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Iain B Gosbell - One of the best experts on this subject based on the ideXlab platform.
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intensive care unit environmental surfaces are contaminated by multidrug resistant bacteria in biofilms combined results of conventional culture pyrosequencing scanning electron microscopy and confocal laser microscopy
Journal of Hospital Infection, 2015Co-Authors: Khalid Johani, Anand K Deva, Anita Jacombs, Iain B Gosbell, Ahmad Almatroudi, Greg S Whiteley, Slade O Jensen, Karen VickeryAbstract:Summary Background Hospital-associated infections cause considerable morbidity and mortality, and are expensive to treat. Organisms causing these infections can be sourced from the inanimate environment around a patient. Could the difficulty in eradicating these organisms from the environment be because they reside in dry surface biofilms? Aim The intensive care unit (ICU) of a tertiary referral hospital was decommissioned and the opportunity to destructively sample clinical surfaces was taken in order to investigate whether multidrug-resistant organisms (MDROs) had survived the decommissioning process and whether they were present in biofilms. Methods The ICU had two ‘Terminal cleans' with 500ppm free chlorine solution; items from bedding, surrounds, and furnishings were then sampled with cutting implements. Sections were sonicated in tryptone soya broth and inoculated on to chromogenic plates to demonstrate MDROs, which were confirmed with the Vitek2 system. Genomic DNA was extracted directly from ICU samples, and subjected to polymerase chain reaction (PCR) for femA to detect Staphylococcus aureus and the microbiome by bacterial tag-encoded FLX amplicon pyrosequencing. Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were performed on environmental samples. Findings Multidrug-resistant bacteria were cultured from 52% (23/44) of samples cultured. S. aureus PCR was positive in 50%. Biofilm was demonstrated in 93% (41/44) of samples by CLSM and/or SEM. Pyrosequencing demonstrated that the biofilms were polymicrobial and contained species that had multidrug-resistant strains. Conclusion Dry surface biofilms containing MDROs are found on ICU surfaces despite Terminal Cleaning with chlorine solution. How these arise and how they might be removed requires further study.
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presence of biofilm containing viable multiresistant organisms despite Terminal Cleaning on clinical surfaces in an intensive care unit
Journal of Hospital Infection, 2012Co-Authors: Karen Vickery, Anand K Deva, Anita Jacombs, James Allan, Pedro Valente, Iain B GosbellAbstract:Summary Background Despite recent attention to surface Cleaning and hand hygiene programmes, multiresistant organisms (MROs) continue to be isolated from the hospital environment. Biofilms, consisting of bacteria embedded in exopolymeric substances (EPS) are difficult to remove due to their increased resistance to detergents and disinfectants, and periodically release free-swimming planktonic bacteria back into the environment which may may act as an infection source. Aim To establish whether reservoirs of MROs exist in the environment as biofilms. Methods Following Terminal Cleaning, equipment and furnishings were removed aseptically from an intensive care unit (ICU) and subjected to culture and scanning electron microscopy (SEM). Samples were placed in 5 mL of tryptone soya broth, sonicated for 5 min before plate culture on horse blood agar, Brillance MRSA and Brilliance VRE agar plates. Samples for SEM were fixed in 3% glutaraldehyde and hexamethyldisilizane (HMDS) prior to sputter-coating with gold and examination in an electron microscope. Findings Biofilm was demonstrated visually on the sterile supply bucket, the opaque plastic door, the venetian blind cord, and the sink rubber, whereas EPS alone was seen on the curtain. Viable bacteria were grown from three samples, including MRSA from the venetian blind cord and the curtain. Conclusion Biofilm containing MROs persist on clinical surfaces from an ICU despite Terminal Cleaning, suggesting that current Cleaning practices are inadequate to control biofilm development. The presence of MROs being protected within these biofilms may be the mechanism by which MROs persist within the hospital environment.
Karen Vickery - One of the best experts on this subject based on the ideXlab platform.
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intensive care unit environmental surfaces are contaminated by multidrug resistant bacteria in biofilms combined results of conventional culture pyrosequencing scanning electron microscopy and confocal laser microscopy
Journal of Hospital Infection, 2015Co-Authors: Khalid Johani, Anand K Deva, Anita Jacombs, Iain B Gosbell, Ahmad Almatroudi, Greg S Whiteley, Slade O Jensen, Karen VickeryAbstract:Summary Background Hospital-associated infections cause considerable morbidity and mortality, and are expensive to treat. Organisms causing these infections can be sourced from the inanimate environment around a patient. Could the difficulty in eradicating these organisms from the environment be because they reside in dry surface biofilms? Aim The intensive care unit (ICU) of a tertiary referral hospital was decommissioned and the opportunity to destructively sample clinical surfaces was taken in order to investigate whether multidrug-resistant organisms (MDROs) had survived the decommissioning process and whether they were present in biofilms. Methods The ICU had two ‘Terminal cleans' with 500ppm free chlorine solution; items from bedding, surrounds, and furnishings were then sampled with cutting implements. Sections were sonicated in tryptone soya broth and inoculated on to chromogenic plates to demonstrate MDROs, which were confirmed with the Vitek2 system. Genomic DNA was extracted directly from ICU samples, and subjected to polymerase chain reaction (PCR) for femA to detect Staphylococcus aureus and the microbiome by bacterial tag-encoded FLX amplicon pyrosequencing. Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were performed on environmental samples. Findings Multidrug-resistant bacteria were cultured from 52% (23/44) of samples cultured. S. aureus PCR was positive in 50%. Biofilm was demonstrated in 93% (41/44) of samples by CLSM and/or SEM. Pyrosequencing demonstrated that the biofilms were polymicrobial and contained species that had multidrug-resistant strains. Conclusion Dry surface biofilms containing MDROs are found on ICU surfaces despite Terminal Cleaning with chlorine solution. How these arise and how they might be removed requires further study.
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presence of biofilm containing viable multiresistant organisms despite Terminal Cleaning on clinical surfaces in an intensive care unit
Journal of Hospital Infection, 2012Co-Authors: Karen Vickery, Anand K Deva, Anita Jacombs, James Allan, Pedro Valente, Iain B GosbellAbstract:Summary Background Despite recent attention to surface Cleaning and hand hygiene programmes, multiresistant organisms (MROs) continue to be isolated from the hospital environment. Biofilms, consisting of bacteria embedded in exopolymeric substances (EPS) are difficult to remove due to their increased resistance to detergents and disinfectants, and periodically release free-swimming planktonic bacteria back into the environment which may may act as an infection source. Aim To establish whether reservoirs of MROs exist in the environment as biofilms. Methods Following Terminal Cleaning, equipment and furnishings were removed aseptically from an intensive care unit (ICU) and subjected to culture and scanning electron microscopy (SEM). Samples were placed in 5 mL of tryptone soya broth, sonicated for 5 min before plate culture on horse blood agar, Brillance MRSA and Brilliance VRE agar plates. Samples for SEM were fixed in 3% glutaraldehyde and hexamethyldisilizane (HMDS) prior to sputter-coating with gold and examination in an electron microscope. Findings Biofilm was demonstrated visually on the sterile supply bucket, the opaque plastic door, the venetian blind cord, and the sink rubber, whereas EPS alone was seen on the curtain. Viable bacteria were grown from three samples, including MRSA from the venetian blind cord and the curtain. Conclusion Biofilm containing MROs persist on clinical surfaces from an ICU despite Terminal Cleaning, suggesting that current Cleaning practices are inadequate to control biofilm development. The presence of MROs being protected within these biofilms may be the mechanism by which MROs persist within the hospital environment.
Randy W Loftus - One of the best experts on this subject based on the ideXlab platform.
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perioperative covid 19 defense an evidence based approach for optimization of infection control and operating room management
Anesthesia & Analgesia, 2020Co-Authors: Franklin Dexter, Michelle C Parra, Jeremiah R Brown, Randy W LoftusAbstract:We describe an evidence-based approach for optimization of infection control and operating room management during the coronavirus disease 2019 (COVID-19) pandemic. Confirmed modes of viral transmission are primarily, but not exclusively, contact with contaminated environmental surfaces and aerosolization. Evidence-based improvement strategies for attenuation of residual environmental contamination involve a combination of deep Cleaning with surface disinfectants and ultraviolet light (UV-C). (1) Place alcohol-based hand rubs on the intravenous (IV) pole to the left of the provider. Double glove during induction. (2) Place a wire basket lined with a zip closure plastic bag on the IV pole to the right of the provider. Place all contaminated instruments in the bag (eg, laryngoscope blades and handles) and close. Designate and maintain clean and dirty areas. After induction of anesthesia, wipe down all equipment and surfaces with disinfection wipes that contain a quaternary ammonium compound and alcohol. Use a top-down Cleaning sequence adequate to reduce bioburden. Treat operating rooms using UV-C. (3) Decolonize patients using preprocedural chlorhexidine wipes, 2 doses of nasal povidone-iodine within 1 hour of incision, and chlorhexidine mouth rinse. (4) Create a closed lumen IV system and use hub disinfection. (5) Provide data feedback by surveillance of Enterococcus, Staphylococcus aureus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp. (ESKAPE) transmission. (6) To reduce the use of surgical masks and to reduce potential COVID-19 exposure, use relatively long (eg, 12 hours) staff shifts. If there are 8 essential cases to be done (each lasting 1-2 hours), the ideal solution is to have 2 teams complete the 8 cases, not 8 first case starts. (7) Do 1 case in each operating room daily, with Terminal Cleaning after each case including UV-C or equivalent. (8) Do not have patients go into a large, pooled phase I postanesthesia care unit because of the risk of contaminating facility at large along with many staff. Instead, have most patients recover in the room where they had surgery as is done routinely in Japan. These 8 programmatic recommendations stand on a substantial body of empirical evidence characterizing the epidemiology of perioperative transmission and infection development made possible by support from the Anesthesia Patient Safety Foundation (APSF).
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perioperative covid 19 defense an evidence based approach for optimization of infection control and operating room management
Anesthesia & Analgesia, 2020Co-Authors: Franklin Dexter, Michelle C Parra, Jeremiah R Brown, Randy W LoftusAbstract:We describe an evidence-based approach for optimization of infection control and operating room management during the coronavirus disease 2019 (COVID-19) pandemic. Confirmed modes of viral transmission are primarily, but not exclusively, contact with contaminated environmental surfaces and aerosolization. Evidence-based improvement strategies for attenuation of residual environmental contamination involve a combination of deep Cleaning with surface disinfectants and ultraviolet light (UV-C). (1) Place alcohol-based hand rubs on the intravenous (IV) pole to the left of the provider. Double glove during induction. (2) Place a wire basket lined with a zip closure plastic bag on the IV pole to the right of the provider. Place all contaminated instruments in the bag (eg, laryngoscope blades and handles) and close. Designate and maintain clean and dirty areas. After induction of anesthesia, wipe down all equipment and surfaces with disinfection wipes that contain a quaternary ammonium compound and alcohol. Use a top-down Cleaning sequence adequate to reduce bioburden. Treat operating rooms using UV-C. (3) Decolonize patients using preprocedural chlorhexidine wipes, 2 doses of nasal povidone-iodine within 1 hour of incision, and chlorhexidine mouth rinse. (4) Create a closed lumen IV system and use hub disinfection. (5) Provide data feedback by surveillance of Enterococcus, Staphylococcus aureus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp. (ESKAPE) transmission. (6) To reduce the use of surgical masks and to reduce potential COVID-19 exposure, use relatively long (eg, 12 hours) staff shifts. If there are 8 essential cases to be done (each lasting 1-2 hours), the ideal solution is to have 2 teams complete the 8 cases, not 8 first case starts. (7) Do 1 case in each operating room daily, with Terminal Cleaning after each case including UV-C or equivalent. (8) Do not have patients go into a large, pooled phase I postanesthesia care unit because of the risk of contaminating facility at large along with many staff. Instead, have most patients recover in the room where they had surgery as is done routinely in Japan. These 8 programmatic recommendations stand on a substantial body of empirical evidence characterizing the epidemiology of perioperative transmission and infection development made possible by support from the Anesthesia Patient Safety Foundation (APSF).
Farrin A Manian - One of the best experts on this subject based on the ideXlab platform.
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implementation of hospital wide enhanced Terminal Cleaning of targeted patient rooms and its impact on endemic clostridium difficile infection rates
American Journal of Infection Control, 2013Co-Authors: Farrin A Manian, Sandra Griesnauer, Alex M BryantAbstract:Background Implementation of a hospital-wide program of Terminal Cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile -associated diarrhea (CDAD) have not been previously reported. Methods This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of Cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent “enhanced Cleaning” consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of Cleaning with bleach instead. Results During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P Conclusion A hospital-wide program of enhanced Terminal Cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.
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impact of Terminal Cleaning and disinfection on isolation of acinetobacter baumannii complex from inanimate surfaces of hospital rooms by quantitative and qualitative methods
American Journal of Infection Control, 2013Co-Authors: Farrin A Manian, Sandra Griesnauer, Diane SenkelAbstract:Quantitative broth cultures were obtained from hospital rooms newly vacated by patients positive for multidrug-resistant Acinetobacter baumannii complex (ABC) before and after Terminal Cleaning and disinfection. Of 10 ABC-positive precleaned room surfaces, 6 (60%) remained culture-positive after Terminal Cleaning and disinfection. Of a total of 16 room surfaces with detectable ABC by the quantitative method, 5 (31.2%; 95% confidence interval, 13.9%-55.8%) were also culture-positive by the qualitative technique.
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isolation of acinetobacter baumannii complex and methicillin resistant staphylococcus aureus from hospital rooms following Terminal Cleaning and disinfection can we do better
Infection Control and Hospital Epidemiology, 2011Co-Authors: Farrin A Manian, Diane Senkel, Sandra Griesenauer, Janice Setzer, Sara A Doll, Annie M Perry, Michelle WiechensAbstract:Objective. To study the frequency of isolation of Acinetobacter baumannii complex (ABC) and methicillin-resistant Staphylococcus aureus (MRSA) from surfaces of rooms newly vacated by patients with multidrug-resistant (MDR) ABC following various rounds of routine Terminal Cleaning and disinfection (C/D) with bleach or 1 round of C/D followed by hydrogen peroxide vapor (HPV) treatment. Setting. A 900-bed tertiary care hospital. Methods. ABC and MRSA cultures were obtained from hospital rooms including 312 rooms (mean, 18.3 sites/room) following 4 rounds of C/D, 37 rooms (mean, 20 sites/room) following 1 round of C/D before and after HPV treatment, and 134 rooms (mean, 20 sites/room) following 1 round of C/D and HPV treatment. Results. Following 4 rounds of C/D, 83 (26.6%) rooms had 1 or more culture-positive sites; 102 (1.8%) sites in 51 (16.4%) rooms grew ABC, and 108 (1.9%) sites in 44 (14.1%) rooms grew MRSA. The addition of HPV treatment to 1 round of C/D resulted in a significant drop in ABC- and MRSA-positive room sites (odds ratio, 0 [95% confidence interval, 0–0.8]; P = .04 for both organisms). Following 1 round of C/D and HPV treatment, 6 (4.5%) rooms were culture-positive for ABC, MRSA, or both. Conclusions. Routine Terminal C/D of hospital rooms vacated by MDRABC-positive patients may be associated with a significant number of ABC- or MRSA-positive room surfaces even when up to 4 rounds of C/D are performed. The addition of HPV treatment to 1 round of C/D appears effective in reducing the number of persistently contaminated room sites in this setting.
John M Boyce - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of ultraviolet devices and hydrogen peroxide systems for Terminal room decontamination: Focus on clinical trials
American Journal of Infection Control, 2016Co-Authors: William A Rutala, Deverick J. Anderson, Emily E. Sickbert-bennett, Luke F. Chen, John M BoyceAbstract:Over the last decade, substantial scientific evidence has accumulated that indicates contamination of environmental surfaces in hospital rooms plays an important role in the transmission of key health care-associated pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, Acinetobacter spp). For example, a patient admitted to a room previously occupied by a patient colonized or infected with one of these pathogens has a higher risk for acquiring one of these pathogens than a patient admitted to a room whose previous occupant was not colonized or infected. This risk is not surprising because multiple studies have demonstrated that surfaces in hospital rooms are poorly cleaned during Terminal Cleaning. To reduce surface contamination after Terminal Cleaning, no touch methods of room disinfection have been developed. This article will review the no touch methods, ultraviolet light devices, and hydrogen peroxide systems, with a focus on clinical trials which have used patient colonization or infection as an outcome. Multiple studies have demonstrated that ultraviolet light devices and hydrogen peroxide systems have been shown to inactivate microbes experimentally plated on carrier materials and placed in hospital rooms and to decontaminate surfaces in hospital rooms naturally contaminated with multidrug-resistant pathogens. A growing number of clinical studies have demonstrated that ultraviolet devices and hydrogen peroxide systems when used for Terminal disinfection can reduce colonization or health care-associated infections in patients admitted to these hospital rooms.
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comparison of fluorescent marker systems with 2 quantitative methods of assessing Terminal Cleaning practices
Infection Control and Hospital Epidemiology, 2011Co-Authors: John M Boyce, Nancy L Havill, Heather L Havill, Elise Mangione, Diane G Dumigan, Brent A MooreAbstract:Objective. To compare fluorescent markers with aerobic colony counts (ACCs) and an adenosine triphosphate (ATP) bioluminescence assay system for assessing Terminal Cleaning practices. Design. A prospective observational survey. Setting. A 500-bed university-affiliated community teaching hospital. Methods. In a convenience sample of 100 hospital rooms, 5 high-touch surfaces were marked with fluorescent markers before Terminal Cleaning and checked after Cleaning to see whether the marker had been entirely or partially removed. ACC and ATP readings were performed on the same surfaces before and after Terminal Cleaning. Results. Overall, 378 (76%) of 500 surfaces were classified as having been cleaned according to fluorescent markers, compared with 384 (77%) according to ACC criteria and 225 (45%) according to ATP criteria. Of 382 surfaces classified as not clean according to ATP criteria before Terminal Cleaning, those with the marker removed were significantly more likely than those with the marker partially removed to be classified as clean according to ATP criteria (P = .003). Conclusions. Fluorescent markers are useful in determining how frequently high-touch surfaces are wiped during Terminal Cleaning. However, contaminated surfaces classified as clean according to fluorescent marker criteria after Terminal Cleaning were significantly less likely to be classified as clean according to ACC and ATP assays.
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comparison of fluorescent marker systems with 2 quantitative methods of assessing Terminal Cleaning practices
Infection Control and Hospital Epidemiology, 2011Co-Authors: John M Boyce, Nancy L Havill, Heather L Havill, Elise Mangione, Diane G Dumigan, Brent A MooreAbstract:Objective. To compare fluorescent markers with aerobic colony counts (ACCs) and an adenosine triphosphate (ATP) bioluminescence assay system for assessing Terminal Cleaning practices.Design. A prospective observational survey.Setting. A 500-bed university-affiliated community teaching hospital.Methods. In a convenience sample of 100 hospital rooms, 5 high-touch surfaces were marked with fluorescent markers before Terminal Cleaning and checked after Cleaning to see whether the marker had been entirely or partially removed. ACC and ATP readings were performed on the same surfaces before and after Terminal Cleaning.Results. Overall, 378 (76%) of 500 surfaces were classified as having been cleaned according to fluorescent markers, compared with 384 (77%) according to ACC criteria and 225 (45%) according to ATP criteria. Of 382 surfaces classified as not clean according to ATP criteria before Terminal Cleaning, those with the marker removed were significantly more likely than those with the marker partially re...