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
More filters
Journal ArticleDOI
Best practices in disinfection of noncritical surfaces in the health care setting: Creating a bundle for success
TL;DR: In this paper, the authors focus on environmental cleaning and improving its efficacy by creating and sustaining a successful cleaning and disinfection program using a bundle approach and require ongoing commitment within the institution.
Journal ArticleDOI
A Multicenter Randomized Trial to Determine the Effect of an Environmental Disinfection Intervention on the Incidence of Healthcare-Associated Clostridium difficile Infection.
Amy J. Ray,Abhishek Deshpande,Dennis Fertelli,Brett Sitzlar,Priyaleela Thota,Thriveen Sankar C,Annette L. Jencson,Jennifer L. Cadnum,Robert A. Salata,Richard R. Watkins,Ajay K. Sethi,Philip Carling,Brigid Wilson,Curtis J. Donskey +13 more
TL;DR: An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI, suggesting interventions that focus only on improving cleaning may not be sufficient to control healthcare- associated CDI.
Journal ArticleDOI
Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis
TL;DR: Use of HP disinfection led to a decrease in residual MRSA contamination in patient rooms compared with detergent, and may also have encouraged the reduction in patient MRSA acquisition.
Journal ArticleDOI
New approaches to decontamination of rooms after patients are discharged.
TL;DR: Hydrogen peroxide vapor has been used for decontamination in the pharmaceutical industry for more than a decade and has recently been used in healthcare facilities, and the contamination of US government buildings with the anthrax bacillus in 2001 generated new interest in methods forDecontaminating rooms and other large spaces in buildings.
Journal ArticleDOI
An integrative review of infection prevention and control programs for multidrug-resistant organisms in acute care hospitals: a socio-ecological perspective.
TL;DR: The overall evidence does support the use of multiple interventions to reduce the rates of MDRO in acute care hospitals, and there is a clear suggestion that multiple simultaneous interventions can be effective in reducing MDRo infections.
References
More filters
Journal ArticleDOI
APACHE II: a severity of disease classification system.
TL;DR: The form and validation results of APACHE II, a severity of disease classification system that uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status, are presented.
Journal ArticleDOI
APACHE II--a severity of disease classification system.
Journal ArticleDOI
Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
John M. Boyce,Didier Pittet +1 more
TL;DR: The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis and provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health- Care settings.
Journal ArticleDOI
Effectiveness of a hospital-wide programme to improve compliance with hand hygiene
Didier Pittet,Stéphane Hugonnet,Stéphan Juergen Harbarth,Philippe Mourouga,V Sauvan,Sylvie Touveneau,Thomas V. Perneger +6 more
TL;DR: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission, and the promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
Journal ArticleDOI
SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus.
Carlene A. Muto,John A. Jernigan,Belinda E. Ostrowsky,Hervé Richet,William R. Jarvis,John M. Boyce,Barry M. Farr +6 more
TL;DR: Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC's long-recommended contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, dose gradient, and specificity for control with this approach.