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Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods

Published online by Cambridge University Press:  14 November 2019

Anat Or Lerner ,
Jalal Abu-Hanna ,
Yehuda Carmeli  and
Vered Schechner Open the ORCID record for Vered Schechner [Opens in a new window]
Anat Or Lerner
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
Jalal Abu-Hanna
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
Yehuda Carmeli
Affiliation:
National Center for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Vered Schechner*
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Author for correspondence: Vered Schechner, Email: vereds@tlvmc.gov.il
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Abstract

Objective:

We evaluated environmental contamination by carbapenem-resistant Acinetobacter baumannii (CRAB), the effectiveness of cleaning practices, the performance of aerosolized hydrogen-peroxide (aHP) technology, and the correlation between measures of cleaning and environmental contamination.

Design:

Serial testing of environmental contamination during a 7-month period.

Setting:

Single-patient rooms in intensive care units (ICUs) and multipatient step-up and regular rooms in internal medicine wards in a tertiary-care hospital with endemic CRAB.

Methods:

CRAB environmental contamination was determined semiquantitatively using sponge sampling.

Results:

In step-up rooms, 91% of patient units (56% of objects) were contaminated, and half of them were heavily contaminated. In regular rooms, only 21% of patient units (3% of objects) were contaminated. In ICUs, 76% of single-patient rooms (24% of objects) were contaminated. Cleaning did not reduce the number of contaminated objects or patient units in step-up rooms. After refresher training, cleaning reduced the proportion of contaminated objects by 2-fold (P = .001), but almost all patient units remained contaminated. Using aerosolized hydrogen peroxide (aHP) disinfection after discharge of a known CRAB-carrier decreased room contamination by 78%, similar to the reduction achieved by manual hypochloride cleaning. Measuring cleaning efficacy using fluorescent gel did not correlate with recovery of CRAB by sponge cultures.

Conclusions:

In step-up rooms, the high number of objects contaminated combined with poor efficacy of cleaning resulted in failure to eliminate CRAB in patient units. Fluorescent gel is a poor detector of CRAB contamination. The role of aHP is still unclear. However, its use in multipatient rooms is limited because it can only be used in unoccupied rooms.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 2 , February 2020 , pp. 166 - 171
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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