1 / 42

A Fresh and Appropriate Approach to Hygienic Cleaning of Environmental Surfaces

A Fresh and Appropriate Approach to Hygienic Cleaning of Environmental Surfaces. Public a ttitudes to w a rds bacterial resistance : a qu a lit a tive study .

kipling
Download Presentation

A Fresh and Appropriate Approach to Hygienic Cleaning of Environmental Surfaces

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. A Fresh and Appropriate Approach to Hygienic Cleaning of EnvironmentalSurfaces

  2. Public attitudes towards bacterialresistance: a qualitative study • Although members of the public can contribute to containing bacterialresistance, most do not feel that they have a personal rolein either the problem or its solution. Campaigns should identify bacterialresistanceas both a hospital and a community problem that individuals have the power toinfluence through specific actions • April 21, 2007 Journal of Antimicrobial Chemotherapy,

  3. Current Practices • Surfactant based cleaning and disinfecting contribution to microbial resistance to biocides and antibiotics. This discussion presents a fresh approach to address these problems…

  4. Current Practices • There is growing evidence today that leaving toxic surfactant detergent disinfectant residues on environmental surfaces and in our waste water contributes to development of bacterial resistance to biocides and antibiotics.

  5. Adaptive Resistance of Salmonella enterica Serovar Enteritidis Biofilms Exposed to Benzalkonium Chloride Antimicrobial Agents Chemother. 2006 November; 50(11): 3588–3596. • Resistance of biofilm pathogens following exposure to either continuous (1 μg ml−1) or intermittent (10 μg ml−1 for 10 min daily) benzalkonium chloride (BC) was examined. • Biofilm pathogens that adapted to BC exposure over 144-hours could survive a normally lethal BC challenge (500 μg ml−1 for 10 min) and then regrow

  6. There are concerns that the inappropriate use (inadequate concentrations, insufficient cleaning before the application, or the presence of sub lethal residual disinfectants following cleaning) of these biocidal compounds may contribute to the spread of bacterial resistance to these compounds, as well as cross-resistance to certain therapeutic antibiotics.

  7. Susceptibility of multiresistant Pseudomonas aeruginosa isolates to a hospital disinfectant and molecular typing • We found isolates with reduced susceptibility to the QAC disinfectant. • Resistance to quaternary ammonium may co-select for antibiotic resistance via class 1 integrons and vice-versa. Mem. Inst. Oswaldo Cruz vol.100 no.5 Rio de Janeiro Aug. 2005

  8. Prolonged treatment of Salmonella enterica serovar Typhimurium with commercial disinfectants selects for multiple antibiotic resistance Journal of Antimicrobial Chemotherapy (2007) 60, 947–955Advance Access publication 13 September 2007 • Our work demonstrates that subinhibitory concentrations of disinfectants, which might occur during poor disinfection and cleaning procedures, can lead to selection of strains with reduced susceptibility, or even resistance to antibiotics. • These effects were more pronounced with a quaternary ammonium based biocide and with the use of high concentrations of triclosan.

  9. Genomics of IncP-1 plasmids isolated from wastewater treatment plants • Based on genomic analysis of IncP-1 resistance plasmids: • These plasmids encode resistance to clinically relevant antimicrobial drug classes including tetracyclines, aminoglycosides, macrolides, β-lactams, chloramphenicol, sulphonamides and trimethoprim. • Additional genes were identified that encode resistance to heavy metals (mercury and chromate) or quaternary ammonium compounds (used in detergents). • Integrons were frequently found on IncP-1 plasmids • ‘Since these elements play an important role in the acquisition and exchange of genes encoding resistance to antibiotics and QACs, their presence on conjugative, broad-host-range plasmids is worrying. Indeed, linkage of genes encoding both antibiotic and QAC resistance allows for selection of drug resistance determinants by disinfectants “ Microbiology reviews July 2007

  10. Disinfectant-resistant bacteria in Buenos Aires city hospital wastewater • Disinfectants present in the hospital wastewater may act as selective pressure for the retention of the plasmids that often contain the genes for resistance to numerous antibiotics (14,22,23,26). It is generally agreed that the selection and dissemination of resistant bacteria in nature should be avoided in order to ensure effective treatment against infectious diseases in humans and maintain an ecological balance that favors the predominance of a susceptible bacterial flora in nature. The indiscriminate use of antimicrobial agents may disrupt the microbial balance in favor of resistance bacteria. In particular, wastewater from hospital plants could play a role in the selection of resistance bacteria in sewage (6,16).

  11. JAC Advance Access published online on January 28, 2008 Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm520 • Objectives: To detect genes conferring resistance to biguanides, quaternary ammonium compounds, β-lactams and fluoroquinolones in clinical methicillin-resistant Staphylococcus aureus (MRSA) and to demonstrate whether reduced susceptibility is spread clonally and if the presence of any of the detected genes links to a specific epidemic MRSA. Finally, to identify if exposure to chlorhexidine may cause reduced susceptibility to antibiotics and chlorhexidine. • Conclusions: In our study, isolates resembling PFGE type EMRSA-16 harboured more biocideresistance genes than other types. The observed reduction in susceptibility of clinical isolates to chlorhexidine may mean that a selective pressure is being exerted by residues in the clinical environment, and highlights the importance of efficacy testing on clinical strains and good infection control practices. The development of reduced microbial susceptibility to biocides represents a serious cause for concern in the clinical environment

  12. Mem. Inst. Oswaldo Cruz vol.102 no.4 Rio de Janeiro June 2007 • A total of 74 methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from three government hospitals in 2002 and 2003 were examined concerning the distribution of qacA/B gene, which is the determinant of resistance to quaternary ammonium compounds largely employed in hospital disinfection. By polymerase chain reaction the qacA/B gene was found in 80% of the isolates, which is a significant result considering it is the first time that qacA/B gene is being reported for Brazilian MRSA strains and it is presented at a high rate.

  13. The association between biocide tolerance and the presence or absence of qac genes among hospital-acquired and community-acquired MRSA isolates • In this study, Hospital Acquired MRSA isolates displayed significantly higher MBC to a quat than MSSA isolates. This would suggest that there is a correlation between antibiotic resistance and biocide tolerance. • Although a definitive link between antibiotic and biocide resistance has not been established, it has been observed that the MBC of QACs was significantly higher for clinical isolates of MRSA than MSSA. • Our study reinforces this link in S. aureus and the issue of biocide–antibiotic co-resistance should no longer be ignored.

  14. The association between biocide tolerance and the presence or absence of qac genes among hospital-acquired and community-acquired MRSA isolates • The continued exposure of bacteria to residual levels of biocides in the hospital environment is causing concern. • The presence of qac genes in the clinical S. aureus population and their ability to develop increased tolerance highlights the importance of effective and rigorous infection cleaning and infection control strategies. • Journal of Antimicrobial Chemotherapy Advance Access published November 2, 2007

  15. Importance of environmental decontamination: a critical view • “ The level of evidence supporting different disinfection and cleaning procedures performed in healthcare settings worldwide is low”. • “It must be kept in mind that the effect of surface disinfection is only transient, microbial contamination will have reached its former level within a few hours.” • “With respect to environmental surfaces, the final assessment of whether use of disinfectants, rather than detergents alone, to reduce nosocomial infection rates in different clinical settings still awaits conclusive study.” Journal of Hospital Infection (2007) 65(S2) 55–57

  16. Importance of environmental decontamination: a critical view • As with proper cleaning procedures, targeted surface disinfection is indispensable in modern hospitals. However, disinfectants may be hazardous to personnel and patients, as well as the environment, and require special safety precautions. An uncritical use of biocides, especially in low concentrations, may lead to the development of resistance. Journal of Hospital Infection (2007) 65(S2) 55–57

  17. MRSA • Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the environment. • CDC MRSA in Schools

  18. Current Practices • The current practice of leaving toxic residues on environmental surfaces after cleaning has not reduced the potential spread of pathogens from environmental surfaces. • Antimicrobial surfactants residues after drying on surfaces are quickly reduced to sub-inhibitory concentrations.

  19. Induction of multiple antibiotic resistance by benzene and benzene- derived active compounds • Objectives: To determine the potential of active compounds (ACs) present in commonly used analgesics/antiseptics and cleaning agents (detergents and disinfectants) to induce multiple antibiotic resistance (MAR) in Bacteroides fragilis. Journal of Antimicrobial Chemotherapy Advance Access published September 20, 2007

  20. Tested inorganic compounds(sodium hypochlorite, ammonium hydroxide and hydrogen peroxide) were essentially non-inducing.

  21. Toxicity of anionic detergents determined by Saccharomycescerevisiae microarray analysisSophon Sirisattha, Yuko Momose, Emiko Kitagawa, Hitoshi Iwahashi* The mRNA expression profiles suggest that LAS and SDS cause damage to membranes and alterations in carbon metabolism, and induce the oxidative stress response. We also found that LAS and SDS induce the pleiotropic drug-resistance network,

  22. Some studies have demonstrated that these residues can increase the persistence of C. Difficile

  23. In vitro effects of environmental disinfectants on spore formation (ii) Fawley WN, et al. Infect Control Hosp Epidemiol 2007;28:920-5.

  24. Antimicrobial Products In The HomeCanadian Pediatric Society, 2006 • Where appropriate, alcohol, bleach or peroxidase-based agents are preferred because they dissipate readily and are less likely to exert prolonged antimicrobial pressure. Agents such as triclosan, chlorhexidine and quaternary ammonium compounds exert more prolonged antimicrobial pressure. Pediatric and Child Health 2006;11:169-173

  25. Surfactants are Toxic • Surfactants used in cleaning and disinfecting of environmental surfaces are all rated as toxic to aquatic life. • Surfactants used in cleaning of environmental surfaces all have toxic effects on microbial populations bactericidal and/or bacteriostatic. • Surfactant toxic effects on microbial populations contributes to bacterial adaptation and resistance development.

  26. Journal of Antimicrobial Agents Volume 28, Issue 6, December 2006

  27. Toxicity of anionic detergents determined by Saccharomycescerevisiae microarray analysisSophon Sirisattha, Yuko Momose, Emiko Kitagawa, Hitoshi Iwahashi* • The concentrations of LAS and SDS that cause growth inhibition were studied after screening of the various concentrations of LAS and SDS that affect cellular growth. The growth curves showed that, at 0.02% LAS and 0.01% SDS, there was a 50% decrease in the specific growth (IC50) after a 2 h treatment.

  28. International Symposium on Environmental Biotechnology 2006, Leipzig, Germany288Effects of detergent shock loads on anaerobic granular sludge morphologyand methanogenic activity After exposure to 0.30 g/L of detergent the COD removal efficiency decreased drastically.

  29. Effect of Surfactants on Soil Bacteriaby LUDWIG HARTMANNHead, Laboratory o] Engineering-BiologyTechnische H ochschule Karlsruhe, Germany

  30. Consumption of Surfactants • In 1998 the estimated annual consumption of surfactants in Europe was 1,696,000 metric tons. • In the same period the estimated total consumption of antibiotics from all sources was less than 1,000 metric tons .

  31. Current Practices • Low Level disinfectant cleaners like quats are used for damp dusting environmental surfaces with a simple wipe and go technique. • More potent disinfectant cleaners are used in isolation areas, for cases of Noroviruses or C. difficile and simply when a higher degree of confidence is required. • Because it is not common practice to maintain anappropriate wet contact time, cleaning staff are using antimicrobial products as cleaners, not disinfectants. • Legally concerns claiming when claiming to disinfect but not following manufacturers instructions for use?

  32. Separate Cleaning From Disinfecting. • One Step Cleaning and Disinfecting is contradictory to the science of disinfection.

  33. Focus on Cleaning. • Use best cleaning practices. • Prevent spreading contaminants.

  34. If your institution insist on cleaning with low level disinfectant cleaners consider using sodium hypochlorite to replace existing cleaning solutions. • Mild odor in low concentrations. • Oxidizes organic soils that harbor many problematic pathogens. • Safe in low concentrations. • Easily formulated into effective cleaning solutions without detergent surfactants. • Reduced environmental pressure on microbial populations..

  35. If your institution insist on cleaning with low level disinfectant cleaners consider using sodium hypochlorite to replace existing cleaning solutions. • Packaged in closed looped containers with accurate dispensers. • Dilute solutions can be made stable for months after dilution when stored in clean work place bottles. • Use in conjunction with best cleaning practices .

  36. All 9 rooms of patients with CDI positive cultures prior to cleaning vs. 7 (78%) after housekeeping cleaning (p = 0.5), vs. only 1 (11%) after bleach disinfection by research staff (p = 0.031) • After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced

  37. Moore & Griffith. J Hosp Infect 2006;64:379-85.

  38. All 9 rooms of patients with CDI positive cultures prior to cleaning vs. 7 (78%) after housekeeping cleaning (p = 0.5), vs. only 1 (11%) after bleach disinfection by research staff (p = 0.031) • After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced

  39. Targeted disinfection after cleaning. • Limit disinfectant use to disinfection. • Replace residue depositing disinfectants. • Use one disinfectant considered effective on all hospital pathogens. • Use cleaning products compatable with hospital disinfectant. • Use safe storage, handling and in use practices. • Sodium hypochlorite is very effective in short contact times when applied to pre cleaned surfaces.

  40. Michael Rochon Cogent Environmental Solutions michael@ecogent.ca 1-877-994-9908

More Related