Robert Weinstein estimated that the source of pathogens causing a healthcare-associatedinfection in the intensive care unit was as follows:
patients’ endogenous flora, 40%–60%;
incl. antibiotic-driven changes in flora;
cross infection via the hands of personnel, 20%–40%;
other (incl. environment): 20%.
Brandt et al, Ann Surg 2008; 248:695-700.
63 surgical departments participating in KISS
>99.000 operations
Turbulent + HEPA versus laminar airflow + HEPA
Multivariate analyis to comtrol for other factors influencingoutcome (SSI)
Brandt et al, Ann Surg 2008; 248:695-700.
Follow-up study taking in account the size of the LAF plenum shows no difference in outcome
Mycobacteria & endoscope
reprocessing
Legionella and aerosols
Nonfermenters (especially Pseudo-
monas & Acinetobacter) in sinks &
ventilators
Molds in hematology units
C. difficile , VRE, MRSA 103 to 109 CFUs/g in stoolNorovirus 1012 particles/g
Environment is generally <10 organisms per cm2
The infectious dose for most environmentally
associated nosocomial pathogens appears to
be low.
Less than 15 S. aureus cells were sufficient to
cause infection in experimental lesions,
Less than 1 CFU/cm2 was sufficient to cause
C. difficile disease in mice
A single norovirus particle is thought to have the
capacity to cause infection
Otter et al ICHE july 2011, vol. 32, no. 7
Contact with hospital room surfaces or medical
equipment by healthcare personnel frequently
leads to contamination of hands and/or gloves.
Weber & ICHE may 2013, vol. 34, no. 5
Improved environmental cleaning has led to
reduced risk of VRE and C. difficile transmission.
Admission to a room previously occupied by a
patient with MRSA, VRE, Acinetobacter, or C.
difficile increases the risk for the subsequent
patient admitted to the room to acquire the
pathogen
Weber & ICHE may 2013, vol. 34, no. 5
Huslage et al. Infect Control Hosp Epidemiol 2010; 31(8):850-853
Obviously all should be clean,but high-touch really needs to be!
Thom et al. Infect Control Hosp Epidemiol 2014;35:1060-62
MSDS Poly spray (silicone quaternary amine)
8 surfaces
sink, call button, bedside table, monitor,
telephone, supply cart, door handle, floor
Results:
No significant effect on environmental
contamination
Thom et al. Infect Control Hosp Epidemiol 2014;35:1060-62
Problem adherence?
Love the concept of changing the surface
Studies with copper, silver silica, Biosafe HM
4100 (polymer) embedded in polyurethane,
light-activated antimicrobials, … have worked
before
Freeman et al. Antimicrobial Resistance and Infection Control 2014, 3:5
Rooms of patients with ESBL-KP have substantially highercontamination rates than those with ESBL-EC. This finding mayhelp explain the apparently higher transmissibility of ESBL-KP in the hospital setting
Kampf et al. BMC Infect Dis 2014;14:37
Reusable tissue dispensers with different surface
disinfectants were randomly collected from
healthcare facilities.
66 dispensers containing disinfectant solutions
with surface-active ingredients were collected in
15 healthcare facilities. 28 dispensers from nine
healthcare facilities were contaminated
In none of the hospitals dispenser processing had
been adequately performed
… it is not about the details of this paper, but the point that even
“helpful parts of the environment” may be a source for infections
Roomservice
Roomservice-plus
Registered nurse
Nurse asistant
Cleaning
Even if you think youknow it, are theyactually doing it?
Highest rate of mannequin contamination was long sleeves + tie (transmission occurred in 4/5 experiments) and lowest withshort sleeves no tie (0/5).
> >
Weber et al. J Hosp Infect 2012;80:252-4
Eli: “flaw in this study was that ties were narrowly defined as neckties and excluded bow ties”
Enter a solution to all of our infection control
problems: the Jumbo Squirting Bow Tie!
This often overlooked clothing accessory is a veritable
infection prevention dream.
A bow tie can increase our professionalism and limit
pathogen transmission.
Add in the "Jumbo Squirting" action and you can squirt
alcohol hand rub into the eyes of non-compliant clinicians
(operant conditioning) and also into your own hands to
improve compliance with the WHO 5 Moments.
http://haicontroversies.blogspot.nl