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

  • Anat Or Lerner (a1), Jalal Abu-Hanna (a1), Yehuda Carmeli (a2) (a3) and Vered Schechner (a1) (a3)

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.

Copyright

Corresponding author

Author for correspondence: Vered Schechner, Email: vereds@tlvmc.gov.il

References

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1. Perez, F, Hujer, AM, Hujer, KM, Decker, BK, Rather, PN, Bonomo, RA. Global challenge of multidrug-resistant Acinetobacter baumannii . Antimicrob Agents Chemother 2007;51:34713484.
2. Rosa, R, Depascale, D, Cleary, T, Fajardo-Aquino, Y, Kett, DH, Munoz-Price, LS. Differential environmental contamination with Acinetobacter baumannii based on the anatomic source of colonization. Am J Infect Control 2014;42:755757.
3. Gong, Y, Shen, X, Huang, G, et al. Epidemiology and resistance features of Acinetobacter baumannii isolates from the ward environment and patients in the burn ICU of a Chinese hospital. J Microbiol 2016;54:551558.
4. Nutman, A, Lerner, A, Schwartz, D, Carmeli, Y. Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii . Clin Microbiol Infect 2016;22:949.e5949.e7.
5. Casini, B, Selvi, C, Cristina, ML, et al. Evaluation of a modified cleaning procedure in the prevention of carbapenem-resistant Acinetobacter baumannii clonal spread in a burn intensive care unit using a high-sensitivity luminometer. J Hosp Infect 2017;95:4652.
6. Maragakis, LL, Perl, TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:12541263.
7.Options for evaluating environmental cleaning. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/toolkits/evaluating-environmental-cleaning.html. Published 2010. Accessed October 21, 2019.
8. Stiller, A, Salm, F, Bischoff, P, Gastmeier, P. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016;5:51.
9. Russotto, V, Cortegiani, A, Raineri, SM, Giarratano, A. Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. J Intensive Care 2015;3:54.
10. Boardman, Anthony E, Forbes, D. A benefit-cost analysis of private and semi-private hospital rooms. J Benefit-Cost Anal 2011;2:127.
11. Ulrich, R, Quan, X, Zimring, C, Anjali, J, Choudhary, R. The role of the physical environment in the hospital of the 21st century: a once-in-a-lifetime opportunity. Healing Photo Art website. https://healingphotoart.org/wp-content/uploads/2012/11/UlrichPhyEnviron.pdf. Published 2004. Accessed October 21, 2019.
12. Ulrich, R. Essay: Evidence-based health-care architecture. Lancet 2006;368:S38S39.
13. Bracco, D, Dubois, M-J, Bouali, R, Eggimann, P. Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2007;33:836840.
14. Brouqui, P. Should we provide acute care in single or double room occupancy? Clin Microbiol Infect 2016;22:402.
15. Huslage, K, Rutala, WA, Sickbert-Bennett, E, Weber, DJ. A quantitative approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol 2010;31:850853.
16. Cheng, VCC, Chau, PH, Lee, WM, et al. Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors. J Hosp Infect 2015;90:220225.
17. Adams, CE, Smith, J, Watson, V, Robertson, C, Dancer, SJ. Examining the association between surface bioburden and frequently touched sites in intensive care. J Hosp Infect 2017;95:7680.
18. La Fauci, V, Genovese, C, Facciolà, A, Palamara, MAR, Squeri, R. Five-year microbiological monitoring of wards and operating theatres in southern Italy. J Prev Med Hyg 2017;58(2):E166E172.
19. Jinadatha, C, Villamaria, FC, Coppin, JD, et al. Interaction of healthcare worker hands and portable medical equipment: a sequence analysis to show potential transmission opportunities. BMC Infect Dis 2017;17:800.
20. Clifford, R, Sparks, M, Hosford, E, et al. Correlating cleaning thoroughness with effectiveness and briefly intervening to affect cleaning outcomes: how clean is cleaned? PLoS One. 2016;11(5):e0155779.
21. Dancer, SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014;27:665690.
22. Boyce, JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016;5:10.
23. Fattorini, M, Ceriale, E, Nante, N, et al. Use of a fluorescent marker for assessing hospital bathroom cleanliness. Am J Infect Control 2016;44:10661068.
24. Boyce, JM, Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32:11871193.
25. Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593599.
26. Boyce, JM, Havill, NL, Dumigan, DG, Golebiewski, M, Balogun, O, Rizvani, R. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Hosp Epidemiol 2009;30:678684.
27. 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.
28. Fu, TY, Gent, P, Kumar, V. Efficacy, efficiency and safety aspects of hydrogen peroxide vapour and aerosolized hydrogen peroxide room disinfection systems. J Hosp Infect 2012;80:199205.
29. Doll, M, Morgan, DJ, Anderson, D, Bearman, G. Touchless technologies for decontamination in the hospital: a review of hydrogen peroxide and UV devices. Curr Infect Dis Rep 2015;17:498.
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Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods

  • Anat Or Lerner (a1), Jalal Abu-Hanna (a1), Yehuda Carmeli (a2) (a3) and Vered Schechner (a1) (a3)

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