Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-28T15:07:38.722Z Has data issue: false hasContentIssue false
  • English
  • Français

Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions

Published online by Cambridge University Press:  10 May 2016

Sean L. Barnes ,
Daniel J. Morgan ,
Anthony D. Harris ,
Phillip C. Carling  and
Kerri A. Thom
Sean L. Barnes*
Affiliation:
Robert H. Smith School of Business, University of Maryland, College Park, Maryland
Daniel J. Morgan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Phillip C. Carling
Affiliation:
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
Kerri A. Thom
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
University of Maryland, College Park, MD 20742 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Extract

Objective

Hand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation.

Methods

We developed an agent-based model of patient-to-patient transmission—via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms—in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and observed data to inform model input parameters.

Results

We simulated 175 parameter-based scenarios and compared the effects of hand hygiene and environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline, a 2∶1 improvement in terminal cleaning compared with hand hygiene was required to match an equal reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the reduction in acquisition due to a 10% improvement in hand hygiene compliance).

Conclusions

Hand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.

Infect Control Hosp Epidemiol 2014;35(9):1156-1162

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1156 - 1162
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. Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States. Atlanta: CDC, 2013.Google Scholar
2. World Health Organization (WHO). WHO Guidelines on Hand Hygiene in Health Care. Geneva: WHO, 2009.Google Scholar
3. Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39(8):1182–1189.Google ScholarPubMed
4. Morgan, DJ, Rogawski, E, Thom, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40(4):1045–1051.Google Scholar
5. Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166(18):1945–1951.CrossRefGoogle ScholarPubMed
6. Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011;17(8):1201–1208.Google Scholar
7. Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol 2008;29(2):149–154.Google Scholar
8. Erasmus, V, Daha, TJ, Brug, H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31(3):283–294.CrossRefGoogle ScholarPubMed
9. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310(15):1571–1580.Google ScholarPubMed
10. Derde, LP, Cooper, BS, Goossens, H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014;14(1):31–39.Google Scholar
11. Carling, P. Methods for assessing the adequacy of practice and improving room disinfection. Am J Infect Control 2013;41(suppl 5):S20–S25.Google Scholar
12. Wilensky, U. NetLogo. Evanston, IL: Center for Connected Learning and Computer-Based Modeling, Northwestern University, 1999.Google Scholar
13. Girou, E, Loyeau, S, Legrand, P, Oppein, F, Brun-Buisson, C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ 2002;325:362.Google Scholar
14. Hornbeck, T, Naylor, D, Segre, AM, Thomas, G, Herman, T, Polgreen, PM. Using sensor networks to study the effect of peripatetic healthcare workers on the spread of hospital-associated infections. J Infect Dis 2012;206(10):1549–1557.Google Scholar
15. Datta, R, Platt, R, Yokoe, DS, Huang, SS. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med 2011;171(6):491–494.CrossRefGoogle ScholarPubMed
16. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37(6):1858–1865.Google Scholar
17. Huskins, WC, Huckabee, CM, O’Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364(15):1407–1418.Google Scholar
18. Morgan, DJ, Pineles, LL, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;31(1):69–73.CrossRefGoogle Scholar
19. 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.CrossRefGoogle ScholarPubMed
20. Carling, PC, Parry, MM, Rupp, ME, et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29(11):1035–1041.CrossRefGoogle ScholarPubMed
21. 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.Google Scholar