1 / 53

Monitoring and Improving the Effectiveness of Surface Cleaning/Disinfection

Monitoring and Improving the Effectiveness of Surface Cleaning/Disinfection. William A. Rutala, PhD, MPH Director, Hospital Epidemiology, Occupational Health and Safety; Research Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology

kevinprice
Download Presentation

Monitoring and Improving the Effectiveness of Surface Cleaning/Disinfection

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Monitoring and Improving the Effectiveness of Surface Cleaning/Disinfection William A. Rutala, PhD, MPH Director, Hospital Epidemiology, Occupational Health and Safety; Research Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology University of North Carolina at Chapel Hill and UNC Health Care, Chapel Hill, NC

  2. DISCLOSURES • Consultation • ASP (Advanced Sterilization Products)-2014 • Clorox-2014, 2015 • Honoraria (2014, 2015) • 3M, ASP, Clorox • Grants • CDC, CMS

  3. Consider contribution of the environment to disease transmission Discuss available options for evaluating/monitoring environmental cleaning/disinfection Discuss methods for improving cleaning/disinfection to include supplemental “no touch” room decontamination LECTURE OBJECTIVES

  4. There is increasing evidence to support the contribution of the environment to disease transmission This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment/equipment ENVIRONMENTAL CONTAMINATION LEADS TO HAIs

  5. MRSA VRE Acinetobacter spp. Clostridium difficile Norovirus Rotavirus SARS KEY PATHOGENS WHERE ENVIRONMENTIAL SURFACES PLAY A ROLE IN TRANSMISSION

  6. ACQUISITION OF MRSA ON HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES

  7. ACQUISITION OF MRSA ON HANDS/GLOVES AFTER CONTACT WITH CONTAMINATED EQUIPMENT

  8. TRANSFER OF MRSA FROM PATIENT OR ENVIRONMENT TO IV DEVICE AND TRANSMISSON OF PATHOGEN

  9. ACQUISITION OF C. difficile ON PATIENT HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES AND THEN INOCULATION OF MOUTH

  10. ALL “TOUCHABLE” (HAND CONTACT) SURFACES SHOULD BE WIPED WITH DISINFECTANT “High touch” objects only recently defined (no significant differences in microbial contamination of different surfaces) and “high risk” objects not epidemiologically defined.

  11. Effective Surface Decontamination Product and Practice = Perfection

  12. LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES Exposure time > 1 min Germicide Use Concentration Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD Improved hydrogen peroxide 0.5%, 1.4% ____________________________________________________ UD=Manufacturer’s recommended use dilution

  13. Does Improving Surface Cleaning and Disinfection Reduce Healthcare-Associated Infections?Donskey CJ. AJIC 2013;41:S12-S19 “As reviewed here, during the past decade a growing body of evidence has accumulated suggesting that improvements in environmental disinfection may prevent transmission of pathogens and reduce HAIs. Although, the quality of much of the evidence remains suboptimal, a number of high-quality investigations now support environmental disinfection as a control strategy”

  14. Alfa et al. AJIC 2015;43:141-146

  15. Use of a Daily Disinfectant Cleaner Instead of a Daily Cleaner Reduced HAI RatesAlfa et al. AJIC 2015.43:141-146 • Method: Improved hydrogen peroxide disposable wipe was used once per day for all high-touch surfaces to replace cleaner • Result: When cleaning compliance was ≥ 80%, there was a significant reduction in cases/10,000 patient days for MRSA, VRE and C. difficile • Conclusion: Daily use of disinfectant applied to environmental surfaces with a 80% compliance was superior to a cleaner because it resulted in significantly reduced rates of HAIs caused by C. difficile, MRSA, VRE

  16. Pathogen Transfer by Detergent WipesRamm et al, AJIC 2015 epubl • All detergent wipes repeatedly transferred significant amounts of MRSA and C. difficile over 3 consecutive surfaces, although the percentage of total pathogens transferred from the wipes after wiping was low

  17. Effective Surface Decontamination Product and Practice = Perfection

  18. There is increasing evidence to support the contribution of the environment to disease transmission This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment ENVIRONMENTAL CONTAMINATION LEADS TO HAIsSuboptimal Cleaning

  19. Thoroughness of Environmental CleaningCarling P. AJIC 2013;41:S20-S25 >110,000 Objects Mean = 32%

  20. Mean proportion of surfaces disinfected at terminal cleaning is 32% Terminal cleaning methods ineffective (products effective practices deficient [surfaces not wiped]) in eliminating epidemiologically important pathogens

  21. Monitoring the Effectiveness of Surface Cleaning/Disinfection

  22. Visual assessment-not a reliable indicator of surface cleanliness ATP bioluminescence-measures organic debris (each unit has own reading scale, <250-500 RLU) Microbiological methods-<2.5CFUs/cm2-pass; can be costly and pathogen specific Fluorescent marker-transparent, easily cleaned, environmentally stable marking solution that fluoresces when exposed to an ultraviolet light (applied by IP unbeknown to EVS, after EVS cleaning, markings are reassessed) MONITORING THE EFFECTIVENESS OF CLEANINGCooper et al. AJIC 2007;35:338; Carling P AJIC 2013;41:S20-S25

  23. SURFACE EVALUATION USING ATP BIOLUMINESCENCE Swab surface luciferace tagging of ATP Hand held luminometer Used in the commercial food preparation industry to evaluate surface cleaning before reuse and as an educational tool for more than 30 years.

  24. DAZO Solution (AKA – Goo)

  25. Target After Marking

  26. TARGET ENHANCED

  27. TERMINAL ROOM CLEANING: DEMONSTRATION OF IMPROVED CLEANING • Evaluated cleaning before and after an intervention to improve cleaning • 36 US acute care hospitals • Assessed cleaning using a fluorescent dye • Interventions • Increased education of environmental service workers • Feedback to environmental service workers †Regularly change “dotted” items to prevent targeting objects Carling PC, et al. ICHE 2008;29:1035-41

  28. Purpose: Compared four methods to assess cleanliness Methods: Study conducted at UNC Health Care using medical, surgical and pediatric wards (both ICU and non-ICU) Results: Compared to microbiological data (Rodac<62.5), 72% (90/125, CI 63-79 %) were classified as clean with fluorescent markers, compared to 27% (34/126, CI 19-36%) were classified as clean according to ATP. 50% surfaces visually clean before cleaning. Conclusion: Fluorescent marker is a useful tool in determining how thoroughly a surface is wiped and mimics the microbiological data better than ATP (<500 RLU). Comparison of Four Methods to Assess CleanlinessRutala, Gergen, Sickbert-Bennett, Huslage, Weber. 2013

  29. Percentage of Surfaces Clean by Different Measurement MethodsRutala, Gergen, Sickbert-Bennett, Huslage, Weber. 2013 Fluorescent marker is a useful tool in determining how thoroughly a surface is wiped and mimics the microbiological data better than ATP

  30. Improving the Effectiveness of Surface Cleaning/Disinfection

  31. ALL “TOUCHABLE” (HAND CONTACT) SURFACES SHOULD BE WIPED WITH DISINFECTANT “High touch” objects only recently defined (no significant differences in microbial contamination of different surfaces) and “high risk” objects not epidemiologically defined.

  32. FREQUENCY (mean) OF HCP CONTACT FOR SURFACES IN AN ICU (N=28) AND WARD (N=24) ICU WARD Huslage K, Rutala WA, Sickbert-Bennett E, Weber DJ. ICHE 2010;31:850-853

  33. MICROBIAL BURDEN ON ROOM SURFACES AS A FUNCTION OF FREQUENCY OF TOUCHINGHuslage K, Rutala WA, Weber DJ. ICHE. 2013;34:211-212 • The level of microbial contamination of room surfaces is similar regardless of how often they are touched both before and after cleaning • Therefore, all surfaces that are touched must be cleaned and disinfected

  34. WipesCotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace Wipe should have sufficient wetness to achieve the disinfectant contact time (e.g. >1 minute)

  35. LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES Exposure time > 1 min Germicide Use Concentration Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD Improved hydrogen peroxide 0.5%, 1.4% ____________________________________________________ UD=Manufacturer’s recommended use dilution

  36. It appears that not only is disinfectant use important but how often is important Daily disinfection vs clean when soiled

  37. Daily Disinfection of High-Touch SurfacesKundrapu et al. ICHE 2012;33:1039 Daily disinfection of high-touch surfaces (vs cleaned when soiled) with sporicidal disinfectant (PA) in rooms of patients with CDI and MRSA reduced acquisition of pathogens on hands after contact with surfaces and of hands caring for the patient

  38. Thoroughness of Environmental CleaningCarling P. AJIC 2013;41:S20-S25 >110,000 Objects Mean = 32%

  39. Practice* NOT Product *surfaces not wiped

  40. NEW “NO TOUCH” APPROACHES TO ROOM DECONTAMINATION

  41. EFFECTIVENESS OF UV ROOM DECONTAMINATION Rutala WA, et al. Infect Control Hosp Epidemiol. 2010;31:1025-1029.

  42. EFFECTIVENESS OF UV-C FOR ROOM DECONTAMINATION (Inoculated Surfaces) 1ICHE 2010;31:1025; 2BMC 2010;10:197; 3ICHE 2011;32:737; 4JHI 2013;84:323l 5ICHE 2012;33:507-12 6ICHE 2013;34:466 * Ws/cm2; min = minutes; NA = not available

  43. HYDROGEN PEROXIDE FOR DECONTAMINATION OF THE HOSPITAL ENVIRONMENT Falagas, et al. J Hosp Infect. 2011;78:171.

  44. Design: 30 mo prospective cohort study with hydrogen peroxide vapor (HPV) intervention to assess risks of colonization or infection with MDROs Methods:12 mo pre-intervention phase followed by HPV use on 3 units for terminal disinfection Results Prior room occupant colonized or infected with MDRO in 22% of cases Patients admitted to HPV decontaminated rooms 64% less likely to acquire any MDRO (95% CI, 0.19-0.70) and 80% less likely to acquire VRE (95% CI, 0.08-0.52) Risk of C. difficile, MRSA and MDR-GNRs individually reduced but not significantly Proportion of rooms environmentally contaminated with MDROs significantly reduced (RR, 0.65, P=0.03) Conclusion-HPV reduced the risk of acquiring MDROs compared to standard cleaning USE OF HPV TO REDUCE RISK OF ACQUISITION OF MDROs Passaretti CL, et al. Clin Infect Dis 2013;56:27-35

  45. Retrospective Study on the Impact of UV on HA MDROs Plus C. difficileHaas et al. Am J Infect Control. 2014;42:S86-90 During the UV period (pulsed Xenon), significant decrease in HA MDRO plus C. difficile. UV used for 76% of Contact Precaution discharges. 20% decrease in HA MDRO plus C. difficile during the 22-m UV period compared to 30-m pre-UV period.

  46. This technology should be considered for terminal room disinfection (e.g., after discharge of patients under CP, during outbreaks) if studies continue to demonstrate a benefit.

  47. Visible Light Disinfection SystemRutala, Gergen, Kanamori, Sickbert-Bennett, Weber. 2015 • Uses blue-violet range of visible light in 400-450nm region through light emitting diodes (LEDs); continuous • Initiates a photoreaction with porphyrins in microbes which yield reactive oxygen • Studies incomplete but have observed significant reductions with some microbes

More Related