Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-09T21:50:30.216Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluating a New Paradigm for Comparing Surface Disinfection in Clinical Practice

Published online by Cambridge University Press:  10 May 2016

Philip C. Carling ,
Jennifer Perkins ,
JoAnn Ferguson  and
Anita Thomasser
Philip C. Carling*
Affiliation:
Carney Hospital and Boston University School of Medicine, Boston, Massachusetts
Jennifer Perkins
Affiliation:
Maple Grove Hospital, Maple Grove, Minnesota
JoAnn Ferguson
Affiliation:
Maple Grove Hospital, Maple Grove, Minnesota
Anita Thomasser
Affiliation:
Ecolab, St. Paul, Minnesota
*
Carney Hospital, 2100 Dorchester Avenue, Dorchester, MA 02124 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Despite an increasing understanding of the importance of near-patient surfaces in the transmission of healthcare-associated pathogens, there remains a need to define the relative clinical effectiveness of disinfection interventions

Design.

A serial 2-phase evaluation of the clinical effectiveness of 2 surface disinfectants.

Setting.

A general acute care hospital.

Methods.

A unique system for quantifying bioburden reduction while monitoring the possible impact of differences in cleaning thoroughness was used to compare the clinical effectiveness of a traditional quaternary ammonium compound (QAC) and a novel peracetic acid/hydrogen peroxide disinfectant (ND) as part of terminal room cleaning.

Results.

As a result of QAC cleaning, 93 (40%) of 237 cleaned surfaces confirmed by fluorescent marker (DAZO) removal were found to have complete removal of aerobic bioburden. During the ND phase of the study, bioburden was removed from 211 (77%) of 274 cleaned surfaces. Because there was no difference in the thoroughness of cleaning with either disinfectant (65.3% and 66.4%), the significant (P > .0001) difference in bioburden reduction can be attributed to better cleaning efficacy with the ND.

Conclusions.

In the context of the study design, the ND was 1.93 times more effective in removing bacterial burden than the QAC (P > .0001). Furthermore, the study design represents a new research paradigm in which 2 interventions can be compared by concomitantly and objectively analyzing both the product and process variables in a manner that can be used to define the relative effectiveness of all disinfection cleaning interventions.

Infect Control Hosp Epidemiol 2014;35(11):1349–1355

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 11 , November 2014 , pp. 1349 - 1355
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Dancer, SJ. Control of transmission of infection in hospitals requires more than clean hands. Infect Control Hosp Epidemiol 2010;31(9):958–960.Google Scholar
2. Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687–699.CrossRefGoogle ScholarPubMed
3. Donskey, CL. Does improved disinfection reduce healthcare-associated infections? Am J Infect Control 2013;41(5 suppl):S12–S19.Google Scholar
4. Webber, D, Rutala, W. Understanding and preventing transmission of healthcare associated pathogens due to the contaminated hospital environment. Infect Control Hosp Epidemiol 2013;34:449–452.Google Scholar
5. Carling, PC, Huang, SS. Improving healthcare environmental cleaning in disinfection: current and evolving issues. Infect Control Hosp Epidemol 2013;34(5):507–513.Google Scholar
6. Rutala, WA, Weber, DJ. Guideline for disinfection and sterilization in healthcare facilities, 2008. Atlanta: Centers for Disease Control and Prevention, 2008. http://www.cdc.gov/hicpac/Disinfection_Sterilization/3_4surfaceDisinfection.html. Accessed March 10, 2014.Google Scholar
7. Guh, A, Carling, PC; the Environmental Evaluation Workgroup. Options for evaluating environmental cleaning. Atlanta: Centers for Disease Control and Prevention, 2010. http://www.cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html Accessed March 10, 2014.Google Scholar
8. Carling, PC, Parry, MM, Rupp, ME, Po, JL, Dick, B, Von Beheren, S. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29(11):1035–1041.CrossRefGoogle ScholarPubMed
9. AORN. Recommended practices for environmental cleaning. In: 2013 Perioperative Standards and Recommended Practices. Denver: AORN, 2013.Google Scholar
10. Carling, PC. Methods for assessing the adequacy of practice and improving room disinfection. Am J Infect Control 2013;41(suppl):S20–S25.Google Scholar
11. Rupp, ME, Fizgerald, T, Sholtz, L, Lyden, E, Carling, PC. Maintaining the gain: program to sustain improvement in environmental cleaning. Infect Control Hosp Epidemiol 2014;35(7):866–868.Google Scholar
12. Wolkewitz, M, Barnett, AG, Palomar Martinez, M, Frank, U, Schumacher, M. Interventions to control nosocomial infections: study designs and statistical issues. J Hosp Infection 2014;86(2):77–82.Google Scholar
13. McDonnell, GE. Chemical disinfection. In: Antisepsis, Disinfection and Sterilization . Washington DC: American Society of Microbiology Press, 2007:115–130, 140–144.Google Scholar
14. Dancer, SJ, White, L, Robertson, C. Monitoring environmental cleaning on two surgical wards. Int J Environ Health Res 2007;18:357–364.CrossRefGoogle Scholar
15. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42(11):1552–1560.Google Scholar
16. Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29(7):593–599.CrossRefGoogle ScholarPubMed
17. Sitzlar, B, Deshpande, A, Fertelli, D, Kundrapu, S, Sethi, A, Donskey, C. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile in isolation rooms. Infect Control Hosp Epidemiol 2013;34(5):459–465.CrossRefGoogle ScholarPubMed
18. Strassle, P, Thom, K, Johnson, JK, et al. The effect of terminal cleaning on environmental contamination rates of multidrug-resistant Acenitobacter baumanii . Am J Infect Control 2012;40:1005–1007.Google Scholar
19. Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:10–15.Google Scholar
20. Dancer, SJ. Hospital cleaning in the 21st century. Eur J Coin Microbiol Infect Dis 2011;30:1473–1481.Google Scholar
21. Carling, PC, Bartley, JM. Evaluating hygienic cleaning in healthcare settings: what you do not know can harm your patients. Am J Infect Control 2010;38:S41–S50.CrossRefGoogle Scholar
22. Humphries, H. Self-disinfecting in microbicide-impregnated surfaces and fabrics: what potential in interrupting the spread of healthcare-associated infection? Clin Infect Dis 2014;58:848–853.Google Scholar
23. Moore, G, Smyth, D, Singleton, J, Wilson, P. The use of adenosine triphosphate bioluminescence to assay the efficacy of a modified cleaning program implemented within an intensive care setting. Am J Infect Control 2010;38:617–622.CrossRefGoogle ScholarPubMed
24. Loveday, HP, Wilson, JA, Pratt, RJ, et al. Epic 3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014:86(supplement 1):S1–S70.CrossRefGoogle Scholar
25. White, LF, Dancer, SJ, Robertson, C, McDonald, J. Are hygiene standards useful in assessing infection risk? Am J Infect Control 36;5:381–384.Google Scholar
26. Dancer, SJ, White, LF, Lamb, J, Girvan, EK, Robertson, C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009;7:28:1–12.CrossRefGoogle Scholar
27. Sherlock, O, O’Connell, N, Craemer, E, Humphreys, H. Is it really clean? an evaluation of the efficacy of four methods for determining hospital cleanliness. J Hosp Infect 2009;72:140–146.Google Scholar
28. Al-Hamad, A, Maxwell, S. How clean is clean? proposed methods for hospital cleaning assessment. J Hosp Infect 2008;70(40):328–334.Google Scholar
29. Boyce, JM, Havill, NL, Havill, HL, Magione, E, Dumigan, TG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32(12):1187–1193.Google Scholar
30. Mulvey, D, Redding, P, Robertson, C, et al. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011;77:25–30.Google Scholar
31. Boyce, JM, Havill, NL, Dumigan, TG, Golebiewski, M, Balogun, O, Rizvani, R. Monitoring the effectiveness of hospital cleaning practices using an ATP bioluminescence assay. Infect Control Hosp Epidemiol 2009;30:988–999.Google Scholar
32. Kuhn, TS. The Structure of Scientific Revolutions. 2nd ed. Chicago: University of Chicago Press, 1970.Google Scholar
33. McDonald, LC, Arduino, M. Climbing the evidentiary hierarchy for environmental infection control. Clin Infect Dis 2013;56(1):36–39.Google Scholar