Reduction in Acquisition of Vancomycin-Resistant Enterococcus after Enforcement of Routine Environmental Cleaning Measures
Mary K. Hayden,Marc J. M. Bonten,Donald Blom,Elizabeth A. Lyle,David A. M. C. van de Vijver,Robert A. Weinstein +5 more
TLDR
Investigating the effects of improved environmental cleaning with and without promotion of hand hygiene adherence on the spread of vancomycin-resistant enterococci as a marker organism found decreased in period 2 and remained low thereafter, suggesting decreasing environmental contamination may help to control thespread of some antibiotic-resistant bacteria in hospitals.Abstract:
Background The role of environmental contamination in nosocomial cross-transmission of antibiotic-resistant bacteria has been unresolved. Using vancomycin-resistant enterococci (VRE) as a marker organism, we investigated the effects of improved environmental cleaning with and without promotion of hand hygiene adherence on the spread of VRE in a medical intensive care unit. Methods The study comprised a baseline period (period 1), a period of educational intervention to improve environmental cleaning (period 2), a "washout" period without any specific intervention (period 3), and a period of multimodal hand hygiene intervention (period 4). We performed cultures for VRE of rectal swab samples obtained from patients at admission to the intensive care unit and daily thereafter, and we performed cultures of environmental samples and samples from the hands of health care workers twice weekly. We measured patient clinical and demographic variables and monitored intervention adherence frequently. Results Our study included 748 admissions to the intensive care unit over a 9-month period. VRE acquisition rates were 33.47 cases per 1000 patient-days at risk for period 1 and 16.84, 12.09, and 10.40 cases per 1000 patient-days at risk for periods 2, 3, and 4, respectively. The mean (+/-SD) weekly rate of environmental sites cleaned increased from 0.48+/-0.08 at baseline to 0.87+/-0.08 in period 2; similarly high cleaning rates persisted in periods 3 and 4. Mean (+/-SD) weekly hand hygiene adherence rate was 0.40+/-0.01 at baseline and increased to 0.57+/-0.11 in period 2, without a specific intervention to improve adherence, but decreased to 0.29+/-0.26 in period 3 and 0.43+/-0.1 in period 4. Mean proportions of positive results of cultures of environmental and hand samples decreased in period 2 and remained low thereafter. In a Cox proportional hazards model, the hazard ratio for acquiring VRE during periods 2-4 was 0.36 (95% confidence interval, 0.19-0.68); the only determinant explaining the difference in VRE acquisition was admission to the intensive care unit during period 1. Conclusions Decreasing environmental contamination may help to control the spread of some antibiotic-resistant bacteria in hospitals.read more
Citations
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Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: recognition and prevention in intensive care units.
Michael Y. Lin,Mary K. Hayden +1 more
TL;DR: The evidence for these interventions to help ICU personnel better control MRSA and VRE in their units is reviewed, such as daily chlorhexidine bathing of all patients in the ICU.
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The stethoscope and healthcare-associated infection: a snake in the grass or innocent bystander?
N. O'Flaherty,L. Fenelon +1 more
TL;DR: In this paper, the authors evaluated the available literature as to the role of the stethoscope in the development of healthcare-associated infection (HCAI) and concluded that stethoscopes should be decontaminated between patients.
Journal ArticleDOI
Rapid control of an outbreak of vancomycin-resistant enterococci in a French university hospital.
Jean-Christophe Lucet,Laurence Armand-Lefevre,J.-J. Laurichesse,A. Macrez,E. Papy,R. Ruimy,C. Deblangy,A. Lozach,I. Lolom,Vincent Jarlier,Antoine Andremont,C. Leport +11 more
TL;DR: An aggressive, co-ordinated, multifaceted strategy was successful in halting a widespread VRE outbreak in this hospital, prompting efforts to eradicate the organism.
Journal ArticleDOI
Proactive Approach for Safe Use of Antimicrobial Coatings in Healthcare Settings: Opinion of the COST Action Network AMiCI.
Merja Ahonen,Anne Kahru,Anne Kahru,Angela Ivask,Kaja Kasemets,Siiri Kõljalg,Paride Mantecca,Ivana Vinković Vrček,Minna M. Keinänen-Toivola,Francy R.L. Crijns +9 more
TL;DR: Attention is drawn on nanomaterial-based antimicrobial surfaces in frequently-touched areas in healthcare settings and the potential of these nano-enabled coatings to induce (eco)toxicological hazard and antimicrobial resistance.
Iconography : Spread of bacteria on surfaces when cleaning with microfibre cloths
TL;DR: Although there was an overall reduction in bacterial counts on the contaminated surface, bacteria were spread to subsequently cleaned surfaces, suggesting that the premoistened microfibre cloth method may spread bacteria.
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