Fighting MRSA in the Hospital Environment A new Approach
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Fighting MRSA in the Hospital Environment
A new Approach
MRSA Conference
July 30, 2007
Philip C. Carling, M.D.
Caritas Carney Hospital and Boston Medical Center
pcarling@cchcs.org
Is Disinfection Cleaning Important?
CDC Monitor (i.e., supervise and inspect)
cleaning performance to ensure consistent cleaning and disinfection of surfaces in close proximity to the patient and likely to be touched by the patient and health care Professionals (e.g. bedrails, carts, bedside commodes, doorknobs, faucet handles). Category 1B.
Management of MDROs in Healthcare Settings – October 2006 V.B.8.b.
IHI“Hospitals should use immediate
feedback mechanisms to assess cleaning and reinforce proper technique”
5 Million Lives Campaign – Guide to Significantly Reducing MRSA Infections
December 2006
How Important is the Environment in the Transmission
of MRSA?
Surface Contamination of Near-patient Environment
23 Studies
0
20
40
60
80
100
C. DIFFICILE VRE MRSA
% C
ON
TAM
INA
TED
How Important is the Environment in the Transmission of MRSA?
• MRSA Survives on Dry Surfaces for 90 to 236 days.
• Until we had PGFE fingerprinting there was no way to study this this issue.
• Reports over the past two years have now shown:A. More extensive environmental Contamination
of the near patient environment than older studies and
B. Patients contract strains from prior room occupants
How Well Do Environmental Disinfectants Work ?
How Well Does Environmental Disinfecting Work ?
• Phenolic Compounds
• Quartinary Amonium Compounds
• Chloride Disinfectants
• Formaldehyde
Kill a wide range of microbial
pathogens
Work Rapidly
Work effectively in clinical
settings
ALL
How Well Does Environmental Cleaning Work ?
Cleaning House: A New Metric in the Objective Evaluation of
Environmental Cleaning
GOAL OF THE PROJECT
To develop a surrogate marking system to evaluate the effectiveness of environmental cleaning/disinfection of the near-patient environment
The Targeting Solution
A mixture of several glues, soaps and a targeting dye which:
Dries rapidly
Environmentally stable
Readily wetted by spray disinfectants
Easily removed with light abrasion
Inconspicuous
Targeting Patient Rooms
Objects were chosen by considering sites
A. A patient was most likely to contaminate and B. A care givers may touch with their hands
Up to 14 objects marked in each room after terminal cleaning
Objects were evaluated after one to two patients had cycled through the room to see if targets had been removed by discharge cleaning activities
Environmental Cleaning Evaluation in Three hospitals
- A confidential evaluation without Environmental Services awareness was implemented- About 50 patient rooms / Hospital- Up to 14 objects marked when the room
was empty- Evaluated after patient had cycled through the room and it had been terminally cleaned
Preliminary Results – Three Hospitals
45 42
56
8682
92
0
20
40
60
80
100
% O
BJEC
TSCL
EANE
D
HOSPITAL A HOSPITAL CHOSPITAL B
Clinical Infectious Diseases – February 2006
Goals of the Multi-institutional Terminal Room Cleaning Project
To determine if:• The targeting methodology is appropriately
user friendly;• The thoroughness of cleaning at other
institutions is similar or different from what we had found to date;
• Cleaning can be improved using focused educational interventions and feedback to the ES staff using limited resources (time).
Health Care Environmental Hygiene Study Group – Acute Hospitals
MA = 6
RI = 5
RESULTS
The Program
Phase I
Covert Baseline Environmental Cleaning Evaluation
(The same as Previously described)
0
2
4
6
8
1-5% 11-15%
21-25%
31-35%
41-45%
51-55%
61-65%
71-75%
81-85%
91-95%
Baseline Environmental Evaluation of 20 Acute Care Hospitals
% of Objects Cleaned
Hos
pita
ls Mean = 48.3 %
PROPORTION OF OBJECTS CLEANED AS PART OF TERMINAL ROOM CLEANING IN 20 ACUTE CARE HOSPITALS
0
20
40
60
80
100
%
The Program
Phase I – Covert Baseline Environmental Evaluation
Phase II
A. Educational Interventions – ES Staff
B. Feedback to the ES – Staff
The Program
Phase I – Covert Baseline Environmental Evaluation
Phase II
A. Educational Interventions – ES Staff
B. Feedback to the ES – Staff
(frequently repeated)
Hospitals Environmental Hygiene Study Group20 Hospital Results
30
50
70
90
PRE INTERVENTION FOLLOWING EDUCATION FOLLOWING FEEDBACK
% o
f O
bjec
ts C
lean
ed
= Mean =/- 95% CI
Health Care Environmental Hygiene Study Group – Massachusetts Hospitals
• Caritas Carney Hospital – 2003• Quincy Medical Center – 2004• Rehabilitation Hospital of the
Cape and Islands – 2004• Braintree Hospital - 2004• Boston Medical Center – 2004• MWMC Natick Campus – 2005• Somerville Hospital – 2005• Brigham and Women's Hospital – 2006• Lahey Clinic – 2007• Shriner’s Burns Institute – 2007• Whidden Hospital – 2007• Mount Auburn Hospital - 2007
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