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New Methods for Decontaminating and Monitoring the Patient Environment.
PHILIP C. CARLING, MD.;
Carney Hosp., Boston, MA.
The evolving understanding of the epidemiology of healthcare associated infections has led to a reconsideration of the importance of contamination of surfaces and objects surrounding patients in the transmission of environmentally resistant pathogens such as Clostridium difficile, VRE, MRSA, Acineobacter baumanii and noro viruses. Although currently used disinfectant chemicals are relatively effective in killing most environmental pathogens, more potent and rapidly acting disinfectants as well as innovative technologies are being developed and tested to better rid environmental surfaces of potentially transmissible pathogens. Despite the use of liquid disinfectants with good invitro efficacy for cleaning high touch objects, recent studies have confirmed an increased risk of subsequent ICU room occupants acquiring MRSA, VRE and A. baumanii when prior room occupants were colonized or infected with these pathogens. These observations as well as a recent study which documented transmission of PGFE identical strains of MRSA from prior room occupants to patients in the Intensive Care setting suggest that the thoroughness of environmental cleaning may potentially be suboptimal. Recent culture based environmental monitoring and studies using direct observation as well as investigation using indirect monitoring tools have confirmed the suboptimal thoroughness of disinfection cleaning of the near-patient environment in individual hospitals. Most recently an indirect methodology using a fluorescent marker was used to evaluate more than twenty acute healthcare facilities ranging in size from 25 to 800 beds. The preliminary results of these studies suggest that the thoroughness of disinfection cleaning may not be optimal in many hospitals and that structured educational interventions and ongoing objective performance feedback to the Environmental Services staff can significantly improve the such cleaning activities.
While optimizing hand hygiene compliance and isolation procedures will remain as critical interventions to limit the transmission of infectious pathogens in health care settings, improving the effectiveness as well as monitoring and improving the thoroughness of disinfection cleaning of the near patient environment has the potential for further improving patient and health care worker safety. |
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