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
Reservoirs of Pathogens Causing Health Care-Associated Infections in the 21st Century: Is Renewed Attention to Inanimate Surfaces Warranted?
TL;DR: This article reviews the accumulated evidence and highlights newer approaches for prevention that include renewed investigation of disinfectant fogging, methods to enhance environmental hygiene, selection of surface materials, and even application of antimicrobials to surfaces in the patient care setting.
Journal ArticleDOI
The Role of the Hospital Environment in the Prevention of Healthcare-Associated Infections by Contact Transmission:
James P. Steinberg,Megan E. Denham,Craig Zimring,Altug Kasali,Kendall K. Hall,Jesse T. Jacob +5 more
TL;DR: The role of the hospital environment in the spread of pathogens by direct and indirect contact is described and the prevention of transmission through interventions involving the built environment is discussed.
Journal ArticleDOI
Integral Control of Health Hazards in Hospital Environment
Mateja Dovjak,Andreja Kukec,Živa Kristl,Mitja Košir,Marjan Bilban,Masanori Shukuya,Aleš Krainer +6 more
TL;DR: An innovative low exergy (LowEx) system was designed and tested and enables individual control of thermal comfort parameters to meet the needs of various users in the same room to classify health hazards specific to the hospital environment.
Journal ArticleDOI
Intensive care unit environments and the fecal patina: a simple problem?
TL;DR: In a single-site, six-ICU study, Morgan and colleagues examine the relative risk of transfer of these MDROs to healthcare workers’ gloves, gowns, and hands after entry into rooms of colonized or infected patients and suggests the environment as an important driver of spread of VRE.
Journal ArticleDOI
Small distances can keep bacteria at bay for days
Bram A. D. van Bunnik,Bram A. D. van Bunnik,Amos Ssematimba,Thomas J. Hagenaars,Gonnie Nodelijk,Manon R. Haverkate,Marc J. M. Bonten,Mary K. Hayden,Robert A. Weinstein,Martin C. J. Bootsma,Mart C.M. de Jong +10 more
TL;DR: The impact of control strategies against indirect transmission can be assessed using the model by estimating the control measures’ effects on the diffusion coefficient and the pathogen decay rate, implying that for control of an infectious agent, the time between the distant exposure and the infection event is important.
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.