I’ve been struggling for years to find the best ‘catch-all’ term to describe hospital cleaning or disinfection or both. And, after much thought, I’ve settled on a proposal to share with you, dear reader: “environmental hygiene”.
Have you ever wondered how on earth vegetative bacteria can survive on dry surfaces for years? Or why when you have an outbreak and you swab the environment you don’t find the outbreak strain even though you’re pretty sure it’s there? Or why a disinfectant that gets a 4-log reduction in the lab can’t eliminate a couple of hundred cfu of bacteria from a dry surface? Dry surface biofilms could be the answer to all these questions! I was involved in a multicentre survey of dry biofilms from across the UK, and we identified dry surface biofilms on 95% of the 61 samples there were tested. Worryingly, viable MRSA was identified on 58% of the surfaces! We need to think carefully about how much of a risk dry surface biofilms present, and whether we need to do more to tackle them.
Marc recently posted about the second clinical outcome findings from the BETR-D study, recently published in the Lancet Infectious Diseases. Marc contended that the team may have been ‘blinded by the [UV] light’ in reaching the conclusion that enhanced terminal room disinfection led to a hospital wide reduction in acquisition of key pathogens. Here, in the spirit of healthy academic debate, I offer another perspective.
Today was the inaugural Healthcare Cleaning Forum. The plan was to showcase some healthcare cleaning and disinfection science at the Interclean Conference in Amsterdam (which is a huge general cleaning show). I think we managed to create some awareness about the unique challenges of cleaning and disinfection in healthcare outside of the usual crowd.
Curtis Donskey’s group recently published a multicentre randomised trial in 16 US hospitals to evaluate the impact of an enhanced cleaning programme (including fluoruescent markers, environmental cultures, and feedback to cleaners) on the transmission of C. difficile. The intervention resulted in an increase in the removal of fluorescent markers, a reduction in environmental contamination with C. difficile, but no reduction in healthcare-associated CDI!
See below details of a survey that you may find interesting to complete. I had a small role in providing some feedback on an earlier version of this survey and I hope it will serve to highlight areas that require more thought and / or research…
On behalf of the International Society of Chemotherapy (ISC) working group on Infection Prevention we would be grateful if you could complete this anonymous survey.
Thought I’d share some key points from the 2016 HIS Spring Meeting.
Outlining the problem(s)
Prof Gary French kicked off the meeting with a (sic) historical perspective, describing how the perceived importance of the environment in transmission has oscillated from important (in the 40s and 40s) to unimportant in the 70s and 80s to important again in the 2000s. Gary cited a report from the American Hospital Association Committee on Infections Within Hospitals from 1974 to prove the point: ‘The occurrence of nosocomial infection has not been related to levels of microbial contamination of air, surfaces and fomites … meaningful standards for permissible levels of such contamination do not exist.’ Gary covered compelling data that contaminated environmental surfaces make an important contribution to the transmission of Gram-positive bacteria and spores, highlighting that C. difficile in particular is a tricky customer, not helped by the fact that many ‘sporicides’ are not sporicidal!