-based ultraviolet light no-touch disinfection systems are being increasingly used for room disinfection after patient discharge with manual cleaning, their effectiveness in the absence of manual disinfection has not been previously evaluated. Our study indicates that pulsed xenon-based ultraviolet light systems effectively reduce aerobic bacteria in the absence of manual disinfection. These data are important for hospitals planning to adopt this technology as adjunct to routine manual disinfection.