Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-14T04:31:04.176Z Has data issue: false hasContentIssue false
  • English
  • Français

An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms

Published online by Cambridge University Press:  02 January 2015

Brett Sitzlar ,
Abhishek Deshpande ,
Dennis Fertelli ,
Sirisha Kundrapu ,
Ajay K. Sethi  and
Curtis J. Donskey
Brett Sitzlar
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio
Abhishek Deshpande
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio
Dennis Fertelli
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio
Sirisha Kundrapu
Affiliation:
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Ajay K. Sethi
Affiliation:
Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
Curtis J. Donskey*
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
*
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (curtisdl23@yahoo.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning.

Design.

Prospective intervention.

Setting.

A Veterans Affairs hospital.

Interventions.

During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection.

Results.

The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P = .024), 48% (P>.001), and 89% (P = .006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively.

Conclusions.

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. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 5: Special Topic Issue: The Role of the Environment in Infection Prevention , May 2013 , pp. 459 - 465
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Bhalla, A, Pultz, NJ, Gries, DM, et al.Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.CrossRefGoogle ScholarPubMed
2.Guerrero, DM, Nerandzic, MM, Jury, LA, Jinno, S, Chang, S, Donskey, CJ. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. Am J Infect Control 2011;40:556–558.CrossRefGoogle ScholarPubMed
3.Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.Google Scholar
4.Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593–599.Google Scholar
5.Eckstein, BC, Adams, DA, Eckstein, EC, et al.Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.CrossRefGoogle ScholarPubMed
6.Carling, PC, Parry, MM, Rupp, ME, Po, JL, Dick, B, Von Beheren, S; Healthcare Environmental Hygiene Study Group. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:1035–1041.Google Scholar
7.Boyce, JM, Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32:1187–1193.CrossRefGoogle ScholarPubMed
8.Nerandzic, MM, Cadnum, JL, Pultz, MJ, Donskey, CJ. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. BMC Infect Dis 2010;10:197.CrossRefGoogle ScholarPubMed
9.Nerandzic, MM, Donskey, CJ. Triggering germination represents a novel strategy to enhance killing of Clostridium difficile spores. PLoS ONE 2010;5:e12285.CrossRefGoogle ScholarPubMed
10.Rutala, WA, Gergen, MF, Weber, DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol 2010;31:1025–1029.CrossRefGoogle ScholarPubMed
11.Boyce, JM, Havill, NL, Moore, BA. Terminal decontamination of patient rooms using an automated mobile UV light unit. Infect Control Hosp Epidemiol 2011;32:737–742.CrossRefGoogle ScholarPubMed
12.Havill, NL, Moore, BA, Boyce, JM. Comparison of the microbiological efficacy of hydrogen peroxide vapor and ultraviolet light processes for room decontamination. Infect Control Hosp Epidemiol 2012;33:507–512.CrossRefGoogle ScholarPubMed
13.Boyce, JM, Havill, NL, Otter, JA, et al.Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008;29:723–729.CrossRefGoogle Scholar
14.Nerandzic, MM, Donskey, CJ. Effective and reduced-cost modified selective medium for isolation of Clostridium difficile. J Clin Microbiol 2009;47:397–400.CrossRefGoogle ScholarPubMed
15.Lawley, TD, Clare, S, Deakin, LJ, et al.Use of purified Clostridium difficile spores to facilitate evaluation of health care disinfection regimens. Appl Environ Microbiol 2010;76:6895–6900.CrossRefGoogle ScholarPubMed
16.Alfa, MJ, Dueck, C, Olson, N, et al.UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol. BMC Infect Dis 2008;8:64.CrossRefGoogle Scholar
17.Boyce, JM, Havill, NL, Lipka, A, Havill, H, Rizvani, R. Variations in hospital daily cleaning practices. Infect Control Hosp Epidemiol 2010;31:99–101.CrossRefGoogle ScholarPubMed
18.Kundrapu, S, Sunkesula, V, Jury, LA, Sitzlar, BM, Donskey, CJ. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers' hands. Infect Control Hosp Epidemiol 2012;33:1039–1042.CrossRefGoogle ScholarPubMed
19.Weiss, K, Boisvert, A, Chagnon, M, et al.Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol 2009;30:156–162.Google Scholar
20.Falk, PS, Winnike, J, Woodmansee, C, Desai, M, Mayhall, CG. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol 2000;21:575–582.CrossRefGoogle Scholar
21.Dancer, SJ, White, LF, Lamb, J, Girvan, EK, Robertson, C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009;7:28.CrossRefGoogle Scholar