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Saving Costs through the Decontamination of the Packaging of Unused Medical Supplies Using Hydrogen Peroxide Vapor

Published online by Cambridge University Press:  02 January 2015

Jonathan A. Otter ,
Elaine Nowakowski ,
James A. G. Salkeld ,
Mike Duclos ,
Catherine L. Passaretti ,
Saber Yezli ,
Tracy Ross ,
Karen C. Carroll  and
Trish M. Perl
Jonathan A. Otter
Affiliation:
Bioquell, Horsham, Pennsylvania
Elaine Nowakowski
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland
James A. G. Salkeld
Affiliation:
Bioquell, Horsham, Pennsylvania
Mike Duclos
Affiliation:
Bioquell, Horsham, Pennsylvania
Catherine L. Passaretti
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Saber Yezli
Affiliation:
Bioquell, Horsham, Pennsylvania
Tracy Ross
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Trish M. Perl*
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Johns Hopkins Hospital, 600 North Wolfe Street, 327 A Billings, Baltimore, MD 21287 (tperl@jhmi.edu)
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Abstract

Objective.

Individually packaged sterile supply items may become contaminated and act as vectors for nosocomial transmission of multidrug-resistant organisms (MDROs). Thus, many hospitals have a policy to dispose of these unused, packaged supply items at patient discharge from the hospital, which has considerable cost implications. We evaluated the frequency of contamination of these items, the efficacy of hydrogen peroxide vapor (HPV) in disinfecting them, and costs associated with discarded supplies.

Design.

Before-after study.

Methods.

A pilot study was performed in the rooms of 20 patients known to be colonized or infected with vancomycin-resistant enterococci (VRE), and a follow-up study was performed in an additional 20 rooms of patients under precautions for various MDROs in 6 high-risk units. Five pairs of supply items were selected. One item of each pair was sampled without exposure to HPV, and the other was sampled after HPV exposure. The cost of discarded supplies was calculated by examining stock lists of supplies stored on the study units.

Results.

Seven (7%) of 100 items were contaminated with VRE in the pilot study, and 9 (9%) of 100 items were contaminated with MDROs in the follow-up study. None of the items were contaminated after exposure to HPV (P < .02 in both the pilot and the follow-up study). The annual cost of supplies discarded at patient hospital discharge was $387,055. This figure does not include the cost of waste disposal and is therefore likely to be an underestimation of the financial burden.

Conclusions.

HPV effectively disinfected the packaging of supply items, which could generate considerable financial and environmental benefits.

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. 472 - 478
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687–699.CrossRefGoogle ScholarPubMed
2.Thom, KA, Johnson, JK, Lee, MS, Harris, AD. Environmental contamination because of multidrug-resistant Acinetobacter bau-mannii surrounding colonized or infected patients. Am J Infect Control 2011;39:711–715.Google Scholar
3.Diaz, MH, Silkaitis, C, Malczynski, M, Noskin, GA, Warren, JR, Zembower, T. Contamination of examination gloves in patient rooms and implications for transmission of antimicrobial-resistant microorganisms. Infect Control Hosp Epidemiol 2008;29:63–65.Google Scholar
4.Rossoff, LJ, Lam, S, Hilton, E, Borenstein, M, Isenberg, HD. Is the use of boxed gloves in an intensive care unit safe? Am J Med 1993;94:602–607.CrossRefGoogle Scholar
5.Johnston, CP, Qiu, H, Ticehurst, JRet al.Outbreak management and implications of a nosocomial norovirus outbreak. Clin Infect Dis 2007;45:534–540.Google Scholar
6.Weber, DJ, Rutala, WA, Miller, MB, Huslage, K, Sickbert-Bennett, E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38(suppl 1):S25–S33.Google Scholar
7.Dietze, B, Rath, A, Wendt, C, Martiny, H. Survival of MRSA on sterile goods packaging. J Hosp Infect 2001;49:255–261.CrossRefGoogle ScholarPubMed
8.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. http://www.cdc.gov/hipac/pdf/MDRO/MDROGGuideline2006.pdf. 2006.CrossRefGoogle Scholar
9.Rutala, WA, Weber, DJ; Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008. http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf. 2008.Google Scholar
10.Health Protection Agency. Working party guidance on the control of multi-resistant Acinetobacter outbreaks, http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Acinetobacter/Guidelines/acineGuidance/. 2006.Google Scholar
11.Kwakye, G, Pronovost P, J, Makary, MA. Commentary: a call to go green in health care by reprocessing medical equipment. Acad Med 2010;85:398–400.Google Scholar
12.Gilden, DJ, Scissors, KN, Reuler, JB. Disposable products in the hospital waste stream. West J Med 1992;156:269–272.Google Scholar
13.Conrardy, J, Hillanbrand, M, Myers, S, Nussbaum, GF. Reducing medical waste. AORN J 2010;91:711–721.Google Scholar
14.Eskenazi, S, Bychkowski, OE, Smith, M, MacMillan, JD. Evaluation of glutaraldehyde and hydrogen peroxide for sanitizing packaging materials of medical devices in sterility testing. J Assoc Off Anal Chem 1982;65:1155–1161.Google Scholar
15.Otter, JA, French, GL. Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor. J Clin Microbiol 2009;47:205–207.Google Scholar
16.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.Google Scholar
17.Passaretti, CL, Otter, JA, Reich, NG, et al.An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis 2013;56:27–35.Google Scholar
18.Manian, FA, Griesnauer, S, Bryant, A. Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates. Am J Infect Control 2012. doi:pii: S0196-6553( 12)01059-0.10.1016/j.ajic.2012.06.014. [Epub ahead of print].Google Scholar
19.Ekman, J, Tsitko, I, Weber, A, Nielsen-LeRoux, C, Lereclus, D, Salkinoja-Salonen, M. Transfer of Bacillus cereus spores from packaging paper into food. J Food Prot 2009;72:2236–2242.Google Scholar
20.Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? a systematic review. BMC Infect Dis 2006;6:130.Google Scholar
21.Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.Google Scholar
22.Drees, M, Snydman, D, Schmid, C, et al.Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–685.CrossRefGoogle ScholarPubMed
23.Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the ICU. Clin Microbiol Infect 2011;17:1201–1208.Google Scholar
24.Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients' environment. Infect Control Hosp Epidemiol 2008;29:149–154.Google Scholar
25.Holmdahl, T, Lanbeck, P, Wullt, M, Walder, MH. A head-to-head comparison of hydrogen peroxide vapor and aerosol room de contamination systems. Infect Control Hosp Epidemiol 2011;32:831–836.Google Scholar
26.Dryden, M, Parnaby, R, Dailly, S, et al.Hydrogen peroxide vapour decontamination in the control of a polyclonal meticillin-resistant Staphylococcus aureus outbreak on a surgical ward. J Hosp Infect 2008;68:190–192.Google Scholar
27.Souhrada, L. Reusables revisited as medical waste adds up. Hospitals 1988;62:82.Google Scholar
28.McVeigh, P. The greening of the OR. Reduce, reuse, recycle. AORN J 1992;56:1040–1045.Google Scholar
29.Otter, JA, Puchowicz, M, Ryan, D, et al.Feasibility of routinely using hydrogen peroxide vapor to decontaminate rooms in a busy United States hospital. Infect Control Hosp Epidemiol 2009;30:574–577.Google Scholar
30.French, GL, Otter, JA, Shannon, KP, Adams, NM, Watling, D, Parks, MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:31–37.Google Scholar