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!
I gave a webinar last week for 3M (you can download my slides here) on “Your hospital room can make you sick: How improved cleaning and disinfection can help”. I asked the audience what they were doing to improve cleaning and disinfection, and thought I would share the findings. I don’t know the exact size of the audience (but it’s usually a couple of hundred mainly US based IPC folks), and the audience were allowed to choose any answers that applied to them for the second two questions.
In this era of increasing patient choice, let’s imagine you were offered the choice between two identical looking hospital rooms. Your chances of picking up a multidrug-resistant organism (MDRO) are approximately doubled if you choose the wrong room. But you have no way of knowing which room is safest.
So what explains this lottery? The key information you have not been told is the MDRO status of the previous room occupants. One of the rooms was previously occupied by a patient with C. difficile, and if you choose this room, your risk of developing C. difficile infection doubles. And it’s not just C. difficile – this same association has been demonstrated for MRSA, VRE, Acinetobacter baumannii and Pseudomonas aeruginosa. Underpinning this association is the uncomfortable fact that cleaning and disinfection applied at the time of patient discharge is simply not good enough to protect the incoming patient.