Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-04-30T11:08:49.280Z Has data issue: false hasContentIssue false

Efficacy of a continuously active disinfectant wipe on the environmental bioburden in the intensive care unit: A randomized controlled study

Published online by Cambridge University Press:  03 July 2023

Gita Nadimpalli
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, The University of Maryland School of Medicine, Baltimore, Maryland
Laurence S. Magder
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Abdolreza Haririan
Affiliation:
Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland
Deborah Stevens
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Lyndsay M. O’Hara*
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
*
Corresponding author: Lyndsay M. O’Hara; Email: lohara@som.umaryland.edu

Abstract

Objective:

To evaluate the efficacy of a new continuously active disinfectant (CAD) to decrease bioburden on high-touch environmental surfaces compared to a standard disinfectant in the intensive care unit.

Design:

A single-blind randomized controlled trial with 1:1 allocation.

Setting:

Medical intensive care unit (MICU) at an urban tertiary-care hospital.

Participants:

Adult patients admitted to the MICU and on contact precautions.

Intervention:

A new CAD wipe used for daily cleaning.

Methods:

Samples were collected from 5 high-touch environmental surfaces before cleaning and at 1, 4, and 24 hours after cleaning. The primary outcome was the mean bioburden 24 hours after cleaning. The secondary outcome was the detection of any epidemiologically important pathogen (EIP) 24 hours after cleaning.

Results:

In total, 843 environmental samples were collected from 43 unique patient rooms. At 24 hours, the mean bioburden recovered from the patient rooms cleaned with the new CAD wipe (intervention) was 52 CFU/mL, and the mean bioburden was 92 CFU/mL in the rooms cleaned the standard disinfectant (control). After log transformation for multivariable analysis, the mean difference in bioburden between the intervention and control arm was −0.59 (95% CI, −1.45 to 0.27). The odds of EIP detection were 14% lower in the rooms cleaned with the CAD wipe (OR, 0.86; 95% CI, 0.31–2.32).

Conclusions:

The bacterial bioburden and odds of detection of EIPs were not statistically different in rooms cleaned with the CAD compared to the standard disinfectant after 24 hours. Although CAD technology appears promising in vitro, larger studies may be warranted to evaluate efficacy in clinical settings.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Warren, BG, Turner, N, Smith, B, et al. Measuring the impact of continuous disinfection strategies on environmental burden in outpatient settings: a prospective randomized controlled trial. Open Forum Infect Dis 2020;7:ofaa431,10.1093/ofid/ofaa431CrossRefGoogle Scholar
Stone, PW, Braccia, D, Larson, E. Systematic review of economic analyses of healthcare-associated infections. Am J Infect Control 2005;33:501509.10.1016/j.ajic.2005.04.246CrossRefGoogle Scholar
Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:114.10.1086/668770CrossRefGoogle Scholar
Burnham, JP, Olsen, MA, Kollef, MH. Re-estimating annual deaths due to multidrug-resistant organism infections. Infect Control Hosp Epidemiol 2019;40:112113.10.1017/ice.2018.304CrossRefGoogle ScholarPubMed
Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338344.10.1097/QCO.0b013e3283630f04CrossRefGoogle ScholarPubMed
Han, JH, Sullivan, N, Leas, BF, Pegues, DA, Kaczmarek, JL, Umscheid, CA. Cleaning hospital room surfaces to prevent healthcare-associated infections. Ann Intern Med 2015;163:598607.10.7326/M15-1192CrossRefGoogle Scholar
Rutala, WA, Weber, DJ. Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: a bundle approach. Am J Infect Control 2019;47S:A96A105.10.1016/j.ajic.2019.01.014CrossRefGoogle ScholarPubMed
Rutala, WA. Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf. Updated May 2019. Accessed May 31, 2023.Google Scholar
Cadnum, JL, Pearlmutter, BS, Jencson, AL, et al. Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms. Infect Control Hosp Epidemiol 2022;43:10171021.10.1017/ice.2021.309CrossRefGoogle ScholarPubMed
Weber, DJ, Kanamori, H, Rutala, WA. ‘No touch’ technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems Curr Opin Infect Dis 2016;29:424431.10.1097/QCO.0000000000000284CrossRefGoogle ScholarPubMed
Lei, H, Jones, RM, Li, Y. Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcus aureus . BMC Infect Dis 2017;17:85.10.1186/s12879-016-2120-zCrossRefGoogle ScholarPubMed
Continuously active disinfection: minimizing the role of surface and equipment recontamination in the transmission of healthcare pathogens. PDI Healthcare website. https://pdihc.com/resource/continuously-active-disinfection-minimizing-the-role-of-surface-and-equipment-recontamination-in-the-transmission-of-healthcare-pathogens/. Accessed March 30, 2022.Google Scholar
Is novel 24-hour continuously active surface disinfection the answer to environmental transmission of healthcare-associated infections? PDI Healthcare website. https://pdihc.com/blog/is-novel-24-hour-continuously-active-surface-disinfection-the-answer-to-environmental-transmission-prevention-of-healthcare-associated-infections/. Accessed September 1, 2022.Google Scholar
Rutala, WA, Gergen, MF, Sickbert-Bennett, EE, et al. Antimicrobial activity of a continuously active disinfectant against healthcare pathogens. Infect Control Hosp Epidemiol 2019;40:12841286.10.1017/ice.2019.260CrossRefGoogle ScholarPubMed
Schmidt, MG, Fairey, SE, Attaway, HH. In situ evaluation of a persistent disinfectant provides continuous decontamination within the clinical environment. Am J Infect Control 2019;47:732734.10.1016/j.ajic.2019.02.013CrossRefGoogle ScholarPubMed
Redmond, SN, Cadnum, JL, Silva, SY, et al. Evaluation of a continuously active disinfectant for decontamination of portable medical equipment. Infect Control Hosp Epidemiol 2022;43:387389.10.1017/ice.2021.66CrossRefGoogle ScholarPubMed
Tamimi, AH, Carlino, S, Gerba, CP. Long-term efficacy of a self-disinfecting coating in an intensive care unit. Am J Infect Control 2014;42:11781181.10.1016/j.ajic.2014.07.005CrossRefGoogle Scholar
Warren, BG, Turner, N, Smith, B, et al. Measuring the impact of continuous disinfection strategies on environmental burden in outpatient settings: a prospective randomized controlled trial. Open Forum Infect Dis 2020;7:ofaa431.10.1093/ofid/ofaa431CrossRefGoogle Scholar
O’Hara, LM, Calfee, DP, Miller, LG, et al. Optimizing contact precautions to curb the spread of antibiotic-resistant bacteria in hospitals: a multicenter cohort study to identify patient characteristics and healthcare personnel interactions associated with transmission of methicillin-resistant Staphylococcus aureus . Clin Infect Dis Off Publ Infect Dis Soc Am 2019;69 suppl 3:S171S177.10.1093/cid/ciz621CrossRefGoogle ScholarPubMed
Jackson, SS, Thom, KA, Magder, LS, et al. Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ gloves and gowns in the intensive care unit. Infect Control Hosp Epidemiol 2018;39:10631067.10.1017/ice.2018.160CrossRefGoogle ScholarPubMed
Environmental sampling. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/sampling.html. Published April 9, 2019. Accessed March 28, 2022.Google Scholar
Ellingson, KD, Pogreba-Brown, K, Gerba, CP, Elliott, SP. Impact of a novel antimicrobial surface coating on healthcare-associated infections and environmental bioburden at 2 urban hospitals. Clin Infect Dis 2020;71:18071813.10.1093/cid/ciz1077CrossRefGoogle ScholarPubMed
Redmond, SN, Cadnum, JL, Silva, SY, et al. Evaluation of a continuously active disinfectant for decontamination of portable medical equipment. Infect Control Hosp Epidemiol 2022;43:387389.10.1017/ice.2021.66CrossRefGoogle ScholarPubMed