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
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Intensive care unit environmental surfaces are contaminated by multidrug-resistant bacteria in biofilms: combined results of conventional culture, pyrosequencing, scanning electron microscopy, and confocal laser microscopy
Honghua Hu,Khalid Johani,Khalid Johani,Iain B Gosbell,Iain B Gosbell,Anita Jacombs,Ahmad Almatroudi,Ahmad Almatroudi,Greg S. Whiteley,Anand K. Deva,Slade O. Jensen,Karen Vickery +11 more
TL;DR: Dry surface biofilms containing MDROs are found on ICU surfaces despite terminal cleaning with chlorine solution, and how these arise and how they might be removed requires further study.
Journal ArticleDOI
Vancomycin-resistant enterococci (VRE): transmission and control.
TL;DR: A scoring system using point values has been demonstrated to be useful in reducing rates of nosocomial VRE colonisation and overuse of antibiotics, and insensitive microbiological methods for detecting VRE in stool.
Journal ArticleDOI
Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention
Margaret M. Quinn,Paul K. Henneberger,Barbara I. Braun,George L. Delclos,Kathleen Fagan,Vanthida Huang,Jennifer S. Knaack,Linda Kusek,Soo-Jeong Lee,Nicole Le Moual,Kathryn A E Maher,Susan McCrone,Amber Hogan Mitchell,Elise Pechter,Kenneth D. Rosenman,Lynne Sehulster,Alicia C. Stephens,Susan Wilburn,Jan Paul Zock +18 more
TL;DR: An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention and a more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C &D in health care.
Journal ArticleDOI
Prevention of hospital-acquired infections: review of non-pharmacological interventions.
TL;DR: Multiple infection control techniques and strategies simultaneously (‘bundling’) may offer the best opportunity to reduce the morbidity and mortality toll of nosocomial infections.
Journal ArticleDOI
An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms.
Brett Sitzlar,Abhishek Deshpande,Dennis Fertelli,Sirisha Kundrapu,Ajay K. Sethi,Curtis J. Donskey +5 more
TL;DR: An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection.
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